Rectal Cancer Rates Increasing in People under 40

LA Times

Although the numbers are still low, they have been rising steadily for the last 20 years. And scientists have yet to identify a reason.

 

Rates of rectal cancer in people younger than 40, although low, have been rising steadily for the last 20 years for reasons that are mystifying scientists, researchers said Sunday.Both colon cancer and rectal cancer are thought to share the same risk factors, but the incidence of colon cancer has remained steady during that period, while the incidence of rectal cancer has grown by an average of 3.8% per year, scientists reported online in the journal Cancer.

"We've scoured the literature for a cause and spoken to others in the field and we haven't identified anything that is able to explain this," said Dr. Joshua Meyer of the Fox Chase Cancer Center in Philadelphia, the lead author of the study. "It's a little bit puzzling."

The incidence of rectal cancer has also been growing in older people during the same time period, but that increase is generally attributed to changes in medical guidelines that called for more frequent screening, which would catch more cases of the cancer.

But people under 40 are generally not screened for colorectal cancer unless they have a family history of the disease, so screening does not account for the increase in that group, Meyer said.

Colorectal cancer is the second-most-common cause of cancer death in the United States; rectal cancer accounts for only a relatively small proportion of those deaths.

Meyer and his colleagues performed the study while he was at the Weill Cornell Medical Center in New York. The group noticed an increase in rectal cancer among their patients under 40 "and we wanted to see if it was real or a change in referral patterns," Meyer said.

The team studied data from the government's Surveillance Epidemiology and End Results cancer registry, which includes about 26% of U.S. cancer cases. They identified 7,661 colon and rectal cancer cases in patients under 40 from 1973 to 2005, then calculated the change in incidence over time.

Overall, the rates in this group were low, as might be expected: 1.11 cases of colon cancer per 200,000 people and 0.42 cases of rectal cancer. But colon cancer incidence remained flat over time, while rectal cancer grew from 1985 onward. The increase was the same for all races and both sexes.

The time between the first presentation of symptoms — typically rectal bleeding — and diagnosis averaged seven months, apparently because physicians assumed the bleeding was caused by hemorrhoids and didn't initially perform more tests.

Other symptoms of rectal cancer include a change in bowel habits, anemia, weight loss and diarrhea.

Risk factors for colorectal cancer include a family history of the disease, obesity, smoking, heavy alcohol use, a diet high in red meat and low in vegetables, and insufficient intake of vitamin D.

The team is not advocating routine screening in Indianapolis cancer treatment centers in patients under 40 because it would not be cost-effective, but does caution physicians to be more aware of the possibility that bleeding could be caused by cancer in younger people.

The researchers could find no evidence that the increase was linked to anal sex, Meyer added. Anal cancers linked to such sex are typically caused by the human papillomavirus, which is common in the gay community. But HPV generally causes adenocarcinomas, he said, and the rectal tumors are squamous cell carcinomas and unlikely to be related.

A New Disease for Lou Gehrig?

Petoskey News-Review

Lou Gehrig’s playing career came to an abrupt end on a spring day in Detroit in 1939, while his Yankees visited Briggs Stadium to face the Tigers.

After 2,130 consecutive games, a streak that started when he replaced Wally Pipp in 1925, Gehrig himself handed the lineup card to the umpires, his name replaced by that of Ellsworth "Babe" Dahlgren.

After nearly one year of progressively declining athletic production and increasing weakness, Gehrig had benched himself for the good of the team.

Only five weeks later, doctors at the Mayo Clinic provided Gehrig a diagnosis, and a little known disease was given a new name. Amyotrophic lateral sclerosis, or ALS, was scarcely known by the public in 1939. Today, Lou Gehrig’s Disease is a diagnosis recognized by many, known as a cruel and fatal sentence.

Unfortunately, 70 years later, a diagnosis of ALS means the same as it did in 1939. We still cannot offer any significant treatment or cure. It’s a frustrating disease, robbing a person of their strength over several months, eventually leading to failure of muscles that are needed to sustain life.

While we have come closer to understanding its mechanisms, the specific cause of ALS has not been determined and it seems likely that several environmental and genetic factors play a role.

Recently, however, researchers at the Boston University School of Medicine and the VA Medical Center provided an interesting twist to the story. They published a study in the September issue of the Journal of Neuropathology & Experimental Neurology describing three athletes who were given a diagnosis of ALS prior to their death but also had difficulties with their memory and thinking.

In the brains of these athletes, each of whom played contact sports, they found the type of pathological changes that some believe can be linked to a lifetime of repetitive head trauma. Interestingly, similar changes were also seen in their spinal cord neurons, the very same neurons that are known to be damaged in ALS.

Are we to conclude that physical trauma is a risk factor for, or maybe even the direct cause of ALS? The short answer is no.

It is much more likely that these athletes suffered from an, as yet, unnamed ailment quite separate from ALS but with a similar final causal pathway, a concept that is reinforced by a lack of head injury history in the vast majority of ALS cases worldwide.

Lou Gehrig, who also played football in high school and college, died from a progressive neurological disorder that took away his strength. We will never know whether he actually had the disease that bears his name, or whether a separate illness, one linked to playing sports, took his life.

In this way, Mr. Gehrig’s immortal image becomes a clear symbol of the unknown, one that continues to inspire St. Louis neurologists, now more than ever.

Good Shepherd adds Cardiologists

Longview News-Journal

Good Shepherd Medical Center has announced the recent appointment of cardiologist Dr. Shafik Hanna-Moussa.

Hanna-Moussa is triple board certified in cardiology, echocardiography and nuclear cardiology, is board eligible in interventional cardiology, and comes to Good Shepherd with a diverse background in medicine.

He most recently was affiliated with the Albert Einstein School of Medicine Beth Israel Medical Center as an interventional cardiology fellow. He practiced invasive cardiology at Heart Care Mid West in Illinois and served as the director of the cardiac catheterization lab at Newport Hospital in Arkansas.

Hanna-Moussa earned his undergraduate degree from Aleppo University Faculty of Medicine in Aleppo, Syria. His postdoctoral training included internal medicine residencies at St. Louis Hospital, also in Alepp, Syria, and Grace Hospital, Wayne State University in Detroit cardiologist. He then attained cardiology fellowships through Providence Hospital in Southfield, Mich.

Special affiliations with professional societies include the American College of Cardiology, American Society of Nuclear Cardiology, American College of Physicians and American Medical Association.

Hanna-Moussa has been published in The Journal of Invasive Cardiology and the International Journal of Angiology.

Novartis gets FDA OK for Blood Pressure Treatment

Reuters

 

Swiss drugmaker Novartis AG received U.S. approval for a new treatment of high blood pressure, broadening the use of Tekturna, the successor to the group's best-selling drug, Diovan.

The U.S. Food and Drug Administration (FDA) approved Tekamlo tablets, a single-pill treatment of high blood pressure combining Tekturna with the widely used calcium channel blocker amlodipine, the Swiss group said on Friday.

Studies showed Tekamlo significantly reduced blood pressure compared to amlodipine or Tekturna alone, Novartis said.

Tekturna is from a new class of drugs that works by directly blocking the hormone renin. Other hypertension drugs also work on the renin-angiotensin system, which regulates blood pressure.

Tekturna's success is key for Novartis as Diovan -- also a high blood pressure treatment -- loses patent protection in 2012.

The group said an estimated 1 billion people globally have high blood pressure, which is a major risk factor for cardiovascular disease, the top cause of death globally.

If left untreated, high blood pressure can cause strokes, heart attacks, heart failure and organ damage, including kidney failure and vision problems. In Michigan, treatment should be sought from a Dearborn cardiology specialist.

In a separate release, Novartis said Swiss authorities approved its leukemia drug Tasigna for adults with newly diagnosed Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) in chronic phase.

Judge's Ruling sets back Stem Cell Research

San Francisco Chronicle

 

Talk about judicial activism. U.S. District Judge Royce Lamberth just ruled that the federal government can't fund any stem cell research because it destroys embryos. He voided not just President Obama's stem cell policy, but former President George W. Bush's policy, too.

Lamberth relied on a reading of the Dickey-Wicker Amendment, which forbids federal funding of "research in which a human embryo or embryos are destroyed." The anti-abortion community is ecstatic, but the ruling goes far further than even Bush's policies on stem cells. Bush approved federal funding of research on stem cell lines that existed by August 2001. It's unlikely that even this policy would be allowed under Lamberth's reasoning.

The Obama administration is already planning an appeal, as it should. Congress could, and should, easily clarify things by simply passing a stem cell funding bill. That would eliminate the need to go through the courts, and the bill would be unlikely to encounter a presidential veto this time around.

In the meantime, the scientific community is frustrated and confused. The California Institute for Regenerative Medicine will be able to press on with its embryonic stem cell research, thanks to the wisdom of California's voters. But it means the institute's scientists won't be able to collaborate with those whose funding was dependent on federal grants.

Congress should move quickly to ensure that this potentially valuable research can continue.

Drugs block Ebola, Marburg Viruses in Tests

LA Times

Synthetic nucleotides halt replication of the viruses in tests on monkeys. The FDA approves clinical trials in primates. 'Any disorder that involves a genetic problem can potentially be treated,' one expert says.

Synthetic nucleotides injected into monkeys can block the replication of Ebola and Marburg viruses, suggesting it eventually may be possible to protect humans against these deadly bioterrorism agents, researchers said Sunday.

The monkeys get very sick, but most of them survive. The agents, called morpholino oligomers, are the first drugs approved by the Food and Drug Administration to go into clinical trials against the viruses — although those trials will, at least initially, be conducted in primates, not humans.

The results are "a potentially important proof of concept but still a long way from a product that can be used with confidence against human infections," said virologist Alan L. Schmaljohn of the University of Maryland School of Medicine, who was not involved in the research.

Schmaljohn cautioned that the drugs were given within an hour after infection and that they could be much less effective later in the course of the disease or against a more aggressive strain of the viruses.

Nonetheless, the experimental drugs represent the first ray of hope against two viruses that are extremely difficult to deal with in natural outbreaks and that keep bioterrorism experts awake at night worrying about their potential use by unprincipled attackers.

Ebola and Marburg are both members of the filovirus family, long threads of RNA that infect humans and other primates, causing hemorrhagic fever and, almost inevitably, death. Although researchers have been working frantically to develop drugs to treat infections, none has yet reached the stage of clinical testing.

The morpholino oligomers are a new class of drugs in a family of what is known as antisense nucleotides. Antisense nucleotides are designed to bind tightly to specific areas of viral messenger RNA, blocking replication. Such compounds already are being used to treat certain types of cancer and cytomegalovirus infections, and they are being tested against HIV. The morpholino oligomers, developed by AVI BioPharma of Washington, D.C., have specialized attachments that stabilize the nucleotides and make them more effective.

The genesis for the studies came in February 2004 when a technician at the U.S. Army Medical Research Institute of Infectious Diseases in Ft. Detrick, Md., accidentally stuck her thumb while working on mice infected with the Ebola virus. She was quickly placed in what researchers there called the "slammer," a maximum-containment isolation unit.

Coincidentally, Dr. Patrick Iversen from AVI had delivered a lecture on campus that day about the use of antisense molecules against viruses. He volunteered to design and synthesize molecules to treat the technician if the need arose. The technician was not infected, but the research led to the report Sunday in the journal Nature Medicine.

Virologist Travis K. Warren of the Army research institute and his colleagues studied one compound, called AVI-6002, in rhesus monkeys infected with the Ebola virus. They found that 60% of the monkeys given a sufficient dose survived the infection, but all who received no drug died.

Separately, they treated 13 cynomolgus monkeys infected with Marburg virus with a second compound, AVI-6003, directed against that virus. All 13 survived. Treating monkeys infected with Ebola with the drug for Marburg produced no results, and vice versa, indicating that the treatment was highly specific.

Because clinical trials cannot be conducted ethically in humans, the FDA permits such drugs to be tested in primates, and the group will soon begin such tests. If they prove successful, the drugs will then be tried when outbreaks of infection occur in Africa.

Warren said the approach could be used to treat a variety of other infectious diseases and inherited problems. "Any disorder that involves a genetic problem can potentially be treated," he said.

Binge Drinking Lethal for Men with Hypertension

Food Consumer

Binge drinking or heavy, sporadic drinking can raise risk of premature death from heart attack or stroke
in men with hypertension or high blood pressure, according to a new study led by researchers from Seoul,  South Korea.

Sull J.W. and colleagues from Eulji University College of Health Science and other academic institutions found that men with Grade 3 hypertension who were also binge drinkers were 12 times as likely to die from cardiovascular events like heart attack or myocardial infarction and stroke than those who did not drink with normal blood pressure.

Among those who had Grade 3 hypertension and were non-heavy binge drinkers, the risk was 4 times as higher to die from heart attack and stroke compared with those who did not drink and had normal blood pressure.

The researchers were able to calculate the effect from heavy binge drinking and hypertension. They found binge drinking boosted the risk of death from cardiovascular events was merely 88 percent, while hypertension boosts the risk by 100 percent compared with nondrinkers with normal blood pressure.

For the study, Sull and colleagues followed 6100 residents in Kangwha County aged 55 or older for 20.8 years, from March 1985 through Dec 2005.  Heavy binge drinking was defined as having 12 or more drinks on one occasion; binge drinking as having 6 or more drinks per event.

Drinking alcoholic beverages, which are recognized by the National Toxicology Program as a human carcinogen, have been linked with numerous serious chronic diseases or conditions including diabetes, metabolic syndrome, and cardiovascular problems.

The issue is controversial, as many studies link light drinking to reduced risk of heart disease, even though alcohol is generally associated with an increased cancer risk.

In any case, binge drinking has not been found to offer any benefit. The study suggests that it can be lethal for men with high blood pressure, and they should seek treatment if necessary from a group such as Alcoholics Anonymous.

According to the U.S. Centers for Disease Control and Prevention, the National Institute on Alcohol Abuse and Alcoholism defines binge drinking as drinking excessive amounts of alcohol in a short time.  This happens typically when men consume 5 or more drinks and women consume 4 or more drinks in about 2 hours.

Binge drinking is common.  The CDC says about 92 percent of U.S. adults report they have engaged in binge drinking in the past 30 days.

In addition to the increased risk of cardiovascular death in men with hypertension, binge drinking in general is associated with high blood pressure, stroke and other cardiovascular diseases, liver disease, neurological damage such as brain shrinkage, sexual dysfunction and poor control of diabetes.

Binge drinking can also lead to unintentional injuries (car crashes, falls, burns and drowning) and intentional injuries (firearm injuries, sexual assault and domestic violence, alcohol poisoning, unsafe sex leading to infection with sexually transmitted disease and unintended pregnancy).

Study Finds Retroviruses in Chronic Fatigue Sufferers

The Wall Street Journal

Researchers said Monday they have identified a family of retroviruses in patients with chronic fatigue syndrome, a finding that is likely to spur patients with the condition to seek treatment with drugs used to fight HIV, the virus that causes AIDS.

The report, published in the Proceedings of the National Academy of Sciences, was accompanied by a call for new clinical trials to test HIV drugs in patients with chronic fatigue syndrome, which afflicts an estimated one million to four million Americans and as many as 17 million people world-wide.

Although HIV and the newly identified virus group are different, both are retroviruses. Based on other recent research linking CFS to a retrovirus called XMRV, some doctors are already prescribing drugs approved for HIV for CFS patients. The syndrome has no known cause and there aren't any effective treatments.

The group of viruses, called murine leukemia virus-related viruses, or MLV, are known to cause cancer and neurological problems in mice, but whether they cause any diseases in humans isn't known. XMRV is among several different members of the MLV family, researchers said.

In the new study, researchers said they found at least one of four different MLV-like viruses in 32 of 37, or 86.5% of patients with chronic fatigue syndrome, compared with just three of 44, or 6.8%, of apparently healthy volunteer blood donors.

The paper is the latest in a series of reports about a possible link between CFS and a virus. Previous studies have focused on XMRV and have turned up conflicting evidence. Indeed, the just-published study was held back from publication in June because it was at odds with a report from the Centers for Disease Control and Prevention, which found no evidence of XMRV in chronic fatigue syndrome patients.

The current paper didn't find XMRV either—one reason it isn't likely to resolve a brewing debate over the role that XMRV may play in the syndrome. But researchers said the variants of MLV-like viruses closely related to XMRV they found in CFS patients was evidence of a link between the virus family and the syndome.

Andrew Mason, a University of Alberta professor, co-wrote the commentary in PNAS calling for trials testing anti-retrovirals in CFS patients who are positive for one of the MLV-related viruses. "If the patients improve, after a certain point you stop debating whether it causes the disease and say the treatment works and we're going to use it,'' said Dr. Mason.

But until further evidence establishing that the virus causes CFS is developed, a large-scale clinical trial testing HIV drugs against the syndrome isn't likely. Norbert Bischofberger, chief scientific officer at Gilead Sciences Inc., the leading maker of HIV drugs, said the company might consider a small pilot trial but would like to see stronger evidence that the viruses cause CFS before launching a large trial. But "I'm very open and this would be a great opportunity,'' he said.

A spokesman for Merck & Co., another major manufacturer of HIV drugs said: "A clinical trial program would be possible to develop only after further substantial evidence of an association with CFS.''

Some doctors and patients are already testing the idea, based in part on a University of Utah and Emory University study in mice which suggested a cocktail of three anti-retroviral drugs appeared to inhibit infection by XMRV.

Jamie Deckoff-Jones, 56, a doctor and CFS patient in New Mexico, has been blogging about her experiences and those of her 20-year-old daughter. They both tested positive for XMRV and are taking a combination of three anti-retrovirals. Dr. Deckoff-Jones said a year ago she could only get up for short periods during the day. After five months on the drugs, she flew last week to Reno for an XMRV conference. Her daughter was able to go to a party and is enrolling in community college.

"This is all very new and there is no way to know if improvement will continue,'' Dr. Deckoff-Jones wrote in an email, "but we appear to be on an uphill course.''

Joseph Brewer, an infectious disease doctor in Kansas City, Mo., who treats AIDS patients, said he now has 15 patients with CFS in his clinic taking anti-retrovirals. "It's a mixed bag,'' said Dr. Brewer about the results. Patients who have been sick less than two years improve more rapidly, he said, adding that one of the challenges is that there is no reliable way to measure the amount of virus present in patients.

Physical Therapy Bill Passes California Legislature

San Fernando Valley BJ

A bill that would prevent degree programs for physical therapists at California State University, Northridge and other state colleges from shutting down passed the state legislature this week.

The State Assembly voted 61 – 2 to send Assembly Bill 2382, which Blumenfield authored, to the governor for his signature.

The legislation creates an exception for California State University programs in new national standards for physical therapists.

The new standards require physical therapists to have doctorate degrees in the field, replacing the current requirements for master’s degrees. However, California’s “master plan” for higher education had prevented the California State University programs from making the change.

The new legislation would allow the state university system to confer “clinical” doctorate degrees for Detroit physical therapy only, allowing the programs to continue.

“Physical therapy is one of the top three jobs in demand today,” Blumenfield said. “We must keep these good paying, professional jobs here in the state and in the San Fernando Valley. The best way to do this is to make sure students can receive their training at California schools.”

The university in Northridge is one of four California state universities to offer physical therapy programs. The other state universities include those in Fresno, Long Beach and Sacramento.

'Party Drug' for Depression?

LA Times

Known to some as 'Special K', ketamine could be developed into a safe medication.

 

Yale researchers hope to develop a form of ketamine — an effective but very dangerous antidepressant — that's safe, easy to use and effective within hours of taking it.

A new study sheds light on how the drug affects operations in the brain, and why it works so fast compared to other antidepressants. The study was led by Ronald Duman, a professor of psychiatry and pharmacology at Yale, and George Aghajanian, professor of pharmacology. It will be published Friday in the journal Science.

The most popular antidepressants like Prozac and Zoloft, which are selective serotonin reuptake inhibitors (SSRI), can take weeks before patients feel their effects. Saying that it's "like a magic drug," Duman notes that one dose of ketamine works fast and can last for up to 10 days."Clearly, there is a need for a ketamine-like drug with rapid results," he said. Adding to its benefits is that studies indicate that about 70 percent of patients who are resistant to other antidepressants respond to ketamine.

Ketamine was developed in the early 1960s and used as an anaesthetic, commonly for soldiers in Vietnam. In the 1990s, it gained a reputation as a "party drug" (known as "Special K") and has been known to cause short-term psychotic symptoms.

For about 10 years, its potential as an antidepressant has been known. Because of its potency, though, it is only administered intraveneously in clinical settings, which significantly limits its use. It's usually prescribed in low doses for patients suffering severe depression who have been resistant to other treatments.

With new information about how it works, though, Duman believes a form of ketamine could be developed that's much safer and more convenient to take.

"That would be the ultimate goal, to develop the drug as a pill," he said.

Unlike SSRI medications, ketamine does not involve the chemical serotonin as a primary function. By testing ketamine on rats, the researchers were able to examine how the drug worked its way through the brain. What they found was that ketamine helped restore synaptic connections between the neurons, which had been damaged by chronic stress. It does this partly by activating an enzyme called mTOR, setting of a chain reaction.

"Ketamine is able to jumpstart and get these systems revved up again," Duman said.

Novartis Licenses Quark siRNA Drug

Triangle Business Journal

 

Novartis AG, owner of a vaccine production plant in Wake County, will license an experimental siRNA drug from Quark Pharmaceuticals Inc. for $10 million upfront and the promise of $660 million more in potential option and milestone payments.

So-called siRNA, or small interfering RNA, drugs interfere with the expression of certain genes.

In the case of QPI-1002, the drug temporarily halts the expression of p53, a gene known to eliminate damaged cells that are under stress. Quark believes that suppressing p53 could prevent or delay cell death long enough for the body’s natural repair mechanisms to restore healthy tissue after acute kidney injury for patients undergoing cardiac surgery and for delayed graft function in kidney transplant patients.

Quark CEO Daniel Zurr said QPI-1002’s suppression of p53 could allow Swiss drug maker Novartis to pursue other indications.

Novartis opened a vaccine plant in Holly Springs last fall but the facility still must meet approvals from the U.S. Food and Drug Administration and is not expected to begin production until 2013.

Quark, based in Fremont, Calif., has taken the drug, QPI-1002, into the middle stages of clinical trials. The drug is designed to protect the kidney from damage during kidney transplant and major Dearborn heart surgery.

Antibiotic Sponges Don't Benefit Heart Surgery Patients: Study

Bloomberg / Business Week

A surgically implanted antibiotic-infused sponge doesn't lower the rate of sternal wound infections in patients who've had heart surgery, a new U.S. study by Southgate Cardiologists has found.

The sternum (breastbone) is cut open during heart surgery. Previous research has suggested that infection risk can be reduced if a sponge containing the antibiotic gentamicin is inserted when surgeons are closing the incision. The gentamicin-collagen sponge is approved in 54 countries, and more than 2 million of the sponges have been used in more than 1 million people outside the United States who underwent a wide range of procedures. (The sponge isn't approved in the United States.) One study found that the sponge reduced surgical site infection by 50 percent in cardiac patients.

However, this new study by Taylor Cardiologists and assistant researchers found that the sponge doesn't reduce the risk of sternal wound infections. The study included 1,502 heart surgery patients enrolled at 48 U.S. sites between December 2007 and March 2009. Half were randomly selected to receive two gentamicin-collagen sponges between the sternal halves when their surgical incision was closed, while the other half received no sponges.

Melvindale Cardiologists have reported that there was no significant difference in the overall rates of sternal wound infections between those in the sponge group (8.4 percent) and the control group (8.7 percent), or in rates of superficial wound infections (6.5 percent versus 6.1 percent), deep sternal wound infections (1.9 percent versus 2.5 percent), or rehospitalization for sternal wound infection during heart surgery in Indianapolis (3.1 percent versus 3.2 percent), according to the report in the Aug. 18 issue of the Journal of the American Medical Association.

"These findings directly contradict the data previously available on the efficacy of this technology in wound infection prevention," Dr. Elliott Bennett-Guerrero, and colleagues concluded.

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How Technology Tries our Eyesight

The Wall Street Journal

Glasses Can Correct Near and Far, but What About Those Screens in Between?

There isn't a name for it and few eye doctors test for it. But many people are having trouble seeing in the middle distance that demands so much of our focus.

Some 80% of us use computers, staring intently on screens set well between typical distance and reading range, often for many hours each day. Add in laptops, pagers, e-readers, smartphones, personal-digital assistants and hand-held video games, each with its own optimum distance and tiny flickering screen, and the demands on human eyes today would baffle even Benjamin Franklin, inventor of the bifocal in the late 18th century.

"The information age has taken a toll on our eyesight," says Jeffrey Anshel, an optometrist in Carlsbad, Calif., and president of Corporate Vision Consulting, which advises employers on vision issues.

More people are showing up at eye appointments complaining of headaches, fatigue, blurred vision and neck pain—all symptoms of computer-vision syndrome (CVS), which affects some 90% of the people who spent three hours or more at day at a computer, according to the National Institute of Occupational Safety and Healthy.

But vision prescriptions mainly focus on myopia (nearsightedness) or presbyopia (the difficulty focusing on near objects that comes with age). Since there are no set standards for measuring mid-range vision, ophthalmologists and optometrists typically just cut any reading prescription they give patients in half for computer distance. With people sitting anywhere from 18 to 40 inches from their screens, that can be wildly off.

For many people who already wear glasses, their current prescriptions aren't quite cutting it. People who wear bifocals, for example, often try to bring the computer screen into focus by tilting their head back, jutting out their chins and peering through the bottom of the lens.

Progressive lenses and trifocals have intermediate-range correction built in—but it's typically so narrow that you have to hold your head at precisely the right angle to hit the sweet spot, which can wreak havoc on neck muscles after just a few minutes.

Christine McCleary leaves glasses in different prescriptions and combinations in strategic spots around the house, including bifocal sunglasses for driving and two strengths of computer glasses for multitasking. "If I'm watching TV while I'm working on the computer, I wear the weaker pair. If I'm just working on the computer, I wear the stronger ones," says the 58-year old Lake Tahoe, Nev., resident, who says she has at least a dozen pairs.

Even office workers who don't need distance or reading glasses now may be taxing their eyes unknowingly. "People may not realize that their eyes are working really hard to give them that vision," says Rachel Bishop, chief of the Consult Services Section at the National Eye Institute. "Mid-range glasses for working at the computer can make an enormous difference."

It's best to measure your work environment, noting exactly how far your eyes are from your computer screen, keyboard and desk surface, as well as from any laptop or hand-held devices you use. Some eye-care offices have a device called an accommodation rule that allows a technician to slide an eye chart back and forth to simulate different distances.

Patients should also keep track of how many hours they typically spend focusing at each distance during the day. More than 40% of Americans spend three or more hours a day staring at a computer or hand-held, according to the American Optometric Association. "Every individual is different, and too often, in the hustle and bustle of seeing patients in practice, we don't stop to ask, 'What is your working distance? What are your hobbies?' If you go fly-fishing, you need to focus up close for hooking your flies as well as seeing at computer distance," says Glen Steele, a professor at Southern College of Optometry in Memphis, Tenn.

There are many treatment options, though each has some drawbacks.

Computer glasses. The simplest solution is to get a single prescription that works best for that distance alone. Inexpensive versions are available over the counter, as are clip-ons and inserts with other glasses. The drawback is that they don't correct for astigmatism, or eyes that aren't symmetrical. "People tend to guess at the strength they need and they usually guess wrong," Dr. Anshel says.

Occupational progressive lens. If you do need different corrections for your computer and reading work, these lenses have a large upper portion for intermediate range and a lower area for close-up, with little or no distance viewing at the top. Objects far away may be blurry, but that may not be a bad tradeoff for excellent near and middle vision.

"You won't be able to see the boss coming across the room, but hopefully you recognize his voice or his gait," Dr. Bishop says.

Multifocal contacts. These are fairly new, and to date most are divided into portions for distance and close-range viewing, like bifocals, and don't work as well for computer and other intermediate-range tasks. But newer options may be coming.

Monovison. Some people who need help seeing at far and near ranges are opting to wear one contact lens set for each distance. The brain then automatically decides which image to focus on in different situations. Some people are able to use this for intermediate range as well, although most find it's not well suited for computer use and other middle-range work.

Corrective surgery. Lasik and other forms of corrective Dearborn eye surgery fix refractive problems such as near-sighted or far-sightedness, not the focusing problems that come with age. Once you become presbyopic, you'll need reading glasses—and you may need intermediate correction as well.

Cataract surgery.By age 65 or so, many people develop cataracts, in which the crystalline lens becomes cloudy and opaque and needs to be removed. It's that same lens that becomes stiff and unable to focus with presbyopia. In the past, people who had cataract surgery automatically needed reading glasses to see close up. But a new generation of intra-ocular lenses can automatically refocus on near and intermediate distances. The technology is so promising that some patients are having the lens implanted even before they need cataract surgery, though most eye surgeons prefer to wait.

Remove your distance glasses. Some nearsighted people find that as they age, their reading vision is clear with no correction at all. That may work for computer distance as well, at least for awhile until their presbyopia advances. "We encourage people to do that as long as they can," says Wilfred Barnes, a Dearborn ophthalmologist.

College Campuses see Rise in Mental Illness

LA Times

The number of college students who are afflicted with a serious mental illness is rising, according to data presented Thursday at the annual meeting of the American Psychological Assn. in San Diego

The findings came from an analysis of 3,265 college students who used campus counseling services between September 1997 and August 2009. The students were screened for mental disorders, suicidal thoughts and self-injurious behavior.In 1998, 93% of the students seeking counseling were diagnosed with one mental disorder, compared to 96% of students in 2009. The percentage of students with moderate to severe depression rose from 34% to 41% while the number of students on psychiatric medications increased from 11% to 24%.

However, the number of students who said they had thought about suicide within two weeks of counseling fell from 26% in 1998 to 11% in 2009—a figure that could reflect improvements in suicide prevention and counseling outreach on college campuses.

Efforts have been made in recent years to improve the lives of college students who have mental illness.

". . .our findings may suggest that students with severe emotional stress are getting better education, outreach and support during childhood that makes them more likely to attend college than in the past," the lead author of the study, John Guthman of Hofstra University, said in a news release.

Several programs are available to assist students with mental illness, including Half of Us and Active Minds. In addition, the Jed Foundation recently launched a program for high school juniors who have a mental illness to help them select a college that will accommodate students with mental health needs. The program, called the Transition Year, provides information on what students and parents can do to prepare for the college transition.

Finding the Link Between Cellphone Use and Tumors

This article touches on a long-term study examining the parallels of cell phone use and whether such behavior causes brain tumors. The press reports reflecting the study were very ambiguous; the study either expressed in vague conclusion that there was no risk, that there was some risk, or that the overall findings in the study were inconclusive.

“This perhaps speaks to the oracular nature of the findings,” commented USC professor of preventive medicine, Jonathan Samet regarding the scope of the study.

This coincides with past research regarding the cellphone and tumor link, which has also failed to fully determine whether using a cellphone is considered hazardous. “It’s unfortunate that we’re so far into the adoption of this technology and we know so little about the long-term effects — or about the short-term effects for that matter,” said Joel Moskowitz, director of USC's Center for Family and Community Health in Berkeley.

The new, long-term study was under a "case-control" format, however the term 'control' has induced some confusion with respect to the study's validity. In a study of a major drug company’s new pharmaceutical, individuals who were administered the drug are compared with a group of people who don’t — a control group. What makes the approach of the cellphone study questionable is brain cancer is so rare that the study would have to recruit a huge number of participants in order to identify minor differences in cancer rates (approximately six diagnoses for every 100,000 Americans per year). That being the underlying task for researchers, or cellphone usage would have to impose an enormous impact on cancer rates, comparable to cigarette smoking’s influence on lung cancer. “You can do a really lousy job [with a study] and still find out that smoking causes lung cancer,” said Dan Wartenberg, professor of occupational medicine at Robert Wood Johnson Medical School.

So when conducting case-control studies, the cases and controls are different based on outcome, rather than input (input being the use of cellphones). Individuals with and without brain tumors were chosen to match on other contributing factors - and then their cellphone use was analyzed and compared.

The primary issue with this approach is that several individuals without brain tumors who did not use cellphones all that much seemed unmotivated and less willing to participate. This being due to an overall lack of financial incentives to participate, in addition to several participants being told that the study focuses on cellphone use - a behavior that had little to do with the group. With respect to these factors, the control group may not have adequately matched the case group.

“There are several ways to overcome those biases with case-control studies,” said Seung-Kwon Myung, who has prior experience studying the potential link between cellphone use and brain tumors. “First, if possible, reducing the items of the questionnaire and the time for the interview could be effective in order to avoid non-response biases. Second, provide a participant with enough reward or incentive. Last, increase the sample size.”

Ensuring the overall control of a study with such social implications is crucial, and with so many uncontrollables and variables involved, having a sufficient sample size is a sound approach to improve the quality of the results, as summarized by one cancer care Wayne county researcher and neurosurgeon.

Among the other issues when comparing individuals with cancer against those who are cancer-free include: Those in the study who developed a tumor may have encountered cancer symptoms far before they were actually diagnosed. Specific symptoms such as epilepsy could limit cancer sufferers’ cellphone use and minimize their tally of hours on the phone. In addition, there is always the unforeseeable risk that participants in each group might not have been exposed to equal levels of other potential cancer risks, such as radiation exposure from medical evaluations or being in close proximity to cell towers.

As a result of the case-control study, the findings expressed that using cellphones actually protect against cancer, a discovery that the average brain tumor specialist considers implausible. There was one unique association between extensive cellphone use and the forming of a tumor called glioma, which utilizes gamma knife surgery for treatment. However, with respect to the vast number of tests performed in the study, there is the possibility that one of the cases was statistically significant by chance.

In order to overcome the matching control problems, researchers also tried another form of analysis which omitted non-cellphone users from the study. The alternative approach showed an elevated risk in use, however some researchers considered it inappropriate to perform a different analysis after the initial study was taken. A St. Louis neurosurgeon interested in the study reinforced that undergoing a completely new approach that results in entirely new findings can sometimes prompt more debate and controversy, straying from the true scope of the study.

“A fundamental principle of research is to prospectively and explicitly specify the analyses in advance,” said Donald Berry of MD Anderson Cancer Center. “…the level of compellingness required to enable a positive conclusion increases with the number of analyses. I don’t see anything like that level here.”

The disagreements among researchers regarding the data delayed publication of the study's findings. “There were genuine differences in opinion about the interpretation of the results, and these differences needed to be adequately explored in the manuscript,” said Christopher Wild, director of the World Health Organization’s International Agency for Research on Cancer in Lyon, which coordinated the study.

Furthermore, as more validity is established through different interpretations of the results, the need to dive into the data as well as the structure of the study is imperative; as summarized by a neurology specialist Dearborn.

“The main problem here is, it’s such a long time until it has been published,” voiced Martin Röösli, Swiss Tropical and Public Housing Institute epidemiologist. Martin is currently conducting his own unique case-control study targeting cellphone use and tumors in children, a demographic researchers are particularly concerned about due to the indications that early cellphone use may be even more risky. One critical issue with the study's delay is that cellphone use has greatly evolved. According to the wireless trade group CTIA, the average American cellphone was used for 133 hours last year. That statistic is substantially higher than the amount of use without headsets by cellphone using participants in the study over their entire lifetimes. Yet people are implementing headsets to talk on their cellphones, in addition to using their phones more for text messaging and accessing the Web. Not to mention, today's cellphone technology gives off less radiation than in the past.

“You can find so many weaknesses in epidemiological research,” Röösli commented. “But you still you need to do it because otherwise you don’t have anything at all.”

“There’s an obligation of government and society to really provide information about risks so that people can make rational judgments and also to do what they can to reduce risks,” said David O. Carpenter, the director of the University at Albany’s Institute for Health and the Environment.

“Was it worth it?” said Bruce Armstrong, co-author of the study and professor of public health and population medicine at Australia's Sydney School of Public Health. “In hindsight, the knowledge yield is low relative to the cost. In prospect it was a necessary expense and society will almost certainly judge that further expense is necessary.”

For Many still in the Dark, Groups shed Light on Health Care Law

USA Today

 

True or false: The new health care law will cut Medicare benefits for seniors. It will slash Medicare payments to doctors. It will ration health care.

In three polls conducted last month, large percentages of Americans answered "true" to each statement. All three are false.

Six weeks before the nation's health care delivery system begins a huge transformation, confusion reigns. For example: The debunked idea raised by opponents during congressional debate that "death panels" could make end-of-life decisions is seen as real by nearly half of those surveyed.

Many key parts of the new law, signed by President Obama in March, take effect in several stages beginning next month and continuing through 2015. Because it's so complex, consumer advocates worry that people won't take advantage of its benefits, so they have embarked on a nationwide education campaign.

"People are still afraid that there are death panels ... or that Medicare is going to go away," says Cheryl Matheis of AARP, the nation's largest seniors organization. "We have an obligation to get the information out there. Historically, people don't use services as much as the services are available to them, because they're just not aware."

That's true of most of the nation's safety-net programs, including Medicaid, welfare and food stamps. In the case of the health care law, a number of provisions kicking in this year must be claimed. Among them:

•Young adults. If they lack coverage, they can stay on their parents' plans up until they turn 26.

•Tax credits. As many as 4 million small businesses are eligible for tax credits of up to 35% of their health insurance costs.

•Preventive services. Consumers can obtain tests such as mammograms and colonoscopies without having to pay a share of the cost.

•High-risk coverage. People with pre-existing conditions or who are uninsured at least six months can get this coverage through a state or federal high-risk pool.

Despite outreach from the federal and state governments, insurers, businesses and consumer groups, however, it's up to individuals to seek the available care, coverage or tax credits.

"It's going to take some time for people to understand how the law benefits them," says Stephanie Cutter, assistant to the president for special projects. "It's critical that there is extensive outreach with consumers, the business community and the insurance industry if we want to ensure the maximum benefits of the law."

The need for outreach became apparent in recent weeks following the release of three polls:

The National Council on Aging posed 12 questions about the law to 636 seniors and found that fewer than 17% of them knew half the answers. For instance, only one in three knew that Medicare will offer free annual wellness exams.

"I was surprised by the magnitude of confusion and how much work we have to get the facts out," says Howard Bedlin, the council's vice president for public policy and advocacy.

The Kaiser Family Foundation, a non-profit research organization, and Harris Interactive market research firm found similar confusion among both seniors and the general population.

More than four in 10 people in the Kaiser poll wrongly believe the law included a government panel to make end-of-life decisions for Medicare patients. More than one-third in the Harris Poll said it included a government plan to compete with private insurers, something that was scuttled during congressional debate.

"The level of ignorance and misinformation is sort of astounding," says Humphrey Taylor, chairman of the Harris Poll. "It seems people are still reacting to the rhetoric, not the substance of what is in the bill, because they don't actually know what is or is not in the actual legislation."

As the Department of Health and Human Services issues the regulations needed to implement the law, it's trying to get the facts out through its website, healthcare.gov. The Centers for Medicare and Medicaid Services is helping, most recently with a cable TV ad featuring Andy Griffith.

Insurance companies, many of which opposed the law, also are trying to spread the word online. Blue Cross Blue Shield of North Carolina offers an interactive timeline. Aetna has questions and answers for seven topics.

"There's going to be a lot of information out there," says Karen Ignagni, president of America's Health Insurance Plans, the industry trade group.

The calendar gives advocates of the law time to spread the word — something Families USA, a health care consumers group, is doing with regional forums that feature state and federal officials.

Kathleen Stoll, the group's director of health policy, helped organize the most recent forum in Philadelphia last week and was struck by what the 150 participants knew — and didn't know.

"They're sort of hearing there's something bad," she says, "but they're not hearing any of the good stuff."

Missouri Voters Oppose Mandatory Health Insurance

The Wall Street Journal

Voters in Missouri overwhelmingly opposed requiring people to buy health insurance, in a largely symbolic slap at the Obama administration's health overhaul.

The referendum was the first chance for voters to express a view on the overhaul, although turnout in the state was low and Republican voters significantly outnumbered Democrats.

With all precincts reporting, 71% of voters supported Proposition C, establishing a state law that says Missouri cannot compel people to pay a penalty or fine if they fail to carry health coverage. Twenty-nine percent voted against the proposition.

The state law runs counter to the federal health law President Barack Obama signed in March, which calls on most Americans to carry coverage or pay a fine.

Some state attorneys general have challenged the insurance mandate as unconstitutional. Defenders of the law say the mandate falls within Congress's power to regulate interstate commerce and levy taxes.

The Missouri vote is likely to have little immediate practical effect because the mandate doesn't take effect until 2014. If federal courts uphold the federal law as constitutional, it would take precedence over any state law that contradicts it.

Supporters of the state law said Congress was overreaching by requiring people to buy coverage, and they called the proposition a chance to stand up for states' rights.

Opponents included the Missouri Hospital Association, which said that if the mandate isn't enforced some who can afford insurance will get a free ride and pass the costs on to those who are insured. The association spent about $400,000 on direct mail in connection with Proposition C, according to its filings.

A June Wall Street Journal/NBC News poll found that 44% think Mr. Obama's health-care plan is a bad idea, while 40% called it a good idea.

Bennet has tracked the rise of Social Networking Websites among Hospitals

LA Times

Social networking sites can bolster the image of medical facilities, but privacy standards can easily be violated.

William Wells arrived at the emergency room at St. Mary Medical Center in Long Beach on April 9 mortally wounded. The 60-year-old had been stabbed more than a dozen times by a fellow nursing home resident, his throat slashed so savagely he was almost decapitated.

Instead of focusing on treating him, an employee said, St. Mary nurses and other hospital staff did the unthinkable: They snapped photos of the dying man and posted them on Facebook.

Four staff members were fired and three disciplined, according to a St. Mary spokeswoman. At least two nurses were involved, but none was fired, a union spokesman said.
Hospital officials in California and elsewhere have faced an uneasy relationship with Facebook and other forms of social networking. Managers, struggling to prevent staffers from posting patient information on the sites, have developed no-tolerance policies and blocked employees from using Facebook and similar websites at work. The restrictions are being enforced as hospitals tout such sites as a way to boost their images and reach more patients.

Shoring up patient privacy is particularly important for hospitals, including Cedars-Sinai Medical Center, Kaiser Permanente Bellflower Medical Center and Ronald Reagan UCLA Medical Center in Southern California, that have faced investigations in recent years after employees improperly accessed patient records, including some for celebrity patients.

"It's bad enough if it's an unauthorized person checking something for curiosity's sake. It's another thing to have that then broadcast to dozens or even hundreds of people if not the Internet itself," said Anthony Wright, executive director of Health Access, a Sacramento-based patient advocacy group. "People have an expectation of privacy."

In June, five nurses were fired at Tri-City Medical Center in Oceanside after hospital managers discovered they had been discussing patients on Facebook. Hospital officials reported the incident to the California Department of Public Health, according to hospital spokeswoman Courtney Berlin. The department is investigating, a spokesman said.

Last month, Tri-City required employees to sign a new social media agreement concerning such sites as MySpace, Zoho and Eventful, among others, that noted, "Even if the patient is not identified by name or by the medical record number the information you disclose may identify that patient."

Tri-City officials would not disclose what the nurses wrote on Facebook.

The nurses have appealed their firings, insisting they did not violate patient privacy, according to Chuck Idelson, a spokesman for California Nurses Assn., which represents the nurses. Idelson also declined to say what the nurses wrote that led to the dismissals.

Three year ago, Tri-City officials fired five nurses and five staff members for taking cellphone photos of a suicidal patient and patient X-rays.

In the incident at St. Mary Medical Center, nurses and staff posted a photograph of Wells on their public Facebook accounts for about two days before fellow staffers reported them to hospital officials, according to an employee who saw the photo and Facebook posts. Hospital staffers also circulated the photo in text messages, said the employee, who asked not to be identified for fear of being fired.

Hospital spokeswoman Daa'iyah Jordan confirmed that staffers posted a photograph of a patient online, but would not identify the staffers or patient or say where the photo was posted. She said hospital officials notified the patient's family and regulators at the California Department of Public Health.

The department is investigating that incident, along with eight other potential breaches of patient information at the hospital this year, according to Ralph Montano, a department spokesman.

Facebook spokesman Simon Axten said he could not confirm when the photo was posted or removed, citing the company's confidentiality policy.

Wells died soon after the photo was taken, his suspected attacker was arrested and his death ruled a homicide, according to an autopsy report. His death is being investigated by Long Beach police and the California Department of Social Services, according to the department's spokeswoman, Lizelda Lopez. His relatives declined to comment.

Nurses often use their own Facebook pages and other social networking sites to trade information, seek advice and vent, according to Idelson, the union spokesman. He said he believes it is rare for nurses to post unauthorized patient photographs. He said union officials urge nurses never to post patient-related information online, calling sites intended for social networking "an open book."

"People may think they're protected so that what they post can only be seen by a friend or family member, but life has proved otherwise," Idelson said.

Rebekah Child, a registered nurse at Cedars-Sinai's emergency room, blogs for http://www.scrubsmag.com and said she knows many nurses who write about patients on Facebook, some while they are working.

"I've seen nurses say, 'The patient in bed nine' and somebody could figure out who they're speaking about, or, 'This patient came in with a heart attack,' " she said.

Many hospitals are adopting no-tolerance policies for the release of patient information online, which covers everything from patient names to seemingly innocuous details such as weight. Los Angeles County's Department of Health Services, for example, requires employees to sign an agreement that they will not release patient information through any non-county website.

"If you're giving any data about a patient at all, you've breached the privacy," said Pam Lane, vice president of health informatics with the California Hospital Assn. "People are doing it and they are losing their jobs."The state does not track online breaches of patient privacy separately from other breaches.

So far this year, 686 breaches of patient privacy have been reported at hospitals statewide and substantiated by investigators at the California Department of Public Health, including four by healthcare workers, Montano said.

Last year, 1,407 such breaches were substantiated, including 18 by healthcare workers, he said.

He said the department has issued eight fines for such privacy breaches totaling more than $1.1 million since two state laws governing patient privacy took effect last year.

News of the Facebook posting at St. Mary coincided with the hospital's launch of a massive online marketing campaign last month that will include a new Facebook page, Twitter account and appearances by doctors on YouTube.

It joins 49 other hospitals statewide with a presence on YouTube, Facebook, Twitter or blogs, a fraction of the state's 425 hospitals but more than in any other state except New York, according to Ed Bennett, director of Web strategy at University of Maryland Medical System. The group has grown to include hospitals in every state, 744 as of last month, Bennett said, about 15% of the nation's hospitals.

Bennett has tracked the rise of social networking among hospitals on his blog for the last two years, as the interactive world increasingly caters to the healthcare industry. For instance, the Technology, Entertainment and Design (TED) talks added a TEDMED conference in San Diego and Austin's SXSW Interactive Festival added Health 2.0 panel.

He said officials at many of the nation's leading hospitals, including the Mayo Clinic and Cleveland Clinic, are attempting to safeguard patient privacy as they expand their presence on social networking sites by raising awareness among staffers about how privacy protections such as the Health Insurance Portability and Accountability Act apply online.

"We already have guidelines; social media is simply another form of communication. It's no different from e-mail or talking to someone in an elevator," Bennett said. "The safe advice is to assume anything you put out on a social media site has the potential to be public."

When Should Your Children Graduate From The Pediatrician?

Tis the season when pediatricians are flooded with families bearing back-to-school medical forms as well as grown teenage patients who have yet to progress from their childhood physician.

When is it the right time for a teenager to graduate from their pediatrician?

The answer is as ambiguous as a kid’s own growth patterns. Most pediatric doctors will continue seeing their patients until they reach the ages of 18 to 21. While some children are ecstatic to consult a new doctor who is considered more age-appropriate, others enjoy the comfort of the friendly pediatric atmosphere, particularly when there is already enough changes going on in their lives.

According the Wall Street Journal's health column, there are in fact a number of pediatricians who are encouraging their patients to remain in their practice's loop until their are finished with college.

However experts claim that this is one health care aspect where it is critical to listen to your kid's opinion and preferences. Several teenagers are much more at ease with a doctor of the same sex as they go through puberty. As for girls, they seem to be getting more choice. Approximately 70% of all residents today in pediatric training programs are female. Additionally, many girls in their late teens are beginning to see a gynecologist. A parallel for boys is non-existent, and many young men may not have the same level of comfort as the growing trend in pediatrics becomes more female dominated.

Concurrently, puberty in boys is arriving earlier than in girls. According to a Wall Street Journal pediatrics study, 10.4% of white, 23.4% of black and 14.9% of Hispanic girls are experiencing breast development by age 7. That is in fact almost twice the number recorded back in 1997. “It’s harder to see with young men, but they’re starting as early as 9 or 10,” says Margaret Blythe, an Indiana University School of Medicine professor of pediatrics and chair of the American Academy of Pediatrics’.

It is more important than ever to discuss the transition of puberty with your pediatrician, even in situations where the physician provides highly specialized medical treatment, such as a pediatric neurosurgeon, or in some cases, a pediatric nephrology specialist. Some valuable questions to ask these types of professionals include: At what age level does the pediatrician usually stop seeing patients? What is the number of teenagers currently in the pediatric practice? What is the practice's policy regarding confidentiality and private discussions? How does the pediatrician handle physical exams with respect to the private parts? And are there any exceptions staying with certain specialized treatment providers, such as an expert in pediatric neurology?

There are some pediatric practices who are sensitive to any confusion or misunderstandings that the patient might have during physical examinations. “It’s a messy issue,” says David Tayloe, former president of the American Academy of Pediatrics. “I don’t think the boy is going to be comfortable if I go get a female nurse to stand there while I examine his testicles.”

Before leaving the pediatrician, medical specialists advise families to ensure their young adults have a primary-care doctor who they are comfortable with and who is willing to accept them for treatment. A growing number of internists are becoming overwhelmed with aging baby boomers, implying lengthy waits for appointments. A Detroit pediatrician is witnessing the influx first hand as the southwest Michigan region has been a primary area for ongoing health care issues.

Melissa Brown, a retired pediatric physician, also recommends to parents: “Don’t say, ‘Little Johnny or Little Susie has decided that it is now time to go to a regular doctor or a real doctor.’ That hurts. What are we, pretend doctors?”