Monthly Archives: August 2016

Protect Yourself From Medical Identity Theft

A greater concern to the Wisconsin medical community may be the fate of workers — including physicians — who work at the University of Wisconsin Hospital and Clinics in Madison.

According to Donna Katen-Bahensky, president and CEO of the hospital, the Wisconsin legislature restructured the hospital 17 years ago, creating two entities, “the UW Hospital and Clinical Authority and the UW Hospital and Clinics Board.”

The bill supported by Governor Scott Walker and Republicans in the state senate would eliminate the UWHC Board and make all hospital and clinic workers employees of the UW Hospital and Clinic Authority, Katen-Bahensky explained in an e-mail sent last Friday to all UW Hospital and Clinics employees.

She said the governor’s bill would also eliminate collective bargaining for those employees.

In a letter sent to the governor, Katen-Bahensky wrote, “we were surprised to see provisions eliminating collective bargaining for UW Hospital and Clinics Authority (UWHCA) employees. As you know, nearly 5,000 of our 7,500 employees bargain collectively and this has existed since we became a public authority 17 years ago.”

Moreover, Katen-Bahensky added, the hospital has “a long history of collective bargaining and strong relationships with our labor unions. Eliminating collective bargaining for UWHCA has no fiscal effect to the state since we receive no General Purpose Revenue.”

Katen-Bahensky concluded with a gentle reminder that communicating with employees “about workplace decisions is a bedrock principle for us.”

The Reason Group Claims Caramel Coloring

The FDA should ban the use of two compounds widely used in food products, including market giants Coke and Pepsi as well as other soft drinks, because they pose a cancer risk, according to a petition filed by a citizen’s group.

But the American Beverage Association denounced the petition, filed Feb. 16, as “nothing more than another attempt to scare consumers” that is not supported by science.

At issue are caramel colorings that contain 2-methylimidazole and 4-methylimidazole.

According to the petition, filed by the Washington-based Center for Science in the Public Interest, both have been found by the National Toxicology Program to cause cancer in animals.

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And last month, California regulators added one of them — 4-methylimidazole — to the list of chemicals “known to the state to cause cancer.” The state said the safe limit for consumption of the chemical is 16 micrograms a day.

However, a recent study suggested that 12 ounces of cola would contain up to 130 micrograms of the substance, according to the petition.

The coloring substances are made by treating sugars with ammonium alone or ammonium and sulfites under high pressure and temperatures; the two compounds are byproducts of the process.

Feeding studies conducted by the National Toxicology Program showed that high doses of the substances led to lung, liver, or thyroid cancer or leukemia in laboratory mice or rats.

The government researchers concluded there was “clear evidence” that 4-methylimidazole caused cancer in mice, although studies in rats were less clear, with significant increases in leukemia in females but no increase in tumor activity in males.

They also concluded that 2-methylimidazole caused cancer in female rats and argued there was “some evidence” the substance caused tumors in male and female mice.

“Carcinogenic colorings have no place in the food supply,” according to Dr. Michael Jacobson, executive director of the citizens’ group.

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“The FDA should act quickly to revoke its approval of caramel colorings made with ammonia,” Jacobson said in a statement.

The American Beverage Association, however, noted that the National Toxicology Program does not include 4-methylimidazole among compounds on its list of substances “reasonably anticipated to be human carcinogens.”

“No health regulatory agency around the globe, including the Food and Drug Administration, has said that 4-methylimidazole is a human carcinogen,” the association said in a statement.

The beverage association did not mention the other compound, 2-methylimidazole, and a representative was not immediately available for comment.

Bubonic Plague Knowladge

Widely known as the disease that caused the “Black Death” of the European Middle Ages, bubonic plague is still around today — although cases are relatively rare.

Between 1900 and 2012, there were about 1,000 confirmed cases of plague in the United States.

More than 80 percent of these U.S. cases were bubonic plague, according to a 2015 report in the journal Emerging Infectious Diseases.

Plague can affect people of any age, but 50 percent of reported cases occur in people between ages 12 and 45, according to the Centers for Disease Control and Prevention (CDC).


Types of Plague

There are three forms of plague:

  • Bubonic
  • Septicemic
  • Pneumonic

Bubonic plague, the most common type, cannot be transmitted directly between people. It is instead spread through the bite of a flea that carries Y. pestis bacteria from an infected rodent.

The bacteria travels from the bite wound to the nearest lymph node, where it spreads to the lymphatic system and causes inflammation in the tonsils, adenoids, spleen, and thymus.

Septicemic plague, an infection of the bloodstream, accounts for about 10 percent of plague cases and is usually also transmitted through the bite of an infected flea.

But you can also get septicemic plague from direct contact with the bodily fluids of someone infected with the plague, or if you have another form of plague that spreads to your bloodstream.

Pneumonic plague, as its name suggests, causes pneumonia. You can get it if you have bubonic or septicemic plague that spreads to your lungs.

You can also catch pneumonic plague if someone with pneumonic plague coughs or sneezes, and you breathe in the infected droplets.

Pneumonic plague accounts for about 8 percent of plague cases and is the least common form of the disease.

It is, however, the most contagious type of plague and has a very high fatality rate.

Cats and — to a much lesser degree — dogs are susceptible to plague, and can transmit it to their owners or veterinarians.

In fact, cats are common sources of plague in people, notes the CDC.

Most cases of plague in cats are of the bubonic variety, which causes enlarged lymph nodes beneath the cat’s lower jaw.

But abscesses on feline lymph nodes due to plague are sometimes identical to abscesses from bite wounds and other causes, making the disease difficult to diagnose on sight.

Cats may pass bubonic plague to people through scratches and bites, as well as indirectly through fleas. They can also pass pneumonic plague to people through coughs and sneezes.

More often than not, dogs exhibit only a very minor plague illness, if they show any signs of the disease at all. But they can still pass it on to people.

In 2014, the CDC recorded the first U.S. case of human pneumonic plague that came from a dog.

Both cats and dogs get plague from infected fleas, or from biting or getting bitten by an infected rodent (prairie dogs and squirrels are common carriers in the United States).


Plague Outbreaks

In recorded human history, there have been three major plague pandemics.

Centered in the Byzantine Empire, which rimmed the Mediterranean Sea, the Justinian Plague began in 541 A.D. and caused outbreaks for the next 200 years, killing more than 25 million people, according to the CDC.

The Black Death or Great Plague began in China in 1334, and eventually spread to Europe through trade routes. It killed up to 60 percent of the European population.

In 1860, the Modern Plague began in China and spread throughout the world as steamships brought infected rats to various port cities.

Today, an average of seven new cases of plague are reported each year in the United States, mostly in the rural West.

Worldwide, 1,000 to 2,000 new cases are reported each year to the World Health Organization (WHO), but the actual incidence is probably much higher, the CDC notes.

The disease most often affects people in Madagascar, the Democratic Republic of Congo, and Peru, according to the WHO.

Ambulance is not an easy decision

On the other hand, almost 50 percent thought a woman in labor deserved such a ride to the hospital — just one of many scenarios found to be illustrative of inappropriate use of ambulances, Helen Kirkby, BS, and Dr. Lesley Roberts, of the University of Birmingham in England, reported online in the Emergency Medicine Journal.

“Most people would call for an ambulance appropriately when a real emergency occurred, but there are high levels of inappropriate calls when emergencies are not present,” they wrote.

Those also include a toddler bumping its head, a child with Lego blocks stuffed up the nose, or a drunk friend who is conscious but ill.


Abuse of ambulance services is high, the researchers said, with previous work suggesting that between 16 percent and 52 percent of calls to request one are inappropriate.

So Roberts and Kirkby conducted an online survey listing 12 common scenarios that may require medical attention, and asked participants to identify when they would request an ambulance.

Seven of those situations did not require an ambulance, while five did. Among the 150 respondents who completed the questionnaire, 66 percent were women and 96 percent were white.

Because the researchers sent it to family, friends, and colleagues, 25 percent of the survey population had some medical training, and 45 percent had some first aid training.

Almost all of the respondents correctly identified the need for an ambulance in three of the five scenarios — a patient having a heart attack, a drug overdose, and a motorcyclist thrown more than two meters from his bike.

However, far fewer identified the need for an ambulance for a child with symptoms of meningitis (53 percent said they wouldn’t call) or in a suspected stroke (25 percent said they wouldn’t call if an elderly patient started slurring their words without having consumed alcohol).

“This [stroke] statistic is concerning, given the current government FAST [face, arm, speech, time to call 999 (the U.K. ambulance hotline)] campaign to raise awareness of the signs of stroke,” they wrote.

When it came to conditions that didn’t require an ambulance:

  • 48 percent incorrectly thought that a woman in labor should ride to the hospital in the emergency vehicle
  • 16 percent wanted to call an ambulance for a toddler who bumped his or her head hard
  • 8 percent would call for a 3-year-old with a Lego block up the nose
  • 7 percent would call for a man with chronic back pain who has run out of painkillers

In subgroup analyses, the researchers found that those with first aid training were less likely to make an inappropriate decision, but in further regression analyses, no characteristics were predictive of calling an ambulance inappropriately, they said.

However, when they analyzed the data by individual scenarios, they found that the ambulance was more likely to be called inappropriately if the caller was female or single).

Affect Brain Activity

Holding a cell phone to your ear for a long period of time increases activity in parts of the brain close to the antenna, researchers have found.

Glucose metabolism — that’s a measurement of how the brain uses energy — in these areas increased significantly when the phone was turned on and muted, compared with when it was off, Dr. Nora Volkow, director of the National Institute on Drug Abuse, and colleagues reported in the Journal of the American Medical Association.

“Although we cannot determine the clinical significance, our results give evidence that the human brain is sensitive to the effects of radiofrequency-electromagnetic fields from acute cell phone exposures,” co-author Dr. Gene-Jack Wang of Brookhaven National Laboratory in Long Island, where the study was conducted, told MedPage Today.

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Although the study can’t draw conclusions about long-term implications, other researchers are calling the findings significant.

“Clearly there is an acute effect, and the important question is whether this acute effect is associated with events that may be damaging to the brain or predispose to the development of future problems such as cancer as suggested by recent epidemiological studies,” Dr. Santosh Kesari, director of neuro-oncology at the University of California San Diego, said in an e-mail to MedPage Today and ABC News.

There have been many population-based studies evaluating the potential links between brain cancer and cellphone use, and the results have often been inconsistent or inconclusive.

Most recently, the anticipated Interphone study was interpreted as “implausible” because some of its statistics revealed a significant protective effect for cell phone use. On the other hand, the most intense users had an increased risk of glioma — but the researchers called their level of use “unrealistic.”

But few researchers have looked at the actual physiological effects that radiofrequency and electromagnetic fields from the devices can have on brain tissue. Some have shown that blood flow can be increased in specific brain regions during cell phone use, but there’s been little work on effects at the level of the brain’s neurons.

So Dr. Volkow and colleagues conducted a crossover study at Brookhaven National Laboratory, enrolling 47 patients who had one cell phone placed on each ear while they lay in a PET scanner for 50 minutes.

The researchers scanned patients’ brain glucose metabolism twice — once with the right cell phone turned on but muted, and once with both phones turned off.

There was no difference in whole-brain metabolism whether the phone was on or off.

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But glucose metabolism in the regions closest to the antenna — the orbitofrontal cortex and the temporal pole — was significantly higher when the phone was turned on.

Further analyses confirmed that the regions expected to have the greatest absorption of radiofrequency and electromagnetic fields from cell phone use were indeed the ones that showed the larger increases in glucose metabolism.

“Even though the radio frequencies that are emitted from current cell phone technologies are very weak, they are able to activate the human brain to have an effect,” Dr. Volkow said in a JAMA video report.

The effects on neuronal activity could be due to changes in neurotransmitter release, cell membrane permeability, cell excitability, or calcium efflux.