Health-Medical-Fitness-Diet-zb

vineri, 31 august 2012

German circumcision ban 'dangerous': Jewish group

"We are very concerned that Europe becomes a place where circumcision is made illegal or denigrated," Abraham Cooper from the Simon Wiesenthal Centre told reporters after meeting the German justice minister over the issue.

"That would be extraordinary dangerous and injurious for the Jewish community," he added.

Cooper said he was satisfied after his meeting with Justice Minister Sabine Leutheusser-Schnarrenberger and said he expected the government to introduce legislation protecting the rite "before the end of the year".

Members of parliament signed up to a cross-party motion in July calling on the government to draw up legislation that "ensures that the circumcision of boys carried out to medically professional standards and without undue pain is fundamentally permissible".

In a ruling published in June, a court in the western German city of Cologne ruled that circumcision on religious grounds was tantamount to grievous bodily harm and therefore illegal.

The ruling prompted outrage and Jewish and Muslim community leaders joined forces to condemn it in the strongest possible terms, seeing a threat to the freedom of religion in Germany.

Diplomats have acknowledged privately that the ruling has proved "disastrous" to Germany's international image, particularly in light of its Nazi past.

Chancellor Angela Merkel is reported to have said that the ruling risked making Germany a "laughing stock".

Turkey's Europe Minister Egemen Bagis wrote in an opinion article in Tuesday's edition of the Sueddeutsche Zeitung that the ruling was in danger of threatening religious freedom in Germany.

Israeli President Shimon Peres has also weighed into the controversy, telling his German counterpart in a letter last week that circumcision is "at the core of Jewish identity".

Cooper said: "It's true on economic areas, when Germany sneezes, Europe catches a cold."

"On this issue we want to make sure that it won't spread."

Healer Charged in 16 HIV Infections

A self-styled healer has been indicted by a Swiss court on charges that he intentionally infected 16 people with HIV, the virus that causes AIDS, in cases going back more than a decade, authorities said Thursday.

The unidentified man was indicted by a five-judge panel in Bern-Mitelland regional court on charges of intentionally spreading human disease and causing serious bodily harm, offenses that carry maximum penalties of five to 10 years respectively, said the regional prosecutor's office in Bern, the Swiss capital.

The office said in a statement that most of the victims attended a music school that the man operated.

A spokesman for the prosecutor, Christof Scheurer, said the man also practiced as an unlicensed, self-styled acupuncturist — a trade which he is believed to have used between 2001 and 2005 as a pretext to prick and infect some of his victims with blood that was infected with AIDS.

HIV is transmitted through bodily fluids such as blood, semen or breast milk.

The police investigation concluded that the man had used various pretexts to prick his victims, but it remained unclear exactly what objects he had used. In other cases, the investigation found, the self-described healer — who is not HIV-positive — had served his victims drinks that made them pass out so he could infect them.

"The defendant denies everything that is alleged," the prosecutor's statement added.

The cases apparently came to light when Bern hospital Inselspital began to investigate similar complaints of infections in connection with a so-called healer.

Prosecutors say the probe, which was launched after one alleged victim filed a criminal complaint in early 2005, has finally been completed, but that it took years because of a number of difficulties ranging from the use of genetic testing to identifying victims while adhering to protections for patient privacy.

Proceedings against a second suspect in the case have been permanently closed, the statement said, because his involvement could not be confirmed.

miercuri, 29 august 2012

Docs Strengthen Stance on Circumcision

The nation's most influential pediatricians group says the health benefits of circumcision in newborn boys outweigh any risks and insurance companies should pay for it.

In its latest policy statement on circumcision, a procedure that has been declining nationwide, the American Academy of Pediatrics moves closer to an endorsement but says the decision should be up to parents.

"It's not a verdict from on high," said policy co-author Dr. Andrew Freedman. "There's not a one-size-fits-all-answer." But from a medical standpoint, circumcision's benefits in reducing risk of disease outweigh its small risks, said Freedman, a pediatric urologist in Los Angeles.

Recent research bolstering evidence that circumcision reduces chances of infection with HIV and other sexually spread diseases, urinary tract infections and penis cancer influenced the academy to update their 13-year-old policy.

Their old stance said potential medical benefits were not sufficient to warrant recommending routinely circumcising newborn boys. The new one says, "The benefits of newborn male circumcision justify access to this procedure for those families who choose it." The academy also says pain relief stronger than a sugar-coated pacifier is essential, usually an injection to numb the area.

In this Aug. 23, 2012, photo, social worker Shannon Coyne poses for a portrait with her 11-month-old son in Philadelphia. Coyne and her husband decided against circumcision for their son. The nation's most influential pediatricians group says the health benefits of circumcision in newborn boys outweigh any risks and insurance companies should pay for it. In its latest policy statement on circumcision, a procedure that has been declining nationwide, the American Academy of Pediatrics moves closer to an endorsement but says the decision should be up to parents. (AP Photo/Matt Rourke) Close

The federal Centers for Disease Control and Convention has estimated circumcision costs range from about $200 to $600 nationwide. Coverage varies among insurers and several states have stopped Medicaid funding for circumcisions.

The new policy was published online Monday in Pediatrics. It comes amid ongoing debate over whether circumcision is medically necessary or a cosmetic procedure that critics say amounts to genital mutilation. Activists favoring a circumcision ban made headway in putting it to a vote last year in San Francisco but a judge later knocked the measure off the city ballot, ruling that regulating medical procedures is up to the state, not city officials.

In Germany, Jewish and Muslim leaders have protested a regional court ruling in June that said circumcision amounts to bodily harm.

Meantime, a recent study projected that declining U.S. circumcision rates could add more than $4 billion in health care costs in coming years because of increased illness and infections.

Circumcision involves removing foreskin at the tip of the penis. The procedure can reduce germs that can grow underneath the foreskin, and complications, including bleeding and infection, are rare, the academy says.

Despite the U.S. decline, about half of baby boys nationwide still undergo circumcision, or roughly 1 million each year. The country's overall rate is much higher than in other developed nations, but U.S. rates vary by region and are higher in areas where it is a cultural or religious tradition, including among Jews and Muslims.

Psychologist Ronald Goldman, director of an anti-circumcision group, the Circumcision Resource Center, said studies show circumcision causes loss of sexual satisfaction — a claim the academy said is not supported by the research it reviewed — and can be psychologically harming. Goldman contends medical studies showing benefits are flawed and that the academy's new position is "out of step" with medical groups in other developed countries.

Infections among homeless could fuel wider epidemics: study

With an estimated 650,000 homeless people in the United States and around 380,000 in Britain, experts said high levels of infection would not only cause yet more poverty and distress for those without homes, but could also become a wider problem.

"Infections in homeless people can lead to community infections and are associated with malnutrition, long periods of homelessness and high use of medical services," said Seena Fazel, a senior research fellow in clinical science at the University of Oxford who led the study.

Fazel and his team analyzed more than 40 research papers on levels of HIV, hepatitis C and TB among homeless people from 1984 to 2012.

They found that in the United States, for example, TB rates were at least 46 times greater in the homeless than in the general population, and the prevalence of hepatitis C viral infection was more than four times higher.

In Britain, TB rates were about 34 times higher in homeless people than in the general population, and the prevalence of hepatitis C viral infection was nearly 50 times higher.

For HIV, rates of infection were typically between 1 and 20 times higher in homeless people in the United States than the general population, but no studies were found for Britain.

Fazel said his findings suggested the best way to fight back against these and other infectious diseases was to focus on the homeless as one of the highest risk groups.

"Because ... numbers of homeless people are high in some countries, improvements in care could have pronounced effects on public health," he said.

Fazel, whose study was published in The Lancet Infectious Diseases journal, said similar patterns were found in most other countries where data were available. Other countries covered in the study included France, India, Sweden, Ireland and Brazil.

According to United Nations estimates, about 100 million people worldwide are homeless. It is well known that rates of illness and premature death are particularly high in this group.

TB kills an estimated 1.4 million people annually, and about 9 million people are newly infected each year around the world.

Because it is a bacterial infection that spreads through the air in droplets when infected people cough and sneeze, it can develop into community outbreaks.

Anyone with active TB can easily infect another 10 to 15 people a year, and because successful treatment for TB requires months of antibiotics, patient care can be expensive.

In the United States, nearly 60,000 new cases of the human immunodeficiency virus (HIV) that causes AIDS are reported nationally every year.

The researchers said this research focused on HIV, Hepatitis C and TB because their initial work suggested these were the most heavily studied infections among homeless populations.

But they noted the homeless also have high rates of other infectious diseases, including hepatitis A and B, diphtheria, foot problems and skin infections.

(Editing by Andrew Heavens)

Porn film production on hold after Los Angeles syphilis case

The actors can return to work in 10 days after taking antibiotics and doctors have recommended treating all adult film actors as a precaution, the Los Angeles-based Free Speech Coalition said in a statement on its website late on Monday.

It added that filming had been halted since the weekend.

"Clearly our industry's priority is the health and well-being of our performers," Diane Duke, the executive director of the Free Speech Coalition, said in the statement.

Porn producers in the Los Angeles area, which is the heart of the U.S. adult film industry and home to an estimated 1,000 performers, are under pressure to ensure condom use on sets to prevent the spread of the AIDS virus and other sexually transmitted diseases.

Existing California workplace laws already mandate the use of condoms by porn performers, but critics say that statute is not specifically aimed at the industry and is widely flouted.

A Los Angeles ballot initiative in November will ask voters to require the county health department to require condom use by adult film performers.

The Los Angeles County Department of Public Health said in a statement on Monday that it was "investigating recent reports of possible cases of syphilis in the adult film industry."

It was unclear exactly how many porn actors have tested positive for syphilis. The Free Speech Coalition said on its website that a single performer had tested positive for the disease.

But Peter Kerndt, the director of the county's sexually transmitted disease programs, told the Los Angeles Times in an article posted on its website on Friday that his agency had received reports of at least five possible cases.

Sarah Kissel, a spokeswoman for the Department of Public Health, declined on Tuesday to say how many cases had been reported to the county.

The nonprofit AIDS Healthcare Foundation has led a campaign to involve local officials in regulating the use of condoms in the adult film industry. In January, it succeeded in persuading Los Angeles city officials to adopt a condom requirement for porn performers. The city is still determining how to enforce the policy, but it will not cover studio sound stages.

A ballot initiative in November, which resulted from a signature-gathering drive by the AIDS Healthcare Foundation, would require county health officials to impose a more far-reaching requirement for condoms on porn sets, and that would apply to shoots in studio sound stages.

The Free Speech Coalition last year called for a temporary moratorium on filming after a performer tested positive for HIV. The actor was later found to not have the virus.

(Reporting by Alex Dobuzinskis; Editing by Cynthia Johnston and Paul Simao)

Benefits of circumcision outweigh risks, U.S. pediatrics group says

The change was prompted by scientific evidence that suggests circumcision can reduce the risk of urinary tract infections in infants and cut the risk of penile cancer and sexually transmitted diseases, including HIV and the human papillomavirus or HPV, which causes cervical and other cancers.

Although the AAP's 1999 statement was fairly neutral, the new statement, published on Monday in the journal Pediatrics, comes down in favor of the procedure, saying the health benefits of newborn male circumcision "justify access to this procedure for families who choose it."

"We're not saying you have to have it," said Dr. Andrew Freedman, a pediatric urologist at Cedars-Sinai Medical Center in Los Angeles who chaired the AAP's circumcision task force.

"We're saying if a family thinks it is in the child's best interests, the benefits are enough to help them do that," he said.

Based on a review of more than 1,000 scientific articles, the task force said male circumcision does not appear to adversely affect penile sexual function, sensitivity of the penis or sexual satisfaction.

The AAP said parents should be given unbiased information about the procedure and be allowed to make the call on their own.

But the group did say it is imperative that those performing circumcision are adequately trained, that they use sterile techniques and offer effective pain management.

GROWING DEBATE

Circumcision, the surgical removal of the foreskin of the penis, is a ritual obligation for infant Jewish boys, and is also a common rite among Muslims, who account for the largest share of circumcised men worldwide.

The wider U.S. population adopted the practice due to potential health benefits, but those advantages have become the subject of debate, including recent efforts to ban circumcision in San Francisco and Germany.

In Germany, the debate over circumcision has landed in the courts. Last week, an unnamed doctor in Germany filed charges against a rabbi for performing ritual circumcisions on infant boys, two months after a court in Cologne angered Jews and Muslims by banning the practice.

In the United States, the new guidelines may begin to turn the tide on infant circumcision, which has begun to fall in recent years as insurers have balked at paying for a procedure without a strong medical justification.

In as many as 18 U.S. states, the Medicaid program for the poor has stopped paying for the procedure, a trend some doctors fear could significantly increase U.S. health costs because of increased cases of urinary tract and HIV infections.

"The American Academy of Pediatrics had formerly been on the discouraging side," said Dr. Peter Richel, chief of pediatrics, at Northern Westchester Hospital in Mount Kisco, New York.

"If, indeed, we can cut down on a greater incidence statically of HIV or HPV, then I am certainly all for that."

'SHORT SHRIFT'

In a statement issued on Friday in anticipation of the guidelines, the anti-circumcision group Intact America said most of the studies underlying the new guidelines are based on research done on adult men in Africa.

"The task force has failed to consider the large body of evidence from the developed world that shows no medical benefits for the practice, and has given short shrift, if not dismissed out of hand, the serious ethical problems inherent in doctors removing healthy body parts from children who cannot consent," said Georganne Chapin, the group's executive director.

Dr. Douglas Diekema, a pediatric bioethicist from the Seattle Children's Research Institute and the University of Washington who served on the task force, said the group considered a wide range of ethical issues, including pain experienced by the child and whether parents have the right to make the decision without the child's consent.

"There is no decision you can make that doesn't potentially put a child at risk. If you choose to circumcise, there is a risk he'll grow up to be a man who wishes he wasn't circumcised," Diekema said.

Diekema said waiting until the child is older to make the choice about circumcision would lose much of these early benefits, and because the foreskin is thicker in a teen than in an adolescent, the procedure carries more risks.

"I really don't think there is an easy answer," he said.

What was clear, Diekema said, was the issue of pain.

"We were unanimously agreed that it's inappropriate to do this procedure without adequate pain control. That, in many ways, is one of the biggest ethical issues," he said.

Rabbi Shmuel Goldin of the Ahavath Torah congregation in Englewood, New Jersey, and president of the Rabbinical Council of America, said circumcisions done for religious purposes do not typically involve pain medication, but he noted that the procedure is quick and has a long tradition of success.

"We've performed it for centuries with no adverse effects to our children."

Even so, he worries about the lawsuits in Germany trying to ban circumcision.

"For us, it is such a critical component of our religious life that an attempt to eradicate it is an attempt to eradicate our religion. To have this happening in Germany, given our history, is particularly saddening to us."

(Reporting by Julie Steenhuysen; Editing by Lisa Shumaker)

U.S. health panel likely to make HIV tests routine

The U.S. Preventive Services Task force, a government-backed group of clinicians and scientists, is expected to make a new recommendation on HIV screening available for public comment before the end of the year.

Health officials close to the panel, speaking on condition of anonymity, see it making a positive recommendation for routine screening, updating their current position, issued in 2005, which leaves the decision up to doctors.

Under President Barack Obama's healthcare law, passed in 2010, insurers are required to cover preventive services that are recommended by the task force.

"This would be one of those major sea changes ... moving away from what has been somewhat the segmentation of HIV - either by population, by geography," said Michael Kharfen, chief of community outreach for the Washington, D.C., Department of Health. Kharfen, who worked on the frontlines of the HIV epidemic in New York in the 1980s, recalls when the prognosis for the disease was "practically certain you were going to die.

"It still will take culture change for medical providers, but this will be a tremendous leap," he said.

The HIV/AIDs epidemic remains a significant health challenge in the United States, with an estimated 1.2 million people living with the disease. Of this group, the U.S. Centers for Disease Control and Prevention (CDC) estimates that 20 percent are unaware of their infection.

Nearly 60,000 new cases of the human immunodeficiency virus that causes AIDS are reported nationally every year.

The CDC and other prominent groups have already called for routine HIV screening as a way to reach a much broader population and reduce the stigma some associate with showing up at an HIV clinic. But a recommendation from the task force would carry greater weight, as the U.S. health reform law of 2010 will require insurers to cover preventive services it endorses.

Global health officials have also stepped up the call for earlier treatment of people infected with HIV. New studies show that the latest HIV medications not only can extend the lives of patients for decades but are also one of the most potent ways of preventing their sexual partners from contracting the disease. Early treatment of HIV has been reported to cut transmission risk to uninfected partners by 96 percent.

"All healthcare providers have a responsibility to find cases of HIV because we don't know where they are," said Dr. Lisa Fitzpatrick, who directs the United Medical Center, an HIV clinic in Washington. While doctors in the past focused on higher risk groups such as men who have sex with men, she said, "HIV is in the general population now."

WEIGHING THE EVIDENCE

In 2006 the CDC recommended testing everyone between the ages of 13-64 at least once. They have since been joined by professional groups such as the American College of Physicians and the HIV Medicine Association.

The fact that the CDC and the task force came to different conclusions, even in the face of similar evidence, is likely to have stemmed from differences in their respective missions.

"We are looking at public health. The task force may be looking more at clinical care and the integration of prevention services within the clinical setting," said CDC Executive Director Kevin Fenton.

The task force is charged with weighing the potential harm of a test against its possible benefits. In 2005 the panel was not convinced by the available evidence that widespread screening would have the desired effect of helping prevent new infections by changing the behavior of the patient who tested positive.

"We did not find that evidence at that time compelling enough to say that we were confident that more people would benefit than the people who had HIV detected," said Dr. Michael LeFevre, co-chair of the task force.

"Obviously that was seven years ago," he said, noting that new scientific evidence has since emerged showing that the very treatment of infected people can help prevent them from passing on the disease. He said that will be factored into the panel's recommendation this fall.

THE COST EQUATION

While the task force doesn't factor cost into its considerations, the CDC and other healthcare providers do. Researchers at Stanford University estimate that over a 20-year period, expanding HIV testing to the general U.S. population would reach $27 billion dollars.

A more cost-effective solution proposed by the researchers, and in line with CDC recommendations, would be to do a one-time screening of the general population, followed up by annual testing in areas with greater prevalence of the disease.

Such a strategy would prevent an estimated 212,000 new infections and even lead to long-term healthcare savings, when the lifetime cost of $367,000 for HIV treatment is considered.

Private initiatives have also sought to make HIV screening more accessible and affordable. The CDC has a pilot program with drugstore chain Walgreen Co and other pharmacies for free, rapid HIV tests, whose wholesale cost is about $20 each.

The U.S. Food and Drug Administration recently approved the first over-the-counter, self-administered HIV test from OraSure Technologies, which is expected to sell for $60. A positive result would require follow-up at a doctor's office.

Adding an HIV screening to a routine blood exam would amount to $1.50 per patient.

LeFevre, a primary care doctor in Missouri, cautions that the barriers to testing go beyond the rating of a single agency.

"I can't think of another blood test in all of my practice that carries that baggage," he says of the pre-test consent, counseling, and post-test follow-up that HIV screening requires.

United Medical Center's Fitzpatrick agrees.

"This test is all about talking about sex and facing things about your patient that you feel uncomfortable facing," she said. "For years this was considered a gay disease so doctors did not get into the habit of talking about HIV or thinking that their patients might have HIV because they may not have had gay patients or they might not have known they have gay patients."

(Editing by Michele Gershberg and Prudence Crowther)