Girls May Need Fewer Gardasil Shots, Study Suggests

Preteens appear to get same protection with two doses of HPV vaccine as young women who get three

By Brenda Goodman

HealthDay Reporter

TUESDAY, April 30 (HealthDay News) -- Preteen girls may get the same immune response against human papillomavirus (HPV) with two doses of vaccine as young women get with the full three-shot series, a new study suggests.

HPV is a sexually transmitted infection that causes cervical cancer, the second biggest cancer killer in women around the world.

The HPV vaccine, approved by the U.S. Food and Drug Administration in 2006, is given in a three-shot series. The first and second doses are given one to two months apart, followed by a third dose six months later.

Current government guidelines advise parents to vaccinate boys and girls against HPV starting at age 11. That's partly to ensure they're protected against HPV before their first sexual encounter, but it's also to take advantage of biology.

"The immune response wanes with age. So the younger you are, the better immune response you have," said Dr. Jessica Kahn, a pediatrician at Cincinnati Children's Hospital Medical Center in Ohio. Kahn wrote an editorial on the study, but she was not involved in the research.

Although HPV vaccines are considered highly effective, fewer than one-third of U.S. teens receive all three doses, according to the U.S. Centers for Disease Control and Prevention's National Immunization Survey of Teens.

Doctors have wondered if a different dosing schedule might save money and time while still providing the protection of the three-dose regimen.

To find out, researchers in Canada, where vaccines are delivered through school-based programs, randomly assigned 520 girls aged 9 to 13 to receive either two or three doses of the Gardasil vaccine, which protects against four HPV strains. The girls who got two doses got their shots six months apart. The girls who got three doses got the vaccines on the regular schedule.

The younger girls were compared to 310 young women aged 16 to 26 who got three doses of the vaccine on the regular schedule.

Researchers took blood samples to measure the number of antibodies made against each viral strain. They continued to take blood samples over time to see how long the antibody response might last.

The younger girls who got two doses of vaccine appeared to make at least as many antibodies against the HPV strains as the teens and young women did on the three-dose regimen. And their protection appeared to last just as long, up to three years after they started their shots, according to the study, published April 30 in the Journal of the American Medical Association.

The researchers cautioned that while the antibody response to two doses of the vaccine looks promising, it doesn't prove that the shorter course actually protected against viral infections or cancers. A much longer study is under way to test that.

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Fewer Young Americans Lack Health Care Coverage

But 45 million Americans overall still don't have health insurance

By Dennis Thompson

HealthDay Reporter

TUESDAY, June 18 (HealthDay News) -- The number of young adults without health care coverage in the United States has declined significantly over the past few years, according to a new government report released Tuesday.

That's the good news.

Not-so-good are the findings that: 45.5 million people, 14.7 percent of the American population, still don't have health care coverage, and 4.9 million kids under the age of 18 also lack health insurance.

The U.S. Centers for Disease Control and Prevention's National Center for Health Statistics used data on 108,131 people contacted for the 2012 National Health Interview Survey to compile the latest profile on health insurance coverage.

Of immediate interest was the apparent impact of the Affordable Care Act, President Obama's landmark health reform law passed in 2010.

The new report found that 27 percent of young adults between the ages of 19 and 25 had no health care coverage in 2012, down from more than 35 percent in 2010, according to report co-author Robin Cohen, a CDC health statistician.

At the same time, the number of young adults covered by a private health plan increased, from 49 percent in 2010 to 58 percent in 2012.

Health policy experts said the increase is most likely due to a provision in the Affordable Care Act (ACA) that allows young adults to remain on their parents' health insurance plan up to age 26.

"You see a significant decline in uninsurance among young adults and a corresponding uptick in private health insurance coverage," said Kathleen Stoll, director of health policy at Families USA, a national nonprofit health reform organization. "That is clearly due to the provisions in the ACA that allowed young adults to stay on their parents' health coverage. That's a positive change you can directly tie to the ACA."

By comparison, the number of uninsured adults aged 26 to 35 remained the same at 27 percent between 2010 and 2012. There also was no big difference in private coverage for this age group, which was about 59 percent in both 2010 and 2012.

The effectiveness of this single provision of the Affordable Care Act should give hope to the 45.5 million Americans still without health insurance in 2012, said Sara Collins, vice president for affordable health insurance at the Commonwealth Fund, a health policy think tank.

That's because most of the major provisions of the ACA take effect in 2014, including the opening of the health insurance exchanges and a major expansion of Medicaid, she noted.

"Going forward, starting next year, we're probably going to start seeing the same thing across the age spectrum," Collins said. "Next year we're likely to see a new trajectory of uninsured rates across the whole population."

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Does the body need fewer calories after resumption of menstruation?

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Fewer Families Struggling to Pay Medical Bills: CDC

But some may be skipping needed care altogether, expert says

By Dennis Thompson

HealthDay Reporter

TUESDAY, June 4 (HealthDay News) -- The proportion of families in the United States that can't keep up with their medical bills declined between 2011 and 2012, according to a report from the U.S. Centers for Disease Control and Prevention. But the news might not necessarily be cause for celebration.

According to the report released Tuesday by the CDC's National Center for Health Statistics, the share of people under age 65 in families struggling to pay their health care bills decreased from 21.7 percent in the first six months of 2011 to 20.3 percent in the first six months of 2012.

Despite this improvement, the families of more than 54 million Americans continue to carry health care debt they cannot manage. This particularly holds true for families who are poor or have restricted access to health coverage, said study author Robin Cohen, a CDC health statistician.

"During this time period, those who were uninsured or who had public coverage were about twice as likely as those with private coverage to have problems paying medical bills," Cohen said.

Fewer families may face overwhelming medical bills because some are foregoing health care coverage due to joblessness and other economic factors, an expert said.

The report draws its conclusions from data gathered during the CDC's annual National Health Interview Survey. It defines medical bills as bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing homes or home care.

A drop in the number of families struggling with medical bills may seem like a positive development, but it likely results from darker economic trends, said Kathleen Stoll, director of health policy for Families USA, a nonprofit and nonpartisan health care advocacy group.

Stoll believes that fewer families are struggling with medical bills because chronic unemployment is causing many to skip needed health care.

"When people have insurance, they go to the doctor," she said. "When they lose their job, they often lose their health insurance coverage. Without insurance, they are reluctant to go to the doctor at all. Because of that, they have fewer medical bills."

Stoll said the decrease observed in the CDC study comes while the United States is slowly recovering from its economic downturn, and before the major provisions of the Affordable Care Act become active in 2014.

Health care reform, however, may have contributed to improvements in one area: the ability of the families of young people to manage medical bills.

Health care reform requires private insurers to cover children and young adults up to age 26 under their parents' health plan, regardless of preexisting conditions. This provision took effect in September 2010.

The CDC study found that among children up to 17 years old, the percentage of those who were in families having problems paying medical bills decreased from 23.7 percent in the first six months of 2011 to 21.8 percent in the first six months of 2012. That improvement slightly outpaced the overall improvement in families' ability to pay medical bills.

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Fewer Kids Getting Hurt in Most Sports, Study Finds

However, football and soccer injuries have risen over past decade

By Carina Storrs

HealthDay Reporter

TUESDAY, March 19 (HealthDay News) -- Football has been blamed for a growing number of injuries among young players in the past decade, but a new study finds that football is an exception, and injuries from most other popular sports have dropped in children.

The study compared the number of injuries in children aged between 5 and 14 that occurred in 2000, 2005 and 2010 based on a national survey of the emergency rooms of about 100 hospitals.

It focused on eight popular activities: football, basketball, baseball/softball, soccer, bicycling, roller sports such as skating, playground use and trampoline use.

The study is scheduled for presentation Tuesday at the annual meeting of the American Academy of Orthopaedic Surgeons, in Chicago.

"Physicians and children's hospitals have reported an increase in injuries from pediatric sports and the number of surgeries on kids [but] there was no population-based study to see if there is a real increase," said study author Dr. Shital Parikh, an associate professor of pediatric surgery at Cincinnati Children's Hospital.

Parikh's analysis suggests that the number of acute injuries, in particular sprains and fractures, has declined over the past decade. The study does not, however, address trends in chronic wear-and-tear damage and injuries that require surgery, such as a torn ligament, and these types of injuries have probably increased, he said.

The study found a more than 13 percent decrease in the rate of injuries seen in emergency rooms between 2000 and 2005 but only a roughly 1 percent decrease between 2000 and 2010.

The rebound in the number of injuries in 2010 appears to be due largely to an increase in the injuries related to football, baseball/softball and soccer between 2005 and 2010.

Looking at the population using U.S. Census Bureau data, Parikh found that for every 1,000 children, 31.9 sustained an injury in 2000 whereas 27.6 and 31.6 did so in 2005 and 2010, respectively.

The biggest drop in injury rate was for bicycling, which saw a more than 29 percent decrease between 2000 and 2005 and a 38 percent decrease overall. During this decade, the sport went from the most dangerous to the second most dangerous.

There were also drops in roller-sport and trampoline injuries of nearly 21 percent and 17.5 percent, respectively, between 2000 and 2010, and to a lesser extent, fewer injuries related to basketball.

Football injury rates, however, shot up by nearly 23 percent between 2000 and 2010, and soccer injuries rose by almost 11 percent.

Muscle and skeletal injuries, such as fractures, sprains and bruises from football and soccer rose by about 24 percent and 9 percent, respectively. Rates of these injuries declined for the other sports, except for baseball and softball, which saw a 2.5 percent increase.

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Fewer Patients Awake During Operations

March 14, 2013 -- Being aware of what's going on during an operation under general anesthesia sounds scary. The good news is a new study suggests it happens less often than had been thought.

Previous research has found that about 1 in 500 patients is aware or awake under general anaesthesia. The new report, from the U.K.'s Royal College of Anaesthetists, finds it is far less common, about 1 case in 15,000.

Researchers also found that even where brain monitoring equipment is available, fewer than 2% of anesthesiologists routinely use it to check the effectiveness of the anesthetic.

The findings come from the biggest study of its kind. It surveyed 7,125 anesthesiologists and coordinators at 329 hospitals across the U.K.

There were 153 cases of "accidental awareness" reported in 2011:

30% happened during surgery.23% happened after surgery but before the full recovery time.47% happened after anesthesia has begun but before surgery had started.

Awareness during surgery was more likely to lead to pain or distress.

"Waking up during surgery is a fear," says researcher Jaideep Pandit, DPhil, a consultant anaesthetist at Oxford University Hospitals in the U.K. "It's a legitimate fear."

He hopes the study will calm some concerns: "Anything to use data to be reassuring is always a good thing."

He admits some under-reporting is possible in the study. Anesthesiologists may have forgotten how many awareness cases they'd seen. Since anesthesiologists don't routinely see patients after operations, they may not always learn about the awareness report. Sometimes patients may forget the incident or think it is too trivial to mention.

How do patients describe the experience of being aware during an operation? These vary greatly, from "the very, very severe adverse experiences of a combination of pain, paralysis, terror," Pandit says, to anecdotal reports of patients almost being fascinated by what's happening around them: "Completely unconcerned and untroubled and almost interested in the proceedings."

He and colleagues are planning more research to focus on patient experiences. "Even for someone who reports they are not particularly bothered by it, at the very least it must be surprising for them."

Brain monitoring systems have been in use the U.K. for about 10 years. The monitors help check that a patient really is under the anesthetic. Pandit says these are available in about two-thirds of hospitals, but even where they are supplied, most anesthesiologists don’t use them. "One would have hoped that if the profession is doing what it wants to do, which is keep people asleep, and there is a monitor that they believe in, that they would of course use it."

There's a debate over how useful the monitors are, and some research suggests they don't appear to help lessen the numbers of people being awake during surgery.

Pandit says it isn’t clear why some people wake up during a procedure while others don't, although it is possible the drugs used for anesthesia have a different effect on different people. "We know that's true of other drugs. Be it antidepressants or cardiovascular drugs or cancer drugs. They don’t all have the same effect in people," he says. "Some people get side effects and some people don't."

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