Nation roundup for July 26
AIDS Experts: Focus on pregnant women not enough
ADVERTISING
WASHINGTON (AP) — Tackling the female side of the AIDS epidemic means going far beyond today’s global focus on pregnant women, specialists told the world’s largest AIDS meeting Wednesday.
Already women make up half the world’s HIV infections. Adolescent girls are at particular risk in the hardest-hit parts of the world, and protecting them requires addressing the poverty, violence and discrimination that too many women experience around the world, said UNICEF Deputy Executive Director Geeta Rao Gupta.
“These adolescent girls and young women, our sisters and daughters, represent an unfinished agenda in the AIDS response,” she told the gathering.
She echoed what has become a recurring theme of the meeting since U.S. Secretary of State Hillary Clinton declared Monday that gender equity is crucial to protecting women.
“Women need and deserve a voice in the decisions that affect their lives,” Clinton said.
“The pandemic has a woman’s shape,” said Annah Sango, 24, of Zimbabwe, who learned she had HIV when she was pregnant and watched her husband die of AIDS a few months later. “We have to reshape our response if we’re going to turn the tide.”
Topping the world’s anti-AIDS goals for women is the effort to nearly eliminate mother-to-child transmission of HIV. The number of babies born with HIV has been dropping steadily for several years as more infected women receive AIDS drugs during pregnancy and while they’re nursing — 57 percent of them last year, according to the United Nations.
But UNICEF HIV adviser Dr. Chewe Luo said that drop isn’t happening fast enough to meet the 2015 target date, and a key reason is that many countries focus just on protecting the baby and not on treating the mother for her own good.
Few countries automatically continue providing the life-saving drugs for mom after her baby is weaned, unless her own condition worsens or she gets pregnant again, Luo said.
“Orphaning will continue to increase if we don’t actually provide treatment for women,” she said.
New guidelines from the World Health Organization encourage countries to start lifelong treatment for all pregnant women, regardless of how healthy they may appear between pregnancies. Luo praised Malawi as the first low-income country to adopt that strategy, and she said Botswana, Rwanda, South Africa and Zambia are considering the same change.
Some 4.8 million people ages 15 to 24 are living with HIV, and two-thirds of them are girls or young women, Rao Gupta added.
Sexual violence and conditions of poverty that frequently lead to girls marrying in their teens for economic security, often to much older men, are chief risks in developing countries, she said.
Woman after woman at the conference spoke of those struggles.
Hellen Amuge of Uganda showed scars on her arm and chest, left when rebels in one of that country’s wars attacked and raped her. When eventually she was diagnosed with HIV, Amuge said her husband abandoned her and their seven children.
“I’m taking my drugs, that’s why you see me healthy like this,” she said. But while pills are free through internationally financed AIDS programs, she said people in her rural area must travel 50 miles to the nearest clinic for their monthly supply. “Getting money for transport is a problem.”
In South Sudan, Evelyn Letio Unzi Boki said, “Men don’t accept to go for testing,” and their often-younger, uneducated wives who are dependent on them for economic survival have no recourse.
“Women don’t have voices,” she said.
Even in the U.S., violence and poverty can play an important role. Here, one in four people living with HIV is female, the vast majority are African-American or Hispanic — and they’re more likely to die of the virus. Increasingly, new infections are concentrated in poor, often inner city, communities where access to health care is limited.
The Affordable Care Act holds the promise of improved treatment for many uninsured Americans with HIV, but a number of states say they may not expand Medicaid services, one key part of that law. A report from the 30 for 30 Campaign, a women’s coalition, found those are states with high numbers of HIV-infected women.
Study questions CT scans to rule out heart attacks
Associated Press
If you’re having chest pains, an advanced type of CT scan can quickly rule out a heart attack. New research suggests this might be good for hospitals, but not necessarily for you.
These heart scans cut time spent in the hospital but didn’t save money, the study found. They also prompted more tests and questionable treatments and gave relatively large doses of radiation to people at such low risk of a heart attack that they probably didn’t need a major test at all.
There is no evidence that adding these tests saved lives or found more heart attacks, wrote Dr. Rita Redberg, a cardiologist at the University of California, San Francisco in an editorial. Her commentary accompanied the study in Thursday’s New England Journal of Medicine. And since radiation from the scans can raise the long-term risk of developing cancer, doctors “may legitimately ask whether the tests did more harm than good,” she wrote.
Let’s be clear: None of this changes the advice to seek help quickly if you’re having chest pain or other signs of a heart attack. Any delay raises the risk of permanent heart damage.
But more than 90 percent of the 6 million people who go to hospitals each year in the U.S. with chest pain have indigestion, stress, muscle strain or some other problem — not heart disease. Doctors are afraid of missing the ones who do have it, and increasingly are using CT scans — a type of X-ray — with an injected dye to get detailed views of arteries.
More than 50,000 of these scans were done in Medicare patients in 2010, and their use is growing. Far more than that were done in younger patients like the ones in this study, who were 54 years old, on average.
The test requires a substantial dose of radiation, which can raise the risk of cancer years down the road. In some cases, patients might just be told that a doctor wants the test. They may be too frightened to question it or unaware they can refuse or ask about other testing options without jeopardizing their care.
The aim of the study was to see whether these heart scans, called coronary CT angiography, were faster, better or less expensive than usual care, such as simpler tests or being kept a while for observation.
Researchers led by Dr. Udo Hoffmann at Massachusetts General Hospital enrolled 1,000 patients who went to one of nine hospitals around the country during regular daytime, weekday hours with chest pain or other possible heart attack symptoms. All showed no clear sign of a heart attack on initial tests — an electrocardiogram and blood work.
They were randomly assigned to further evaluation either with a CT angiography scan or whatever is standard at that hospital, such as a treadmill or other heart tests.
Those given the CT scans spent an average of 23 hours in the hospital versus 30 hours for the others. More patients given the scans were sent home directly from the emergency room rather than being admitted — 47 percent versus 12 percent.
“Identifying the underlying cause of chest pain more quickly with CT scans could allow medical care providers to better allocate limited resources to the patients who are most in need of treatment” while letting others go home faster, said a statement by Dr. Susan Shurin, acting director of the National Heart, Lung, and Blood Institute, which sponsored the study.
However, the average cost of care was $4,289 for patients given the CT scans versus $4,060 for the others, despite spending seven hours less in the hospital. That’s because CT scans led to more follow-up tests and treatments, even though the burden of disease was about the same; 8 percent of both groups turned out to have heart disease and only 5 of the 1,000 had had a heart attack.
In the CT group, 29 patients wound up getting a heart bypass or artery-opening angioplasty and stent procedures versus 18 patients in the usual care group.
That suggests overtreatment, said Dr. W. Douglas Weaver, a former American College of Cardiology president from Henry Ford Hospital in Detroit.
“If you look more, you’ll find more, and the more you’ll do” to treat whatever is found, said Weaver, who had no role in the study. He also said time in the hospital seemed unusually long for both groups — most hospitals have protocols to evaluate such cases within 12 hours.
Furthermore, patients fared the same in the month after their ER visit regardless of how the hospital evaluated them for chest pain. No heart attacks were missed, and no one died.
Those given CT scans had nearly triple the amount of radiation — about 14 millisieverts (a measure of dose) versus less than 5 millisieverts for the others, some of whom received tests requiring less radiation.
“Exposures of 10 millisieverts have been projected to lead to 1 death from cancer per 2,000 persons,” Redberg wrote in her editorial.
“Equally alarming, the testing may lead to an increased risk of breast cancer among these patients, many of whom are middle-aged women.”
Radiation risks are a growing concern — Medicare’s HospitalCompare website recently started adding information on inappropriate radiation exposure rates at the hospitals it tracks.
Many study authors have consulted for imaging device makers and radiology groups.
A much larger study comparing CT scans and other tests for evaluating heart risks in 10,000 patients is under way now, but it won’t provide answers for several years.
In the meantime, a patient’s gender, age, and history of chest pain or other illnesses such as diabetes go a long way toward predicting risk as long as the initial EKG and blood work suggest no problem, Redberg contends.
“With no evidence of benefit and definite risks, routine testing in the emergency department of patients with a low-to-intermediate risk…should be avoided,” she wrote. “The question is not which test leads to faster discharge of patients from the emergency department, but whether a test is needed at all.”
Skydiver Fearless Felix jumps from 18 miles up
Associated Press
Skydiver “Fearless Felix” Baumgartner has done it again.
On Wednesday, Baumgartner took another stratospheric leap, this time from an altitude of more than 18 miles — an estimated 96,640 feet, nearly three times higher than cruising jetliners. He landed safely near Roswell, N.M. His top speed was an estimated 536 mph, said Brian Utley, an official observer on site.
It’s the second test jump for Baumgartner from such extreme heights and a personal best. He’s aiming for a record-breaking jump from 125,000 feet, or 23 miles, in another month. He hopes to go supersonic then, breaking the speed of sound with just his body.
“It has always been a dream of mine,” Baumgartner said in a statement following Wednesday’s feat. “Only one more step to go.”
Longtime record-holder Joe Kittinger jumped from 102,800 feet — 19.5 miles — in 1960 for the Air Force. Kittinger monitored Wednesday’s dry run from a mini Mission Control in Roswell.
As he did in March, the 43-year-old Austrian ascended alone in an enclosed capsule lifted by a giant helium balloon that took off from Roswell. He wore a full-pressure suit equipped with parachutes and an oxygen supply — there’s virtually no atmosphere that far up.
It took about 1½ hours to reach his target altitude. He was in free fall for an estimated three minutes and 48 seconds before opening his parachutes.
“It felt completely different at 90,000 feet,” Baumgartner noted. “There is no control when you exit the capsule. There is no way to get stable.”
In March, Baumgartner jumped from 71,581 feet, more than 13 miles, saluting before stepping from the capsule. Bad weather earlier this week delayed the second test jump until Wednesday.
NASA is paying close attention to this Red Bull-funded project dubbed Stratos, short for stratosphere. The space agency wants to learn all it can about potential escape systems for future rocketships.
Baumgartner won’t come close to space, even on the ultimate jump that’s planned for late August or early September. Space officially begins at 100 kilometers, or 62 miles — more than 328,000 feet.
Baumgartner, a former military parachutist and extreme athlete, has jumped more than 2,500 times from planes and helicopters, as well as from skyscrapers and landmarks, including the 101-story Taipei 101 in Taiwan.
Kittinger, who turns 84 on Friday, was an Air Force captain when he made his historic jump for what was called Project Excelsior. He reached 614 mph on that dive, equivalent to Mach 0.9, just shy of the sound barrier.
Baumgartner expects to accelerate to 690 mph on his final plunge.
Judge appoints temp guardian for Jackson children
LOS ANGELES (AP) — A judge on Wednesday intervened in the turmoil roiling the Jackson family, appointing the son of Tito Jackson to serve as temporary guardian of Michael Jackson’s children in the absence of the family matriarch and in the midst a feud over the pop superstar’s estate.
Superior Court Judge Mitchell Beckloff temporarily suspended Katherine Jackson as the children’s guardian because she was in Arizona and hadn’t spoken with them in several days. He appointed Tito Joe “TJ” Jackson to serve as temporary guardian with the ability to control the hilltop home where the children live and to take on other supervision duties.
Beckloff said there was no evidence that Katherine Jackson had done anything wrong but instead it appeared she was being prevented from fulfilling her role as guardian through the “intentional acts of third parties.” He didn’t elaborate but made the decision after reading court filings in which TJ Jackson expressed concern that Katherine Jackson was being prevented from returning
He cited a Monday incident in which Janet, Randy and Jermaine Jackson arrived at the children’s home and told them they could speak with their grandmother but had to leave with them.
“This was odd and disturbing to me and (the children) and heightened our concern that our grandmother was being prohibited from returning home,” TJ Jackson wrote in a sworn statement.
Beckloff listened as attorneys described Katherine Jackson’s demeanor as unusual on phone calls placed to the children hours before the hearing.
TJ Jackson’s attorney Charles Shultz also revealed in court filings that the children were forced to miss school Wednesday because of concerns about their security. Shultz wrote in a filing that around 3:30 a.m. a new security team arrived at the Jackson home in suburban Calabasas claiming they had been authorized by Katherine Jackson to take charge.
He wrote that the guards asked about the children’s school. “That last inquiry caused the head of security to be concerned and he advised that (the children) stay home from school on Wednesday.”
Beckloff ruled the Jackson children could not leave California without court approval.
Katherine Jackson’s attorney Perry Sanders Jr. said after the hearing that he spoke with his client as she was driving back to Los Angeles from Tucson, Ariz., where she had been since July 15.
“She sounded absolutely fine, lucid and her normal self,” he said.
Sanders plans to ask the court to reinstate Katherine Jackson as guardian of the children when she is back in Los Angeles. He was looking forward to meeting with her in person on Thursday.
The developments came after days of turmoil among the Jackson family that included a relative reporting Katherine Jackson missing before she was located safely with other family members in Arizona and an altercation between relatives on Monday.
Jermaine Jackson has said his mother was following doctor’s orders to cut off communications with the children, who range in age from 10 to 15. He didn’t provide further details.
Sanders said he was told she had high blood pressure before she left for Arizona.
His co-counsel, Sandra Ribera, expressed concerns during the hearing that Katherine Jackson may have been held against her will. Ribera said one of the singer’s children told her a conversation with the 82-year-old woman on Tuesday seemed to be monitored and influenced by others in the room.
Arizona authorities contacted Katherine Jackson on Sunday evening and it was determined she was safe, though her lack of communication with her grandchildren was described by TJ Jackson and others as unusual and unprecedented.
In addition to concerns about the safety of Jackson’s children, some of Michael Jackson’s siblings have recently called on the executors of his estate to resign.
Randy Jackson appeared Tuesday on Al Sharpton’s MSNBC show PoliticsNation and said he believes his brother’s will is a fake and that the executors have engaged in criminal activity.
The estate, which recently reported it saw $475 million in gross earnings since Jackson’s death in June 2009, has denied wrongdoing and called the accusations “false and defamatory.”
Randy Jackson also claimed in Twitter posts on Wednesday that his mother told TJ Jackson not to pursue the temporary guardianship.
“His performance in court today breaks my heart,” Randy Jackson wrote.
The Jackson children have remained at the home they share with their grandmother in suburban Calabasas amid questions about Katherine Jackson’s whereabouts and why she hadn’t spoken with them since July 15.
Sheriff’s deputies were called to the house on Monday after two factions of the family were involved in Monday’s driveway confrontation. The incident remains under investigation.
Beckloff, who also oversees financial issues affecting Jackson’s estate, was initially reluctant to appoint a temporary guardian but changed his mind after hearing from several attorneys who expressed concern about the family’s problems.
TJ Jackson filed his petition under seal but appeared in court and was appointed temporary guardian after describing a “strange” conversation he had with Katherine Jackson on Tuesday evening.
“I’ve never heard my grandmother talk like that,” he said reluctantly. “In every way. The sound in her voice. The pauses.”
He said some of her speech sounded slurred and she used words that made him wonder if she was speaking in code.
The children’s guardian ad litem, Margaret Lodise, said she spoke with the children and the two oldest, Prince and Paris, supported the appointment of a temporary guardian. Lodise did not ask the youngest son, 10-year-old Blanket, for his views.
Lodise is responsible for overseeing the children’s interests in the estate of their father.
Schultz said TJ Jackson didn’t want to replace Katherine Jackson as permanent guardian. Still, the judge noted that TJ Jackson would have to petition to become the permanent guardian within 48 hours and added that such a petition might not be heard if Katherine Jackson re-emerges.
Sanders said he would fight any move to have her permanently replaced.
He said he met with Randy and Janet Jackson in Tucson, Ariz., on Tuesday, but he was not allowed to see his client. He said he still hoped the recent events were a misunderstanding, but he described them as “chaos.”
___
