Hospitals, red tape may be limiting tubal ligations

NEW YORK (Reuters Health) – Women in California and Texas have varying access to “getting their tubes tied” immediately after giving birth, according to a new study, but the reasons are still unclear researchers say.

Analyzing the records of nearly 890,000 mothers across 499 hospitals in both states, they found that more women in Texas got the voluntary sterilization procedure after delivery in 2009 than did women in California.

But the differences were not clearly linked to obvious factors – such as cost or religiously affiliated hospitals that refuse to do the surgery. Further, sterilization rates ranged from zero to 15 percent in California hospitals and between zero and 30 percent in Texas hospitals.

“This huge variation we’re seeing both between the two states and within facilities raises a red flag,” said study author Dr. Daniel Grossman, senior associate at Ibis Reproductive Health. “Our paper raises more questions than it answers,” he told Reuters Health.

Differences in federal funding could explain some of the discrepancies. Federal funds through Title X and Medicaid programs reach more women in California than Texas, Grossman said.

In his team’s report, published in the journal Obstetrics & Gynecology, the researchers suggest that Texas women have fewer low-cost family planning options, which may act as an incentive to get their tubes tied for contraceptive purposes.

Conversely, the more generous family planning funding in California might mean that women have access to low-cost options beyond sterilization after delivery.

Nonetheless, surgical sterilization remains very popular in the U.S. and nearly a third of women with children use it for family planning purposes, according to some estimates.

A 2011 study from the Centers for Disease Control and Prevention, for example, found that tubal sterilization was performed following every one in 13 births in the U.S. between 2001 and 2008, while insertion of a contraceptive IUD was done after one in every 37,000 births. (See Reuters Health story of August 26, 2011.)

In the new study, Grossman and his colleagues found that in California, one in every 15 women had her tubes tied after delivery, compared with Texas where one in 10 women was sterilized after delivery.

They looked at several factors that might explain the variation in rates, but none stood out as a clear cause. Variation was similar among private versus publicly insured patients and among mothers who delivered by cesarean section – a procedure that might make it easier to have elective sterilization right after delivery.

The age of the mothers also did not explain the disparities. The data did not include the number of previous children the women had.

Differences in accessibility might arise from several other sources, the researchers suggested. Catholic hospitals ban sterilization, but non-Catholic hospitals could also have policies that limit tube tying.

“It doesn’t matter if it’s at an institutional level or a state level, it’s always the least mobile, the poorest (women) who don’t have the choice,” said Dr. Cori Baill, a physician at The Menopause Center in Orlando, who has counseled mothers in family planning issues.

Baill, who was not involved in the current study, said poor women who lack prenatal care will not have sterilization as an option since Medicaid requires expectant mothers to sign consent forms 30 days before delivery. “It’s ridiculous that Medicaid rule still exists,” Baill told Reuters Health.

Night and weekend staffing could also affect the variation in tube tying since doctors may not be around to perform the elective surgery, Baill added.

Though the current study did not examine how many mothers requested their tubes tied after delivery, Grossman and colleagues are examining the demand for sterilization in an ongoing pilot study in El Paso, Texas.

“Women across the country should be able to access the form of contraception that they want,” Grossman said. “We need more information to determine what accounts for this variability.”

SOURCE: http://bit.ly/Uqx8hQ Obstetrics & Gynecology, online December 20, 2012.

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House back Sunday night, will have 29.5 hours to strike deal on fiscal cliff

President Barack Obama salutes as he returns via Marine One from a Christmas visit with his family in Hawaii, to …Will parachutes be provided? Republican House leaders informed their rank-and-file on a conference call Thursday that they have to be back at work at 6:30 p.m. Sunday – giving them, oh, 29.5 hours to forestall the “fiscal cliff.”

Absent a last-minute compromise, Americans will see across-the-board income-tax hikes and painful federal spending cuts come into force January 1. Some economists fear that, taken together, the measures could plunge the economy into a new recession.

Technically, however, the Congress could vote the cliff into oblivion at any time – either before OR after the income-tax increases and spending cuts are slated to take effect. Republican House Majority Leader Eric Cantor noted on Twitter that lawmakers “may be in session through Wednesday, January 2.”

House Speaker John Boehner told his troops on the conference call that the Senate would have to act first, either by passing, or by amending, legislation the House has already passed to avert the cliff.

“If the Senate will not approve these bills and send them to the president to be signed into law in their current form, they must be amended and returned to the House,” he said, according to a source on the call.

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China tightening controls on Internet

BEIJING (AP) — China‘s new communist leaders are increasing already tight controls on Internet use and electronic publishing following a spate of embarrassing online reports about official abuses.

The measures suggest China’s new leader, Xi Jinping, and others who took power in November share their predecessors’ anxiety about the Internet’s potential to spread opposition to one-party rule and their insistence on controlling information despite promises of more economic reforms.

“They are still very paranoid about the potentially destabilizing effect of the Internet,” said Willy Lam, a politics specialist at the Chinese University of Hong Kong. “They are on the point of losing a monopoly on information, but they still are very eager to control the dissemination of views.”

This week, China’s legislature took up a measure to require Internet users to register their real names, a move that would curtail the Web’s status as a freewheeling forum to complain, often anonymously, about corruption and official abuses. The legislature scheduled a news conference Friday to discuss the measure, suggesting it was expected to be approved.

That comes amid reports Beijing might be disrupting use of software that allows Web surfers to see sites abroad that are blocked by its extensive Internet filters. At the same time, regulators have proposed rules that would bar foreign companies from distributing books, news, music and other material online in China.

Beijing promotes Internet use for business and education but bans material deemed subversive or obscene and blocks access to foreign websites run by human rights and Tibet activists and some news outlets. Controls were tightened after social media played a role in protests that brought down governments in Egypt and Tunisia.

In a reminder of the Web’s role as a political forum, a group of 70 prominent Chinese scholars and lawyers circulated an online petition this week appealing for free speech, independent courts and for the ruling party to encourage private enterprise.

Xi and others on the party’s ruling seven-member Standing Committee have tried to promote an image of themselves as men of the people who care about China’s poor majority. They have promised to press ahead with market-oriented reforms and to support entrepreneurs but have given no sign of support for political reform.

Communist leaders who see the Internet as a source of economic growth and better-paid jobs were slow to enforce the same level of control they impose on movies, books and other media, apparently for fear of hurting fledgling entertainment, shopping and other online businesses.

Until recently, Web surfers could post comments online or on microblog services without leaving their names.

That gave ordinary Chinese a unique opportunity to express themselves to a public audience in a society where newspapers, television and other media are state-controlled. The most popular microblog services say they have more than 300 million users and some users have millions of followers reading their comments.

The Internet also has given the public an unusual opportunity to publicize accusations of official misconduct.

A local party official in China’s southwest was fired in November after scenes from a videotape of him having sex with a young woman spread quickly on the Internet. Screenshots were uploaded by a former journalist in Beijing, Zhu Ruifeng, to his Hong Kong website, an online clearing house for corruption allegations.

Some industry analysts suggest allowing Web surfers in a controlled setting to vent helps communist leaders stay abreast of public sentiment in their fast-changing society. Still, microblog services and online bulletin boards are required to employ censors to enforce content restrictions. Researchers say they delete millions of postings a day.

The government says the latest Internet regulation before the National People’s Congress is aimed at protecting Web surfers’ personal information and cracking down on abuses such as junk e-mail. It would require users to report their real names to Internet service and telecom providers.

The main ruling party newspaper, People’s Daily, has called in recent weeks for tighter Internet controls, saying rumors spread online have harmed the public. In one case, it said stories about a chemical plant explosion resulted in the deaths of four people in a car accident as they fled the area.

Proposed rules released this month by the General Administration of Press and Publications would bar Chinese-foreign joint ventures from publishing books, music, movies and other material online in China. Publishers would be required to locate their servers in China and have a Chinese citizen as their local legal representative.

That is in line with rules that already bar most foreign access to China’s media market, but the decision to group the restrictions together and publicize them might indicate official attitudes are hardening.

That comes after the party was rattled by foreign news reports about official wealth and misconduct.

In June, Bloomberg News reported that Xi’s extended family has amassed assets totaling $ 376 million, though it said none was traced to Xi. The government has blocked access to Bloomberg’s website since then.

In October, The New York Times reported that Premier Wen Jiabao’s relatives had amassed $ 2.7 billion since he rose to national office in 2002. Access to the Times’ Chinese-language site has been blocked since then.

Previous efforts to tighten controls have struggled with technical challenges in a country with more than 500 million Internet users.

Microblog operators such as Sina Corp. and Tencent Ltd. were ordered in late 2011 to confirm users’ names but have yet to finish the daunting task.

Web surfers can circumvent government filters by using virtual private networks — software that encrypts Web traffic and is used by companies to transfer financial data and other sensitive information. But VPN users say disruptions that began in 2011 are increasing, suggesting Chinese regulators are trying to block encrypted traffic.

Curbs on access to foreign sites have prompted complaints by companies and Chinese scientists and other researchers.

In July, the American Chamber of Commerce in China said 74 percent of companies that responded to a survey said unstable Internet access “impedes their ability to do business.”

Chinese leaders “realize there are detrimental impacts on business, especially foreign business, but they have counted the cost and think it is still worthwhile,” said Lam. “There is no compromise about the political imperative of controlling the Internet.”

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iOS apps see Christmas sales spike shrink in 2012

Distimo just released its statistics on Christmas Day app downloads and revenue growth… and the download spike is far smaller than it was last year. Back in 2011, Christmas Day iOS app download volume spiked 230% above the December average. This year, the increase was just 87% — far below industry expectations. The revenue spike came in at 70%.

[More from BGR: Google names 12 best Android apps of 2012]

Interestingly, iPad downloads increased by 140% this Christmas, implying that the iPhone download bounce was really modest.

[More from BGR: New purported BlackBerry Z10 specs emerge: 1.5GHz processor, 2GB RAM, 8MP camera]

A few weeks ago, AppAnnie released statistics showing that iOS app revenue growth had stalled over the summer of 2012, whereas Android app revenue growth was relatively strong at 48% over a five month period. Both Distimo and Appannie are respected companies and their analytics are closely followed by app industry professionals. Could it be that the pace of iPhone app revenue growth has slowed down sharply from 2011 levels, even if Distimo and AppAnnie numbers aren’t entirely accurate?

This article was originally published by BGR

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“Rescue Me” singer Fontella Bass dies aged 72

(Reuters) – American soul singer Fontella Bass, who topped the R&B chart in 1965 with the song “Rescue Me,” died in St. Louis. She was 72.

Bass died in hospice care on Wednesday night from complications of a heart attack she suffered three weeks ago, her daughter, Neuka Mitchell, told Reuters. Bass had also suffered from strokes in recent years.

“She’s going to be missed,” Mitchell said. “Her big personality. Her love for family. Her big, giving heart and her cooking.”

She was known as the “queen of soul food” to her family, Mitchell said.

Bass was born into a singing family in St. Louis. Her mother, Martha Bass, was a singer in the Clara Ward Singers gospel group. Her brother, the late R&B singer David Peaston, scored a handful of hits in the 1980s and 1990s.

Bass first achieved success dueting with Bobby McClure in 1965 on songs such as “Don’t Mess Up A Good Thing” and “You’ll Miss Me (When I’m Gone),” both of which were hits on the pop and R&B charts.

Bass’ biggest hit came with “Rescue Me,” which shot up the Billboard pop charts in the fall of 1965, becoming one of the most popular soul hits of all time.

“It held a special place in her heart,” Mitchell said of the song. “She sang it every time she performed.”

The song has been covered and sampled numerous times over the years, including by pop stars Linda Ronstadt and Cher, and more recently in 2000 by UK group Nu Generation, who remixed the song into a dance track.

Nu Generation’s remix, “In Your Arms (Rescue Me)” hit the top 10 of the UK singles chart.

Bass had moderate success in later years with a gospel album in the 1990s, but was unable to emulate the popularity set by “Rescue Me.”

She was married to jazz trumpeter and composer Lester Bowie. The two spent time living in Europe in the late 1960s and early 1970s before moving back to the United States.

Funeral arrangements for Bass have not been finalized. The singer is survived by her four children.

(Reporting by Eric Kelsey and Piya Sinha-Roy; Editing by Doina Chiacu)

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Senator McConnell says still time to avert “fiscal cliff”

WASHINGTON (Reuters) – The top Republican in the U.S. Senate, Mitch McConnell, on Thursday said that there is still time to avert the “fiscal cliff” and a “wholly preventable economic crisis.”

In a speech on the Senate floor McConnell warned, however, that Senate Republicans “aren’t about to write a blank check for anything Senate Democrats put forward just because we find ourselves at the edge of the cliff.”

Lawmakers and President Barack Obama are up against a December 31 deadline for finding a way to stop $ 600 billion in potentially harmful tax hikes and spending cuts from taking effect with an alternative deficit-reduction formula.

(Reporting By Richard Cowan and David Lawder; Editing by Sandra Maler)

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George H.W. Bush in intensive care

HOUSTON (AP) — A spokesman says former President George H.W. Bush is in the intensive care unit at a Houston hospital.

Bush's spokesman, Jim McGrath, said late Wednesday that the former president was admitted to the ICU on Sunday at Methodist Hospital, "following a series of setbacks including a persistent fever."

McGrath says Bush is alert and conversing with medical staff, and that doctors are cautiously optimistic about his treatment.

No other details about his medical condition were provided, but McGrath says Bush is surrounded by family.

Earlier Wednesday, McGrath said a fever that kept Bush in the hospital over Christmas had gotten worse and that doctors had put him on a liquids-only diet.

A bronchitis-like cough initially brought Bush to the hospital in late November. McGrath says the cough has improved.

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Afghan bomber attacks near major US base

KABUL, Afghanistan (AP) — A vehicle driven by a suicide bomber exploded at the gate of a major U.S. military base in eastern Afghanistan on Wednesday, killing the attacker and three Afghans, Afghan police said. The Taliban claimed responsibility for the attack.

Police Gen. Abdul Qayum Baqizai said a local guard who questioned the vehicle driver at the gate of Camp Chapman was killed along with two civilians and the assailant. The camp is located adjacent to the airport of the capital of Khost province, which borders Pakistan. Chapman and nearby Camp Salerno had been frequently targeted by militants in the past, but violent incidents have decreased considerably in recent months.

Taliban spokesman Zabihullah Mujahid said in an email that the bomber targeted Afghan police manning the gate and Afghans working for the Americans entering the base. He claimed high casualties were inflicted.

NATO operates with more than 100,000 troops in the country, including some 66,000 American forces. It is handing most combat operations over to the Afghans in preparation for a pullout from Afghanistan in 2014. Militant groups, including the Taliban, rarely face NATO troops head-on and rely mainly on roadside bombs and suicide attacks.

NATO forces and foreign civilians have also been increasingly attacked by rogue Afghan military and police, eroding trust between the allies.

On Tuesday, the Interior Ministry said a policewoman who killed an American contractor in Kabul a day earlier was a native Iranian who came to Afghanistan and displayed “unstable behavior” but had no known links to militants.

The policewoman, identified as Sgt. Nargas, shot 49-year-old Joseph Griffin, of Mansfield, Georgia, on Monday, in the first such shooting by a woman in the spate of insider attacks. Nargas walked into a heavily-guarded compound in the heart of Kabul, confronted Griffin and shot him once with her pistol.

The U.S-based security firm DynCorp International said on its website that Griffin was a U.S. military veteran who earlier worked with law enforcement agencies in the United States. In Kabul, he was under contract to the NATO military command to advise the Afghan police force.

The ministry spokesman, Sediq Sediqi, told a news conference that Nargas, who uses one name like many in the country, was born in Tehran, where she married an Afghan. She moved to the country 10 years ago, after her husband obtained fake documents enabling her to live and work there.

A mother of four in her early 30s, she joined the police five years ago, held various positions and had a clean record, he said. Sediqi produced an Iranian passport that he said was found at her home.

No militant group has claimed responsibility for the killing.

The chief investigator of the case, Police Gen. Mohammad Zahir, said that during interrogation, the policewoman said she had plans to kill either the Kabul governor, city police chief or Zahir himself, but when she realized that penetrating the last security cordons to reach them would be too difficult, she saw “a foreigner” and turned her weapon on him.

There have been 60 insider attacks this year against foreign military and civilian personnel, compared to 21 in 2011. This surge presents another looming security issue as NATO prepares to pull out almost all of its forces by 2014, putting the war against the Taliban and other militant groups largely in the hands of the Afghans.

More than 50 Afghan members of the government’s security forces also have died this year in attacks by their own colleagues. The Taliban claims such incidents reflect a growing popular opposition to the foreign military presence and the Kabul government.

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Samsung expects to ship more than half a billion phones in 2013

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Web-based info may not increase cancer screening

NEW YORK (Reuters Health) – Offering women information on colon cancer screening via the web does not get them to take up screening any more effectively than printed materials, according to a new study.

“It’s disappointing that the web didn’t have more effect,” said Dr. David Weinberg of Fox Chase Cancer Center in Philadelphia, the report’s lead author.

Although the U.S. Preventive Services Task Force recommends that adults between ages 50 and 75 get screened regularly for colorectal cancer, about 40 percent of people don’t follow those guidelines.

To raise awareness of the recommendations and encourage people to go get screened, researchers have developed a variety of approaches, Weinberg said, including videos and printed materials. But none of these “have been tremendously successful,” he added.

Dr. Hamant Roy, director of gastroenterology research at NorthShore University HealthSystem in Evanston, Illinois, said one method that has been shown to be effective is simply having doctors spend time with their patients to talk about the cancer tests.

“But one of the issues is they have to see more and more people with less and less time, so it gets really hard to have these discussions with patients,” said Roy, who was not involved in the new study.

To see whether the web might provide an easily accessible and inexpensive alternative for getting people to comply with screening recommendations, Weinberg and his colleagues asked 865 women who were coming in for routine gynecology appointments to participate in the study.

Of those, 171 saw their doctor as normal, 349 also received printed materials about colon cancer screening at the time of their visit and 345 were offered access to a web site that contained the same information as the printed matter.

Included in the materials was information about the benefits of screening and harms of going unscreened, as well as background on the various types of colon cancer screen available: a stool test once a year, a sigmoidoscopy every five years or a colonoscopy every 10 years.

All the women were eligible to get screened for colon cancer based on their age and health status.

Four months after the doctor visit, however, roughly 12 percent of the women – regardless of whether they received the extra information or not – had gotten a colon cancer screen.

Roy called the numbers “dismal.”

“At the end of the day, something is better than nothing,” he said, but compared to screening rates for breast cancer, the uptake for colorectal cancer screening was quite low.

Among the women in the study, published in the Archives of Internal Medicine, 73 percent had received a mammogram in the past year.

On the other hand, Weinberg said, “you might argue their participation in the study did manage to raise their interest level enough” to get screened.

Not enough, however, to get most of the women to even access the website Weinberg’s group had developed.

Only 24 percent had logged on, according to the researchers’ records, and just 16 percent of the women remembered going to the website.

Weinberg still thinks there might be ways that the web could be helpful.

“I think that the web has great promise…the question is, how do you get people to look at it in the first place?” he said.

Perhaps following up with people to ask them about their experience on the website might improve their participation, he suggested.

Roy agreed that it would be premature to toss out the web as a potential tool for increasing screening rates.

“It seems like the energy to get people over the hump to get colorectal screening is higher than simply passively going to a website. I think the website is maybe helpful, but there needs to be more help to get them over the edge,” he said.

SOURCE: http://bit.ly/VizaRR Archives of Internal Medicine, online December 17, 2012.

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