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Effectiveness Of Pelvic Floor Exercises, Digital Vaginal Palpation And Interpersonal Support On Stress Urinary Incontinence
UroToday.com - Pelvic floor muscle exercise (PFME) is most appropriate for patients with mild-to-moderate stress urinary incontinence (SUI). To obtain therapeutic efficacy, it is crucial that PFME be performed correctly and consistently. Without appropriate training; however, up to 30% of patients are not aware of how to perform PFME.
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Advocates At Kenya Conference Explore New Strategies To Combat HIV/AIDS In Africa
Nearly 30 years after the emergence of HIV/AIDS, the global health community must develop new strategies to curb the spread of the disease in sub-Saharan Africa, some experts said Tuesday ahead of the Global Citizens Summit for Social Mobilization to End AIDS in Nairobi, Kenya, AFP/Google.com reports. The advocates also stressed the need for innovative approaches to health financing as international donors shift their attention toward other issues and as the ongoing economic downturn threatens fundraising prospects. The conference, which opens Wednesday, includes participants from 32 countries, primarily in Africa.According to Wasai Jacob Nanjakululu of Oxfam, about 90% of HIV-positive people are unaware of their status and 70% of people in need of treatment are not accessing medical care. Leonard Okello, an HIV/AIDS specialist with ActionAid International, added that the global health community is "far from winning the struggle against" HIV/AIDS. Okello said the conference will examine the shortcomings of earlier HIV/AIDS policies and explore new methods to address the disease. "There are a lot of res in HIV/AIDS programs but not much of that reaches the community," Okello said, asking, "What is it that we should radically change?" (AFP/Google.com, 5/26). According to IRIN/PlusNews, conference participants also plan to discuss "people-centered" approaches to combating HIV/AIDS at the Nairobi meeting. ActionAid Report Calls For Improvements in Basic Health Care To Address HIV/AIDS
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Opinion Pieces Discuss Whether Current Efforts To Fix Health Costs Will Produce Sufficient Savings
David Brooks, New York Times: Health care costs have become "the crucial issue of [President Obama"s] whole presidency," Times columnist Brooks writes. According to Brooks, Obama"s original plan was to fund his priorities, including education and energy, with debt that would be paid off with future savings resulting from health care reform. Brooks writes that Obama"s aides have been discussing "game-changers" -- such as health information technology, wellness programs, preventive medicine, comparative effective measures and altering reimbursement policies -- that would result in cost reductions. However, Brooks writes that most experts do not think such efforts would "produce much in the way of cost savings over the next 10 years" and that "nobody is sure" the efforts would "ever produce significant savings." Brooks writes that because "there are deep structural forces, both in Medicare and the private insurance market" that make it "nearly impossible to put together a majority coalition for a bill" challenging those structures, reform efforts this year likely will produce a "medium-size bill that expands coverage to some groups but does relatively little to control costs." Brooks concludes, "Without serious health cost cuts," Obama"s agenda "will hasten fiscal suicide" (Brooks, New York Times, 5/15).
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Prostate Cancer Screening Has Yet To Prove Its Worth

The recent release of two large randomized trials suggests that if there is a benefit of screening, it is, at best, small, says a new report in CA: A Cancer Journal for Clinicians. Authored by Otis W. Brawley, M.D. of the American Cancer Society and Donna Ankerst, Ph.D. and Ian M. Thompson, M.D. of the University of Texas Health Science Center at San Antonio, the review says because prostate cancer is virtually ubiquitous in men as they age, it is clear that a goal of "finding more cancers" is not acceptable. Instead, public health principles demand that screening must reduce the risk of death from prostate cancer, reduce the suffering from prostate cancer, or reduce health care costs when compared with a non-screening scenario. The authors suggest prostate cancer screening has yet to reach one of these standards to date. No major medical group, including the American Cancer Society, currently recommends routine prostate cancer screening for men at average risk. In the United States, prostate cancer will affect one man in six men during his lifetime. Since the mid-1980s, screening with the prostate-specific antigen (PSA) blood test has more than doubled the risk of a prostate cancer diagnosis. The review says a decrease in prostate cancer death rates has been observed since that time, but the relative contribution of PSA testing as opposed to other factors, such as improved treatment, has been uncertain. The report says a computer modeling study using National Cancer Institute"s Surveillance, Epidemiology, and End Results (SEER) registries estimated that more than one in four cancers detected in whites (29 percent) and nearly half of cancers detected in blacks (44 percent) were overdiagnosed cancers. A similar model using data from Europe estimated a 50 percent overdiagnosis rate. The authors say patients who are diagnosed with clinically insignificant tumors are subject to unnecessary diagnostic tests and unneeded treatment and suffer psychosocial harms. They are also labeled "a cancer patient," which can have negative economic consequences. Also, say the authors, overdiagnosis significantly affects 5-year survival statistics, making them uninformative in demonstrating progress in cancer control. The report says the future of prostate cancer will include better screening tests, better methods to assess a man"s risk of prostate cancer, and prevention strategies, including the use of finasteride, a drug currently used for the treatment of urinary symptoms related to prostate enlargement. In a separate but related editorial, Peter Boyle, Ph.D., D.Sc., of the International Prevention Research Institute, Lyon, France and report co-author Dr. Brawley say "the real impact and tragedy of prostate cancer screening is the doubling of the lifetime risk of a diagnosis of prostate cancer with little if any decrease in the risk of dying from this disease." They say in 1985, before PSA screening was available, an American man had an 8.7 percent lifetime risk of being diagnosed with prostate cancer and a 2.5 percent lifetime risk of dying from the disease. Twenty years later, in 2005, an American man had a 17 percent lifetime risk of being diagnosed with prostate cancer and a 3 percent risk of dying from the disease. They add that even in the best case scenario, applying the findings of a European trial that found PSA led to a 20 percent reduction in the risk of death, the average man who chooses screening decreases his risk of prostate cancer death from a lifetime risk of 3 percent to a lifetime risk of 2.4 percent. In exchange, he doubles the chances of becoming a prostate cancer patient, his risk of diagnosis rising from about nine percent to at least 17 percent. They conclude that "men should discuss the now quantifiable risks and benefits of having a PSA test with their physician and then share in making an informed decision," and that "the weight of the decision should not be thrown into the patient"s lap." Article: "Screening for Prostate Cancer," Otis W. Brawley, MD; Donna Ankerst, PhD; and Ian M. Thompson, MD, CA Cancer J Clin, July/Aug 2009 doi:10.3322/caac.20026. Editorial: "Prostate Cancer: Current Evidence Weighs Against Population Screening," Peter Boyle, PhD, DSc; Otis W. Brawley, MD, CA Cancer J Clin, July/Aug 2009 doi:10.3322/caac.20025. David Sampson American Cancer Society


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