Doctors Really Do Raise Your Blood Pressure

WEDNESDAY, March 26, 2014 (HealthDay News) -- Patients' blood pressure readings are notably higher when they're taken by a doctor than by a nurse, a new study finds.

This link between doctors and higher blood pressure readings is known as the "white coat effect," and is believed to be the result of patients being more nervous when examined by a physician.

This effect has been noted in a number of previous studies, but this new paper is the first to confirm it, according to the study authors.

The investigators analyzed data from more than 1,000 people who had blood pressure readings taken by both doctors and nurses during the same visit. The readings taken by doctors were significantly higher than those taken by nurses, the study authors found.

The findings, published in the current issue of the British Journal of General Practice, should lead to changes in the way blood pressure readings are taken, according to lead author Dr. Christopher Clark, of the University of Exeter Medical School, in England.

"Doctors should continue to measure blood pressure as part of the assessment of an ill patient or a routine check-up, but not where clinical decisions on blood pressure treatment depend on the outcome," Clark said in a university news release.

"The difference we noted is enough to tip some patients over the threshold for treatment for high blood pressure, and unnecessary medication can lead to unwanted side-effects," he said.

"Some patients may be erroneously asked to continue to monitor their own blood pressure at home, which can build anxiety. These inappropriate measures could all be avoided by the simple measure of someone other than a doctor taking the blood pressure recording," Clark added.

He suggested that researchers "should also think carefully about how to account for this effect in studies that compare treatment by doctors and nurses. Some studies have concluded that nurses are better at treating [high blood pressure], when in fact those findings could be down to this recording bias."

More information

The U.S. National Heart, Lung, and Blood Institute explains how to prevent high blood pressure.

Copyright c 2014?HealthDay. All rights reserved.

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UnitedHealth drops thousands of doctors from insurance plans: WSJ

(Reuters) - UnitedHealth Group dropped thousands of doctors from its networks in recent weeks, leaving many elderly patients unsure whether they need to switch plans to continue seeing their doctors, the Wall Street Journal reported on Friday.

The insurer said in October that underfunding of Medicare Advantage plans for the elderly could not be fully offset by the company's other healthcare business. The company also reported spending more healthcare premiums on medical claims in the third quarter, due mainly to government cuts to payments for Medicare Advantage services.

The Journal report said that doctors in at least 10 states were notified of being laid off the plans, some citing "significant changes and pressures in the healthcare environment." According to the notices, the terminations can be appealed within 30 days.

Tyler Mason, a UnitedHealth spokesperson, was not immediately available for comment when reached by Reuters.

The insurer told the WSJ that its provider networks were always changing and that it expected its Medicare Advantage network to be 85 percent to 90 percent of its current size by the end of 2014.

UnitedHealth is participating in about a dozen new state insurance markets that launched on October 1 to offer subsidized health coverage under President Barack Obama's healthcare overhaul.

The insurer said previously it planned to withdraw from some markets in 2014 because of the government funding cuts.

Another top health insurer, Aetna Inc , also warned in October that it expected slowing growth in 2014 in its Medicare Advantage plans.

(Reporting by Zeba Siddiqui in Bangalore; Editing by Peter Cooney)

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Look Beyond the Sun for Skin Cancer Culprits, Doctors Warn

FRIDAY, June 21 (HealthDay News) -- Think "skin cancer" and blame immediately goes to the sun. Justifiably so -- though not totally, skin doctors say.

"Hands down, sun exposure is the biggest risk factor for skin cancer," said Dr. Sherrif Ibrahim, an assistant professor of dermatology at the University of Rochester Medical Center in New York. "And it's a cumulative risk. The more exposure you've gotten, the bigger the risk. The skin doesn't know if you're out one time for an hour or 12 times for 5 minutes at a time. Your skin keeps a running meter."

That's important to know as summer officially begins, according to skin health experts at the American Academy of Dermatology.

Each year, more than 3.5 million basal and squamous cell skin cancers, known as non-melanoma cancers, are diagnosed in the United States, according to the American Cancer Society. These types of skin cancer aren't as deadly as melanoma, which affects about 75,000 U.S. residents annually. About 9,000 people die from melanomas and 2,000 from non-melanoma skin cancers each year, according to the society.

However, the sun isn't the only thing that can be problematic. Tattoos, certain chemicals, other diseases and possibly even those better-for-the-environment light bulbs all have been linked to skin cancer.

And people who think tanning beds are safer than soaking up the sun should think again, Ibrahim suggested.

"There's an unquestionable link between tanning booths and skin cancer," Ibrahim said. "There's been an enormous surge in the popularity of tanning booths, and with it the average age of people with melanomas is much lower. I had a 22-year-old patient just the other day."

This is because it doesn't matter if the ultraviolet light comes from the sun or from an artificial source. Dr. Alan Fleischer, a dermatology professor at Wake Forest Baptist Medical Center in Winston-Salem, N.C., explained that "the kind of light produced by tanning beds isn't better or worse than natural sunshine, but people may get more and longer exposure, especially in areas where outside, they might display more modesty."

Even getting a manicure can expose you to ultraviolet light.

"Ultraviolet nail treatment units do produce UV light, but the risk is quite small," said Fleischer. The lights are used to help gel or regular polishes set or harden.

Despite the low risk, the American Academy of Dermatology still recommends putting sunscreen on your hands before you get a manicure.

Even things that seem unrelated to UV light -- such as getting an organ transplant or a tattoo, or having an autoimmune disease -- have been linked to skin cancer diagnoses.

People who've had an organ transplant have an extremely elevated risk for skin cancer -- up to 200 times higher than others, according to Ibrahim.

This stems from the medications that must be taken after a transplant to suppress the immune system. As a result, the immune system, which normally fights off growing cancer cells, may not be strong enough to do its job.

Organ transplant recipients should talk to a dermatologist to get an idea of their baseline risk for skin cancer and find out how often they need to be screened. Ibrahim said that some high-risk people who've had organ transplants need screening every three to four weeks.

Although tattoos aren't known to increase the risk for skin cancer, tattoos can make it harder to detect cancer-related changes in moles. If you're considering a tattoo, make sure there aren't any moles in the area you're thinking about inking, according to experts from the American Academy of Dermatology.

Like people who've had an organ transplant, those with autoimmune diseases often take medications that suppress their immune system. These drugs can also increase their chances of developing skin cancer, Fleischer said.

The experts also pointed out other potential sources of skin cancer risk, including:

Compact fluorescent bulbs: These "eco-friendly" lightbulbs emit ultraviolet light, which normally isn't a problem because of a coating on the bulbs. However, if there's a crack in the coating, UV light can come through. A study in the journal Photochemistry and Photobiology showed that these bulbs can emit some UV light, but no one has yet shown a link to skin cancer. Previous radiation: Areas of skin that have been exposed to radiation, such as that used for treatment of other types of cancer, have an increased risk for skin cancer, according to the American Cancer Society.Parkinson's disease: A study in the Archives of Neurology found an increased risk for melanoma in people with Parkinson's disease. The authors, whose research was published in September 2012, suspect that some of the genes that cause Parkinson's disease may also give rise to skin cancers. Smoking: Researchers also suspect a link between cigarette smoking and skin cancer. Two studies -- one published in June 2012 in the Archives of Dermatology and the other in December 2011 in the journal Cancer Causes and Control -- found that squamous cell cancer was more common in smokers than in nonsmokers.Chemical exposure: Workplace exposure to certain chemicals can increase the risk of non-melanoma skin cancers, according to the American Cancer Society. These chemicals include arsenic, which is found naturally in well water and is used in the manufacture of some pesticides, as well as tar, coal, paraffin, and some types of oil.Driving: Fleischer said that in the United States, skin cancers are much more common on the left side of the body because of the time spent driving. In Europe, more cancers occur on the right side. And, though he said he hasn't seen any studies on it, he suspects that people who regularly drive convertibles probably have higher rates of skin cancer because of increased exposure.

Both Fleischer and Ibrahim recommended wearing sunscreen regularly (applying liberally and reapplying often), avoiding the midday sun, seeking shade, wearing a wide-brimmed hat outside and covering up as much of your body as possible to lessen your sun exposure.

Though other factors can and do increase risk, "there's no question that the sun is the biggest risk factor for all types of skin cancer," Fleischer said.

More information

The American Academy of Dermatology has more about skin cancer.

SOURCES: Alan Fleischer, M.D., professor, dermatology, Wake Forest Baptist Medical Center, Winston-Salem, N.C.; Sherrif Ibrahim, M.D., assistant professor, department of dermatology, University of Rochester Medical Center, Rochester, N.Y.

Copyright c 2013 HealthDay. All rights reserved.

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Doctors sometimes over-treat blood pressure: study

AppId is over the quota
AppId is over the quota

NEW YORK (Reuters Health) - A new study suggests veterans hospitals are following guidelines when it comes to treating patients with diabetes and high blood pressure -- but some diabetics with healthy readings may also be getting intensive blood pressure treatment that won't do them much good.

"Good control of blood pressure is important for decreasing bad outcomes for patients (with diabetes), such as heart attacks and kidney disease," said Dr. Eve Kerr, the study's lead author from the Department of Veterans Affairs Ann Arbor Healthcare System and the University of Michigan.

Doctors have gotten very good at making sure everyone at risk gets treated with blood pressure medications, she added. But some patients who needed blood pressure medications to begin with might end up not needing them later on.

"Sometimes when blood pressure gets too low, it's okay to back off," Kerr told Reuters Health.

Her team examined the medical records of close to one million diabetes patients treated at VA medical centers and outpatient clinics.

The vast majority of patients age 18 to 75 -- 94 percent -- either had normal blood pressure or were getting high blood pressure treated according to guidelines.

That means most diabetic veterans are getting the help they need when it comes to high blood pressure monitoring and treatment. But although under-treating blood pressure may not have been a big problem in the VA group, over-treatment seemed to be at least as common, if not more so, the researchers found.

More than one-third of patients treated at the VA with a blood pressure below 130/65 mm Hg were on at least three blood pressure lowering drugs, or were having their drug regimen increased. That was equal to eight percent of all diabetic veterans.

High blood pressure is considered to be 140/90 mm Hg or higher, according to the National Institutes of Health.

Depending on the hospital, between three and 20 percent of diabetic veterans were possibly being over-treated with blood pressure medications, Kerr and her colleagues reported Monday in the Archives of Internal Medicine.

Not only might those drugs be unnecessary, but they could cause problems for patients as well, researchers said.

"You don't want to put patients on medications unnecessarily, because there's risks with any medication -- whether it's a nuisance risk of a dry mouth or it could be potentially more serious, like making your blood pressure too low and having you more at risk for falls," said Eileen Handberg, a cardiology researcher from the University of Florida in Gainesville.

"You don't want to treat someone's blood pressure to the point that they're weak and dizzy because their blood pressure is too low," Handberg, who wrote a commentary published with the study, told Reuters Health.

She said guidelines don't currently set a lower limit for recommended blood pressure in diabetic patients -- and because of that, it's hard to say doctors in this study were doing anything wrong when they prescribed more blood pressure lowering drugs to people who might not have needed them.

Still, Handberg added, "There is a lot of conversation about, maybe lower isn't always better."

One limitation of the new study is that it can't show whether patients were actually harmed by their blood pressure getting too low, said Dr. Franz Messerli, director of the high blood pressure program at St. Luke's-Roosevelt Hospital in New York.

"We don't know whether over-treatment or under-treatment increased heart attack, stroke or death, and that's obviously the important issue," Messerli, who wasn't involved in the research, told Reuters Health.

Kerr said the new study can help inform future guideline-makers about how diabetic patients are currently being treated -- and how often too much blood pressure treatment might be a concern.

Researchers agreed that patients who find their blood pressure numbers dropping very low or who have side effects such as dizziness should talk with their doctors about their blood pressure and the possibility they can ease off aggressive treatment.

SOURCE: http://bit.ly/LPkvZ8 Archives of Internal Medicine, online May 28, 2012.