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British Medical Association Concerned About NHS Preparedness For New Working Time Regulations
With just days to go before the implementation of the 48-hour working week for junior doctors, the BMA"s junior doctors" leader warns that not all of the NHS is prepared for the European Working Time Directive.
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Denver Post Examines Efforts To Establish Needle-Exchange Programs In Colorado
The Denver Post on Friday examined efforts to establish needle-exchange programs in Colorado to reduce the risk of HIV and hepatitis C among injection drug users. According to the Post, 185 cities in Colorado have needle-exchange programs, but legislation that would have legalized needle exchanges statewide did not advance in the Legislature this year. "The issue is more complex than it perhaps first appears," Evan Dreyer, a spokesperson for Gov. Bill Ritter (D), said, adding that "law enforcement and the Colorado Department of Public Health and Environment both expressed serious reservations" about a proposal that would have legalized needle-exchanges statewide. A coalition of public health officials, treatment providers and advocates are increasing efforts to establish a needle-exchange program in Denver, the Post reports. The Denver Drug Strategy Commission in February recommended that Mayor John Hickenlooper consider a pilot needle-exchange program, DDSC Director Karla Maraccini said. The commission is looking at different programs to develop a model following Hickenlooper"s request for additional research. However, Denver District Attorney Mitch Morrissey has concerns that a local needle-exchange program would violate state law, according to Morrissey"s spokesperson Lynn Kimbrough. Eric Brown, a spokesperson for Hickenlooper, added, "Anything in contradiction to city or state law would have to be carefully considered." Proponents of needle-exchange programs say they prevent HIV and hepatitis C, but opponents say they condone injection drug use. Mark Thrun, director of HIV prevention for Denver Public Health, said, adding that needle-exchange programs prevent IDUs from "getting these chronic, potentially fatal diseases" and give public health workers "an opportunity to link them into treatment; and it lessens the economic burden on the already overburdened health care system." Thrun noted that several studies have found that needle-exchange programs do not encourage or prolong injection drug use and make IDUs more likely to seek treatment. In addition, a 2005 CDC study found that 86% of exchange programs make treatment referrals and that more than 80% offer counseling and testing for HIV/AIDS and hepatitis C.Nancy Steinfurth, executive director of the Hep C Connection, noted that an estimated 10% of HIV cases and 70% of hepatitis C cases are transmitted through needles (Auge, Denver Post, 5/15).
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Green Paper Funding Proposals "Disastrous" For People With Mental Health Problems
People with mental health problems could find themselves without adequate help and support under proposals set out in today"s green paper on adult social care, warns leading mental health charity Rethink.
Mental Health

What Should A Teenage Girl Do If She Finds A Lump In Her Breast?

If a lump is found in the breast of an adolescent girl, she often will undergo an excisional biopsy. However, breast cancer is rare in adolescents, and the vast majority of teenage breast lumps turn out to be benign masses that are related to hormones. A recent Loyola University Health System study published in the American Journal of Roentgenology suggests that a breast ultrasound examination might eliminate the need for biopsy in many cases. Loyola radiologists performed ultrasound examinations on 20 girls ages 13 to 19 who had lumps in their breasts, including one girl who had a lump in each breast. The ultrasound studies indicated that 15 of the 21 lumps appeared to be benign, while and six were suspicious. Follow-up biopsies or clinical examinations found that all 21 lumps were benign. These findings suggest that if a breast ultrasound finds nothing suspicious, the patient likely does not need to have an excisional biopsy, said lead author Dr. Aruna Vade, a professor in the Department of Radiology at Loyola University Chicago Stritch School of Medicine. In an excisional biopsy, the surgeon makes an incision along the contour of the breast and removes the lump. However, this procedure can be painful, change the shape of the breast and leave a small scar. Vade and her colleagues indicated that excisional biopsies should be reserved for solid breast masses that are suspicious or show progressive growth or masses that are found in patients who are known to have a primary malignant tumor or family history of cancer. Their study is published in the September, 2008 issue of the American Journal of Roentgenology. Among girls younger than 19, there are fewer than 25 cases of breast cancer per 100,000 per year, according to the National Cancer Institute. The vast majority of breast lumps in adolescents are benign and tend to wax and wane. Over time, many disappear. Many teenage girls undergo biopsy of breast lumps because of parental anxiety and surgeons" concerns, Vade said. Vade and colleagues wrote that for adolescents who present with solid masses that appear benign on ultrasound examination, "we conclude that excisional biopsy may not always be necessary." Vade"s co-authors are Dr. Kathleen Ward, medical director of Women"s Health Imaging, Loyola University Health System; Dr. Jennifer Lim-Dunham, clinical associate professor in the Department of Radiology, Loyola University Chicago Stritch School of Medicine; Dr. Davide Bova, assistant professor of radiology at Stritch and Dr. Vaishali Lafita, a radiology resident at Loyola University Medical Center. Loyola University Health System


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