More RA Drug Therapy, Less Joint Surgery

WEDNESDAY, October 30, 2013 — The use of medications like biologic drugs in patients with rheumatoid arthritis is linked to reduced incidence of orthopedic surgery, according to new research presented at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals in San Diego.
RA occurs when the immune system attacks tissue in joints, causing inflammation. It is a chronic condition that can also affect other organs in the body. RA incidence is two to three times higher in women than men, according to the U.S. Centers for Disease Control.
“We demonstrated a reduced incidence of orthopedic surgery over time,” wrote lead researcher Korosh Hekmat, MD, in an email. Dr. Hekmat is a specialist in internal medicine and rheumatology at Malmö University in Sweden. "Adjustment for age, sex and disease duration had no significant impact on these findings. Women and patients with positive RF [rheumatoid factor] were more likely to require small joint surgery,” he added.
Hekmat and his colleagues looked at the incidence of orthopedic joint surgery performed on 2,342 patients with RA in a specific geographical area. Patient-completed health questionnaires from specific years were paired with data in the Swedish national health registry on biologic drug use records and surgical records. The researchers compared orthopedic surgery incidence rates from 1998 to 2001 to rates from 2002 to 2006 and 2007 to 2011.

The rate of orthopedic surgeries decreased over time. The incidence rate was 94.6 during the years 1998 to 2001, and then 71.8 from years 2007 to 2011. During the study period, the gradual decline in surgeries corresponded with an increased use of pharmacologic drugs for RA, especially biologics. (Researchers didn’t verify whether individual patients were using these drugs.)
The incidence of all orthopedic surgeries for patients with RA was 82.3 out of 1,000 people throughout the entire study period. There were overall declines in large joint (for example, hip) and small joint (hand, wrist, ankle, foot) surgeries, but no declines in knee surgeries.
Female gender was a predictor of surgery and a greater rate of disability was associated with an increased incidence of surgery. Hekmat said he didn’t know why being female was a predictor of surgery, but speculated that one reason could be that women have more severe RA.
“Even though the incidence of orthopedic surgery has declined over time … rheumatoid arthritis is still associated with chronic joint destruction," he said, adding that "the need for orthopedic surgery, especially total joint replacement, is an important severe, long-term outcome for the disease. We need to identify these patients, for example, with simple clinical measures at baseline for better and more aggressive treatment."
This research will help rheumatologists determine which patients may be at risk of or more likely to require orthopedic surgery, Hekmat said.

Avonte Oquendo Spotted Riding The Subway? Boy In Photo Resembles Missing Autistic Teen

UPDATE: Police said Thursday that a boy seen in a photo riding the subway is not Avonte Oquendo, the autistic New York City teen who's been missing for nearly a month.
From The AP:

A 13-year-old snapped the picture Tuesday and later posted it on his Facebook page. Authorities said Thursday that the boy shown in the photo went with his mother to see police.
The boy resembles 14-year-old Avonte Oquendo (ah-VAHN'-tay oh-KEHN'-doh), who was last seen on Oct. 4 walking out of his Queens school.
The teen who took the photo approached the boy and asked if he was Avonte. But the boy didn't respond.
Avonte's parents had said they couldn't be sure that the photo showed their son.

Bryan Sweatt 911 Call Captures Minutes Before 6 Shot Dead

GREENWOOD, S.C. -- GREENWOOD, S.C. (AP) — Facing problems with the law and in his personal life, 27-year-old Bryan Sweatt called a police dispatcher to vent. When she asked him what was wrong, he replied he was "stressed out" and about to kill himself.
With a woman's voice crying in the background, the dispatcher asked if he had a gun. His reply: "a 44." Then the phone line went dead.
The chilling call was the first clue that something had gone terribly wrong inside a one-story rural home in this tight-knit community of 23,000 people where six people, including Sweatt, were found shot to death.
Police say Sweatt broke into his girlfriend's parents' house Tuesday and waited for them and the girlfriend to come home. When they did, Sweatt fatally shot her, her parents and two children living there and himself, said Greenwood County Sheriff Tony Davis said.
"Once you see a horrific scene like this it never leaves you. It's with you day in and day out," he said.
The victims were identified as Richard Fields, 51; his wife, Melissa Fields, 49; their daughter Chandra Fields, 26; and two of the couple's grandchildren who lived with them: William Robinson, 9; and Tariq Robinson, 11.
Sweatt was in the middle of a custody fight with Chandra Fields over their 7-month-old daughter, who was not among those killed. He also was facing a burglary charge that could have put him behind bars for years.
Richard Fields had warned him to stay away from his house and the dirt track Sweatt had built in the backyard for his all-terrain vehicles.
Davis didn't specify a motive for the shootings, but said it appears they stemmed from a "domestic violence situation."
He said Sweatt felt that Chandra Fields wasn't allowing him to see their infant child often enough.
It's unclear how many — if any — victims had been shot before he made the call at 5:54 p.m. Tuesday from the home. A police report said a dispatcher heard a woman in the background say: "Do not point that at me" before the call was disconnected.
Sweatt allowed four children to escape — his 7-month-old daughter, the infant's cousin and two neighborhood children who came to the door after school to play with the Fields' grandchildren.
No one knows why Sweatt let them live and shot the others, Davis said.
"I cannot tell you at this point that I have all the answers for you," he said.
While they're still searching for clues, one thing is clear: Sweatt was facing serious problems.
Sweatt had a lengthy arrest record that dates back nearly a decade, according to state police records. Most of his charges were related to property crimes, such as burglary or forgery, although he was arrested once on aggravated assault charges.
He was supposed to be in court Tuesday on a burglary charge, Davis said. The sheriff didn't have many details about the hearing, but said Sweatt faced up to 30 years if he was convicted.
On July 6, 2012, a woman filed a complaint, saying she wanted to have Sweatt checked out because he was threatening suicide, according to a Greenwood County sheriff's office report. She also said she was afraid of him. No charges were filed.
Neighbors said that a few months ago, Richard Fields started allowing Sweatt to store his recreational vehicles on his property on a rural stretch of road south of Greenwood in northwestern South Carolina.
Neighbor Jeff Hicks said he didn't mind initially, but things quickly changed. Strangers began showing up and racing the four-wheelers long into the night, he said. Fields had complained about the noise and said he was going to ask Sweatt to stop coming around.
"He just couldn't take it anymore. He was just fed up," Hicks said.
Hicks said he had frequently talked with his quiet, friendly neighbor about hog hunting and other outdoor activities.
"It's a shame. It just tears you up," said Hicks, who last saw Fields on Tuesday morning. "I waved to him, and now I'll never see him again. That's how short life is."
Sheriff Davis said Fields also believed Sweatt had stolen property from him and told him "not to come back."
Officers went to the home after receiving the 911 call from Sweatt. Davis said while police were on their way, a neighbor called 911 saying four children from that address had arrived at her house and told her a shot had been fired.
On the tape released Wednesday, the neighbor was frantic.
"I just got four kids at my door and they said somebody just killed their momma," the woman told the dispatcher.
When the dispatcher asked what happened, one of the children replayed the scene. She said Sweatt had taken her mother to the "back of the room ... and heard the gun go off."
"You just take care of those children for us," the dispatcher told the woman.
After about an hour and "several unsuccessful attempts" by officers to make contact with anyone in the home, SWAT entered and discovered the bodies, authorities said.
"This is a tragedy," said neighbor Ansel Brewer. "It just so hard to imagine something like this going on here. Why would someone do this?"
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Associated Press writers Meg Kinnard and Jeffrey Collins in Columbia and Lisa J. Adams in Atlanta contributed to this report.

Terrelle Pryor scores on longest QB run in NFL history

On the very first play from scrimmage, Oakland Raiders quarterback Terrelle Pryor kept the football and ran 93-yards for a touchdown.
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The run was the longest QB run in NFL history. Pittsburgh's defense didn't even get a finger on him. It was also the longest run from scrimmage in Raiders' history.
That's a history that includes Bo Jackson and Marcus Allen if you're trying to put that in perspective. The previous record was 92 yards, set by Jackson in 1989.
The run came on a read-option on the Raiders' first offensive play of the game. Pryor took the snap, cut to the outside and never looked back.

5 Things Super Successful People Do Before 8 AM: Forbes

Rise and shine! Morning time just became your new best friend. Love it or hate it, utilizing the morning hours before work may be the key to a successful, and healthy, lifestyle. That’s right, early rising is a common trait found in many CEOs, government officials, and other influential people. Margaret Thatcher was up every day at 5 a.m.; Frank Lloyd Wright at 4 am and Robert Iger, the CEO of Disney wakes at 4:30am just to name a few. I know what you’re thinking – you do your best work at night. Not so fast. According to Inc. Magazine, morning people have been found to be more proactive and more productive. In addition, the health benefits for those with a life before work go on and on. Let’s explore 5 of the things successful people do before 8 am.
1. Exercise. I’ve said it once, I’ll say it again. Most people that work out daily, work out in the morning. Whether it’s a morning yoga session or a trip to the gym, exercising before work gives you a boost of energy for the day and that deserved sense of accomplishment. Anyone can tackle a pile of paperwork after 200 ab reps! Morning workouts also eliminate the possibility of flaking out on your cardio after a long day at work. Even if you aren’t bright eyed and bushy tailed at the thought of a 5 am jog, try waking up 15 minutes early for a quick bedside set of pushups or stretching. It’ll help wake up your body, and prep you for your day.
2. Map Out Your Day. Maximize your potential by mapping out your schedule for the day, as well as your goals and to dos. The morning is a good time for this as it is often one of the only quiet times a person gets throughout the day. The early hours foster easier reflection that helps when prioritizing your activities. They also allow for uninterrupted problem solving when trying to fit everything into your timetable. While scheduling, don’t forget about your mental health. Plan a 10 minute break after that stressful meeting for a quick walk around the block or a moment of meditation at your desk. Trying to eat healthy? Schedule a small window in the evening to pack a few nutritious snacks to bring to work the next day.
More from Forbes:
--The Most Common Practices Of Super-Achievers
--16 Things You Should Do at the Start of Every Work Day
--16 Things You Should Do At The End Of Every Work Day
3. Eat a Healthy Breakfast. We all know that rush out the door with a cup of coffee and an empty stomach feeling. You sit down at your desk, and you’re already wondering how early that taco truck sets up camp outside your office. No good. Take that extra time in the morning to fuel your body for the tasks ahead of it. It will help keep you mind on what’s at hand and not your growling stomach. Not only is breakfast good for your physical health, it is also a good time to connect socially. Even five minutes of talking with your kids or spouse while eating a quick bowl of oatmeal can boost your spirits before heading out the door.
4. Visualization. These days we talk about our physical health ad nauseam, but sometimes our mental health gets overlooked. The morning is the perfect time to spend some quiet time inside your mind meditating or visualizing. Take a moment to visualize your day ahead of you, focusing on the successes you will have. Even just a minute of visualization and positive thinking can help improve your mood and outlook on your work load for the day.
5. Make Your Day Top Heavy. We all have that one item on our to do list that we dread. It looms over you all day (or week) until you finally suck it up and do it after much procrastination. Here’s an easy tip to save yourself the stress – do that least desirable task on your list first. Instead of anticipating the unpleasantness of it from first coffee through your lunch break, get it out of the way. The morning is the time when you are (generally) more well rested and your energy level is up. Therefore, you are more well equipped to handle more difficult projects. And look at it this way, your day will get progressively easier, not the other way around. By the time your work day is ending, you’re winding down with easier to dos and heading into your free time more relaxed. Success!

Health Care Website Will Take Month To Fix, Obama Administration Says

WASHINGTON -- WASHINGTON (AP) — It should be working well by the end of November. That's the Obama administration's rough timetable for completing a long list of fixes to HealthCare.gov, the new, trouble-plagued website for uninsured Americans to get coverage.
Summarizing a week's worth of intensive diagnostics, the administration acknowledged Friday the site has dozens of complex problems and tapped a private company to oversee fixes.
Jeffrey Zients, a management consultant brought in by the White House to assess the extent of problems, told reporters his review found dozens of issues across the entire system. The site is made up of layers of components that are meant to interact in real time with consumers, government agencies and insurance company computers.
It will take a lot of work, but "HealthCare.gov is fixable," Zients declared.
The vast majority of the issues will be resolved by the end of November, he asserted, and there will be many fewer screen freezes. He stopped short of saying problems will completely vanish.
The troubles have been nightmarish for the White House, which had promoted enrollment to be as simple as making a purchase on Amazon.com. This week, President Barack Obama declared himself frustrated by the setbacks while still trumpeting the benefits of the health care law and encouraging consumers to apply by phone if the website proved a hindrance.
In his weekly radio and internet address Saturday, Obama vowed that "in the coming weeks, we are going to get it working as smoothly as it's supposed to." In the meantime, he encouraged the public to call 1-800-318-2596 or visit LocalHelp.HealthCare.gov.
"We're only a few weeks into a six-month open enrollment period, and everyone who wants insurance through the marketplace will get it," he said.
As part of its effort to repair the system, the administration said it is promoting one of the website contractors, a subsidiary of the nation's largest health insurance company, to take on the role of "general contractor" shepherding the fixes.

Quality Software Services Inc. — owned by a unit of UnitedHealth Group— was responsible for two components of the government's online insurance system. One is the data hub, a linchpin that works relatively well, and the other is an accounts registration feature that initially froze and caused many problems.
HealthCare.gov was supposed to be the online portal for uninsured Americans to get coverage under Obama's health care law. Envisioned as the equivalent of Amazon.com for health insurance, it became a huge bottleneck immediately upon launch Oct. 1. The flop turned into an embarrassment for Obama and will likely end up as a case study of how government technology programs can go awry.
The briefing from Zients came a day after executives of QSSI and the other major contractor, CGI Federal, told Congress that the government didn't fully test the system and ordered up last-minute changes that contributed to logjams. Next week, Health and Human Services Secretary Kathleen Sebelius is scheduled to testify.
Visiting a community health center on Friday in Austin, Texas, Sebelius said that "in an ideal world there would have been a lot more testing" but added that her department had little flexibility to postpone the launch against the backdrop of Washington's unforgiving politics. House Republicans trying to defund the nation's health insurance program precipitated a government shutdown.
In the Republican address, Rep. Fred Upton of Michigan, the chairman of the House Energy and Commerce Committee, asked whether the problems evident now foreshadowed future troubles with the health care law.
"In a few short months, families across the country will be subject to penalties under the law's individual mandate," he said. "How can the administration punish innocent Americans by forcing them to buy a product many cannot afford, from a system that does not work?
Zients gave some new details about the extent of the problems, but administration officials are still refusing to release any numbers on how many people have successfully enrolled. Although 700,000 have applied for coverage through the new online markets, it's believed only a fraction of that number actually managed to sign up. Before the website went live, an administration estimate projected nearly 500,000 people would sign up in October alone.
The marketplaces are the gateway to obtaining health insurance under the new health care law, which requires most Americans to have coverage by Jan. 1. Middle-class people who don't have insurance on the job can purchase a private plan with new tax credits to make the premiums more affordable. Low-income people will be steered to an expanded version of Medicaid in states that agree to extend the safety net program.
The federal government is running the insurance markets or taking the lead in 36 states. The rest were set up by states themselves.
Consumers have until Dec. 15 to sign up for coverage to take effect Jan. 1. Under the law, pre-existing medical conditions will no longer be a barrier. But the markets also need lots of young, healthy customers to keep premiums affordable. Open enrollment season extends until Mar. 31.
Zients said almost daily fixes are already having an impact. For example, more than 90 percent of users can now complete one of the first steps, creating an account.
But the application process, which involves submitting and verifying personal information and income details, remains "volatile," he said. At one point, as few as one-third of users were getting through that part.
Zients said there are two big categories of problems. Performance issues involve the speed and reliability of the website. Functional issues are bugs that keep the software from working as intended. Among the high-priority issues is that insurers are getting enrollments with incomplete, incorrect or duplicative information.
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Online:
Obama's address: http://www.whitehouse.gov
Republican address: http://www.gop.gov

Quincy Jones Sues Michael Jackson's Estate

LOS ANGELES -- LOS ANGELES (AP) — Quincy Jones sued Michael Jackson's estate claiming he is owed millions in royalties and production fees on some of the superstar's greatest hits.
Jones' lawsuit Friday seeks at least $10 million from the singer's estate and Sony Music Entertainment, claiming the entities improperly re-edited songs to deprive him of royalties and production fees. The music has been used in the film "This Is It" and a pair of Cirque du Soleil shows based on the King of Pop's songs, the lawsuit states.
Jones also claims that he should have received a producer's credit on the music in "This Is It." His lawsuit seeks an accounting of the estate's profits from the works so that Jones can determine how much he is owed.
The producer worked with Jackson on three of his most popular solo albums, "Off the Wall," ''Thriller" and "Bad."
Jackson's estate wrote in a statement that it was saddened by Jones' lawsuit. "To the best of its knowledge, Mr. Jones has been appropriately compensated over approximately 35 years for his work with Michael," the statement said.
An after-hours message left at Sony Music's New York offices was not immediately returned.
Jackson's hits "Billie Jean," ''Thriller" and "Don't Stop 'Til You Get Enough" are among the songs Jones claims were re-edited to deprive him of royalties and his producer's fee.
Jones' lawsuit states the producer's contracts called for him to have the first opportunity to re-edit or alter the songs, in part to protect his reputation.