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  • October 09, 2018 6:59 AM | Anonymous

    October 9, 2018, HealthDay News  

    More than 14 million additional 11- to 12-year-olds need to be vaccinated to reach the American Cancer Society goal of 80 percent of adolescents being up to date (UTD) with the human papillomavirus vaccination (HPVV) by their 13th birthday by 2026, according to a study published online in Cancer. 

    Read more.

  • October 06, 2018 8:19 AM | Anonymous

    AAPA  

    PA Week is here, and we have everything you need to celebrate. Print banners, promote the profession, participate in our Instagram photo contest, watch our PA Week Video contest submissions and vote for your favorite, and — most importantly, share your PA pride! 

    Read more.

  • October 05, 2018 8:17 AM | Anonymous

    October 5, 2018, Infections Disease Advisor via Monthly Prescribing Reference  

    The use of a moderate to low susceptibility antibiotic to treat a urinary tract infection (UTI) may result in a 1.74-fold increase in the odds of an emergency department readmission within 30 days for another UTI, according to a study presented at the IDWeek in San Francisco, Oct. 3-7.  

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  • October 05, 2018 8:15 AM | Anonymous

    October 5, 2018, Healio  

    Most women who received an injection of brexanolone — a positive allosteric modulator of -aminobutyric-acid type A receptors — for postpartum depression had significant and clinically meaningful reductions of the condition at 60 hours vs. placebo, according to findings recently published in The Lancet. 

    Read more.

  • October 05, 2018 8:12 AM | Anonymous

    October 3, 2018, HealthDay News  

    For breast cancer survivors, treatment and age-related phenotypes and genotypes are associated with a longitudinal decrease in cognitive function, according to a study published online Oct. 3 in the Journal of Clinical Oncology.

    Jeanne S. Mandelblatt, M.D., M.P.H., from Georgetown University in Washington, D.C., and colleagues recruited 344 newly diagnosed non-metastatic breast cancer survivors matched with 347 cancer controls aged 60 years or older without dementia or neurological disease. Before systemic treatment/control enrollment and 12 and 24 months later, the researchers collected data including biospecimens, surveys, FACT-cog self-reported cognition, and neuropsychological tests measuring attention, processing speed, and executive function (APE) and learning and memory (LM).

    The researchers found that treatment correlated with longitudinal cognition scores: Worse APE scores were seen for survivors receiving chemotherapy, while those initiating hormonal therapy had lower LM scores at 12 months compared with other groups. There was variation in the group-by-time differences based on APOEgenotypes; only ε4+ survivors on hormone therapy had short-term decreases in adjusted LM scores. The three-way interaction was not significant for APE, but scores were significantly lower for ε4+ survivors exposed to chemotherapy at 24 months compared with ε4+ controls (−0.40 versus 0.01). On all cognitive measures, increasing age correlated with lower baseline scores; frailty correlated with baseline APE and self-reported decline.

    "These data could inform treatment decision-making and survivorship care planning," the authors write.

    Several authors disclosed financial ties to the biopharmaceutical industry.

    Abstract/Full Text (subscription or payment may be required)


  • October 03, 2018 4:06 PM | Anonymous

    Offered via the National AHEC Organization 


    Topic:
    "Since You Asked: Persuading Parents that HPV Vaccine is Safe and Effective in Practice" 

    Thursday, November 1, 2018 , 3-4 p.m. ET 

    Register Now!

    Description: 

    Dr. Kristin Oliver (Mount Sinai, New York) and Dr. Sharon Humiston (Children's Mercy, Missouri) will talk about practical approaches to persuading parents that HPV vaccine is safe and effective in a busy clinical setting. These two pediatricians will highlight tools to get your whole office team giving not just strong, but effective recommendations.


    Learn more.

  • October 03, 2018 6:33 AM | Anonymous

    October 3, 2018, News Medical  

    The study was published on the 1st of October 2018 in the latest issue of the Journal of Neurology Neurosurgery and Psychiatry.

    The team of researchers looked at these neurological conditions among the elderly to estimate the prevalence of the problem, explained senior author of the study Professor Arfan Ikram.

    "We grouped these diseases together not only because they are common but also because there are indications that these often co-occur and might share some overlapping causes.”

    Professor Arfan Ikram, Senior Author

    He added that if the causes of these diseases overlap, prevention strategies and treatments could also overlap. Some of the proposed strategies, he noted, could cut down the risk of these neurological conditions by as much as 20-50%.

    The researchers looked at over 12,000 healthy individuals over 45 years of age and followed them up between 1990 and 2016.

    Over these 26 years, 5291 people died. Among all the participants, around 1500 presented developed dementia, 1285 had a stroke (65 percent of these were ischemic strokes) and 263 were diagnosed with Parkinson’s disease. Among those with dementia, 80 percent developed Alzheimer’s disease.

    When analyzing the incidences based on gender, the team noted that the chances of a woman aged over 45 years developing any of these conditions was around 48 percent while the chances of the men over 45 years of age getting one of these diseases was slightly lower, at around 36 percent.

    Ikram explained that the gender difference was mainly because men tend to have a shorter lifespan.

    He explained that one potential reason for the lesser incidence of these diseases in men was that they often die earlier and not because of any special protective effect of their gender.

    He added that women lived longer and thus were twice as much likely to develop dementia and stroke.

    Ikram suggested that the risk of each condition could be lowered by a healthy lifestyle with a balanced diet, regular exercise, and smoking.

    These measures have been proven to reduce the risk of dementia and stroke, and may also reduce the risk of Parkinson’s disease.

    The team explained that the study includes people of European ancestry only, who tend to have a longer lifespan. Other ethnicities and populations should also be studied, they suggest.


  • October 02, 2018 7:24 AM | Anonymous

    October 2, 2018, HealthDay New

    Women plagued by recurrent urinary tract infections (UTIs) may look no farther than their kitchen tap for relief, a new study suggests.

    Researchers found that women who drank plenty of water had a significant reduction in their odds for a recurrence of the common infections.

    "This study provides convincing evidence that increased daily intake of water can reduce frequent UTIs," said lead researcher Dr. Thomas Hooton. He's clinical professor of medicine in the division of infectious diseases at the University of Miami.

    Water appears to work its magic "presumably via the flushing effect of increased urine volume, but there may be other effects we are not aware of," Hooton said in a university news release.

    One specialist in women's health said the UTI-fighting benefits of hydrating with H2O have long been suspected, but not confirmed in a clinical trial until now.

    "Ask anyone who's had even one UTI, they are no fun," said Dr. Jill Rabin, who helps direct Women's Health Services at Northwell Health in New Hyde Park, N.Y.

    "In this study, women were included if they'd had three or more episodes in the prior year -- definitely painful and life-disrupting," noted Rabin, who wasn't involved in the new study.

    "Drinking more water to improve one's health is probably safe and, if tap is used, pretty inexpensive," she added. "Producing additional urine -- and thus increasing voiding frequency -- may raise one's awareness of the importance of keeping the bladder as empty as possible, which can help reduce UTIs."

    The new trial included 140 younger, premenopausal women in Europe who had all experienced high numbers of recurrent UTIs. Their total daily fluid intake at the start of the study totaled less than six 8-ounce glasses per day.

    During the year-long trial, half of the women drank just over six cups more each day of water, in addition to their regular daily fluid intake. Intake remained the same for the other half of women.

    The reduction in UTI frequency for those who drank the additional water was significant. While the average number of UTIs during the study period was 3.2 for women who did not increase their water intake, it fell to 1.7 for those women whose intake rose, the findings showed.

    There was also a significant reduction in antibiotic use among the women who drank more water. Antibiotics are the main treatment of UTIs, and cutting down on the overuse of antibiotics is key to curbing the emergence of microbes resistant to the drugs.

    Hooton said the trial was long overdue.

    "While it's been widely assumed that increased water intake helps to flush out bacteria and reduce the risk of recurrent UTI, there has been no supporting research data showing such a beneficial effect of water," he said.

    The study did not determine the ideal amount of daily water intake to reduce the risk of UTIs, or whether boosting water intake would help women who are at a lower risk of recurrent UTIs than the group chosen for this trial.

    Dr. Elizabeth Kavaler is a urology specialist at Lenox Hill Hospital in New York City. She said the trial highlights the notion that "water is the preferred beverage for overall bladder and kidney health." She added that "the amount that we each need depends on the environment, activity level and diet."

    The study was published online Oct. 1 in JAMA Internal Medicine. It was funded by Danone, Inc., the maker of Evian bottled water.

  • September 27, 2018 8:53 AM | Anonymous

    September 27, 2018, Rockafelleer Unversity via Medical Press 

    Thanks to improvements in antiretroviral therapy, HIV is now a manageable condition. Yet even the best drugs do not entirely eliminate the virus, which latently lingers in the body, threatening to rise to dangerous levels should a patient forget or forgo treatment. To remain healthy, people infected with HIV must therefore adhere to strict medication regimens, which typically involve ingesting pills every day for the rest of their lives.

    New clinical trials from Rockefeller University researchers suggest that a novel immunotherapy, a combination of two anti-HIV antibodies, is capable of suppressing HIV for months at a time. The drugs, called broadly neurtralizing antibodies or bNAbs (pronounced bee-nabbs), were found to be both safe and more effective than any previously tested antibody therapy. The results were published in Nature and Nature Medicine.

    The power of antibodies

    Antiretroviral therapy, the gold standard for HIV treatment, works almost perfectly in . But in the real world, things are more complicated. Some patients neglect to take their meds, or lose access to healthcare. And inconsistency in treatment presents a risk not only to the person infected, but to the population at large: when the  is not adequately controlled, the likelihood of transmission increases.

    To protect both individuals and communities, researchers are hoping to develop drugs that don't rely on vigilant daily dosing. The results of the new studies, led by Michel C. Nussenzweig, Marina Caskey, and their colleagues, suggest that such a medication may in fact be on the horizon.

    Nussenzweig, the Zanvil A. Cohn and Ralph M. Steinman Professor, initially identified the antibodies, known as 3BNC117 and 10-1074, while studying people whose bodies successfully combat HIV without the help of drugs. In these so-called "elite controllers," natural antibodies target proteins on the outside of the virus and recruit the body's immune system to combat infection.

    The ultimate goal of bNAb therapy is to turn anyone taking the medication into an elite controller, effectively suppressing the virus through an enhanced immune response. These drugs have the added benefit of remaining in the body longer than , and therefore should require less frequent administration.

    Previous studies have shown that treatment with a single bNAb reduces the levels of virus in the blood, but these effects are short-lived. Over time, HIV mutates in such a way that the antibody can no longer find and fight the virus.

    Because 3BNC117 and 10-1074 attack HIV from two different angles, the researchers suspected that administering the two drugs together might evade resistance—an approach first tested in animals. Following the success of these initial experiments, Nussenzweig and Caskey, an associate professor of clinical investigation, adapted the treatment for use in humans.

    In their phase 1b clinical trial, published in Nature, participants stopped taking antiretroviral drugs and subsequently received three infusions of the two bNAbs over the course of six weeks. The researchers report that, among nine individuals who carried viruses that were sensitive to both antibodies, this treatment suppressed HIV for an average of 21 weeks, and over 30 weeks in some patients. Unlike individuals receiving only one bNAb, those receiving combination therapy did not develop resistance if their viruses were sensitive to the antibodies. Moreover, participants experienced no major side effects, the most significant reaction being mild fatigue in a small portion of patients.

    Participants entering this first trial were not viremic—meaning, HIV was not actively circulating in their bloodstream because antiretroviral drugs had brought the virus to very low or undetectable levels. The second study, published in Nature Medicine, showed that bNAbs were also effective in treating viremic patients; in this case, combination therapy reduced virus levels for up to three months.

    The future of bNAbs

    Caskey and Nussenzweig say that although  is very promising, bNAb treatments do have their limitations. The HIV virus comes in many varieties, not all of which respond to a given antibody.

    "These two antibodies are not going to work for everyone," says Caskey. "But if we start to combine this therapy with other antibodies or with antiretroviral drugs, it could be effective in more people—and that's something we hope to look at in future studies."

    Nussenzweig adds that, over time, bNAb therapy could prompt the body to produce HIV-fighting antibodies on its own. "Like some anti-cancer antibodies, these drugs could interact with the host immune system to boost natural immunity," he says.

    Further research might also lengthen the amount of time for which these drugs are effective. The studies showed that bNAbs can control HIV for more than four months in some people—an impressively long suppression period. Still, Nussenzweig suspects that this period could be extended yet further through the use of newly-developed bNAb variants.

    "The expectation is that these new variants will have three- to four-fold longer half-lives," he says. "So we may be able to give the  once or twice a year."

    The researchers believe that bNAbs have the potential to change not only how we treat HIV, but also how we prevent it. Currently, people at risk for contracting the virus can take preemptive antiretroviral medication. But that too requires daily dosing, and many people follow the regimen imperfectly. Like long-acting birth control, long-acting HIV medication would allow people to achieve the desired outcome without being perfect pill takers.

    "If future studies are similarly successful, bNAbs could really become a practical alternative to ART," says Caskey, "an alternative that would be safe and wouldn't require a pill every day."

    More information: Pilar Mendoza et al, Combination therapy with anti-HIV-1 antibodies maintains viral suppression, Nature (2018). DOI: 10.1038/s41586-018-0531-2


  • September 24, 2018 10:00 AM | Anonymous

    September 25, 2018, Medscape 

    Obesity almost doubles the risk for urinary incontinence (UI) in young and middle-aged women compared with women of normal weight, the authors of a new meta-analysis warn.

    These findings are significant because those with a history of even mild UI when young are more likely than women without such a history to have increasingly bothersome symptoms as they grow older, and the longer they have the excess weight, the greater the risk for UI, lead author Tayla Lamerton, a PhD candidate in women's health at the University of Queensland, Brisbane, Australia, and colleagues write.

    The study was published online September 19 in Obesity Reviews.

    Once considered a condition of mostly older or multiparous women, UI, defined as the involuntary loss of urine, has become increasingly prevalent in younger and nulliparous women, leading to a search for causes, Lamerton and colleagues explain. Recent research suggests that overweight and obesity may increase the risk for UI in women, possibly because excess abdominal weight places increased pressure on the bladder, which may, in turn, exceed urethral closure pressure leading to urine leakage.

    They suggest that clinicians "emphasize the role of excess weight on pelvic floor weakening and subsequent risk for incontinence" along with its metabolic risks. In fact, maintenance of a healthy weight could be presented to younger women as a strategy for preventing UI.

    The data support a new clinical guideline from the US Women's Preventive Services Initiative that recommends all women, even adolescents, be screened for UI once a year, although not all experts agree with this recommendation.

    Excess Weight Overshadows Age as a Risk Factor for UI

    In their study, Lamerton and coauthors searched for articles published in English up until September 2017. Inclusion parameters were cohorts with a mean age of 55 years or younger at baseline; excess weight measured using body mass index (BMI), weight, or waist circumference; follow-up of more than 2 years; and use of a risk ratio (RR) estimate of the association between excess weight and UI, among other criteria.

    The final analysis included 14 studies with 47,293 women from eight countries: Australia, France, United States, Denmark, England, Scotland, Wales, and the Netherlands. Most participants came from a single study with a sample size of 30,982.

    Among women who were overweight, defined as a BMI of 25 to 30 kg/m2, the risk for UI was increased by about a third compared with women with a normal BMI (pooled risk estimate, 1.35; 95% CI, 1.20 - 1.53). For women who were obese, defined as a BMI > 30 kg/m2, the pooled risk estimate was 1.95 (95% CI, 1.58 - 2.42), again compared with normal-weight women.

    "Overall," the authors write, "the pooled estimate of the risk for developing UI because of excess weight exposure (overweight plus obesity) was 1.68 (95% CI, 1.47 - 1.92)."

    They did not observe any differences in UI risk between women younger than 36 years of age and those aged 36 to 53 years.

    "This result points to the importance of excess weight, above and beyond age-related risk," they add.

    The authors also determined whether excess weight was associated with an increased risk for any of the four subtypes of UI:

    • Stress UI: Involuntary loss of urine associated with activities such as coughing or sneezing;
    • Urge UI: Urinary leakage associated with or immediately preceded by a feeling of urgency;
    • Mixed UI: A combination of urge and stress UI symptoms; and
    • Severe UI: Urinary leakage of unusually high frequency or amount.

    Of the 14 studies included in the analysis, five provided risk estimates according to these subtypes. In a pooled risk estimate, the risk for mixed UI was 2.45, followed by 2.28 for severe UI, 1.90 for urge UI, and 1.83 for stress UI. These differences were not significant.

    In an overall estimate that combined all subtypes, "excess weight doubled the risk of developing any UI subtype," with an effect size of 2.0 (95% CI, 1.74 - 2.31).

    One major limitation was that only five of the studies adjusted for whether women had ever given birth, meaning the risk estimates may not have been completely independent of parity, the authors write.

    Also, none of the studies categorized participants according to subcategories of obesity, so estimation of UI risk according to severity of obesity was not possible. Also, the analysis was limited to studies published in English and conducted in high-income Western nations.

    UI is a complex issue, especially among younger women, Lamerton said in a news release about the study.

    "Understanding overweight and obesity as a determinant of urinary incontinence could play a role in the way we counsel those affected by the condition, and our findings provide a building block to further explore lifestyle interventions for preventing and managing incontinence," she stressed.

    The authors have reported no relevant financial relationships.

    Obesity Reviews. Published online September 19, 2018. Abstract



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