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  • November 03, 2016 10:54 AM | Deleted user

    AAPA

    The PA profession is turning 50 and bringing the celebration to Las Vegas for AAPA 2017. Go beyond your daily practice and join more than 8,000 PAs and students at the world's largest PA event May 15-19, 2017. Don't miss more than 250 CME credits, a 50th anniversary celebration event and an innovative and humorous perspective on healthcare from our keynote speaker Zubin Damania, MD — aka ZDogg MD. Register today at the low Cyber Monday rate. 

    Register Now: http://aapaconference.org/register/

  • November 03, 2016 10:50 AM | Deleted user

    by Lindsey Wahowiak on Nov 2, 2016 • 2:47 pm

    This "Anatomy of a Papaya" is used to teach a variety of reproductive health skills, including contraceptive insertion.

    This “Anatomy of a Papaya” is used to teach providers a variety of reproductive health skills, including contraceptive insertion.

    Long-acting reversible contraceptives — intrauterine devices and birth control implants — are the most effective methods to prevent pregnancy. But too many people who want to choose LARC as their form of birth control are unable to get it in a timely manner because community health clinic staff is untrained or unprepared to perform an insertion.

    But that doesn’t have to be the case. At a Wednesday morning session on “Expanding LARC Access and Training the Community Health Workforce,” reproductive health experts shared their tools for success in preparing community health clinic staff to stock, educate about and insert IUDs and implants. The best part: Most of the tools for training are low-cost or free and available online.

    Stefanie Boltz, of the Bixby Center for Global Reproductive Health, shared many of the tools that can be used in trainings or classroom settings. Online resources like Papaya Workshop (a very interesting way to practice a variety of reproductive health services — on fruit!), the Global Library of Women’s HealthJhpiego (an affiliate of Johns Hopkins University) and Innovating Education in Reproductive Health all offer free videos to use as teaching tools for people learning to insert the devices. In particular, Innovating Education in Reproductive Health, a project of the Bixby Center, is open source, meaning anyone can use the website and download its tools without a login, Boltz told attendees. Some of the trainings include information on health disparities, she noted, while an important resource has been the site’s contraceptive counseling training, which teaches clinic staff to improve care through listening to patients’ needs.

    Of course, training is only part of the solution. Aisha Mays, a family physician and clinical researcher at Advancing New Standards in Reproductive Health, part of University of California-San Francisco, said supervising people as they practice inserting LARC helps clinic staff gain confidence in their skills, which then allows them to offer the full spectrum of reproductive health options more regularly. Where Planned Parenthood clinics are able to offer same-day insertion to 95 percent of patients seeking LARC, community health clinics were only able to offer same-day insertion to about a third of those asking for it. However, after going through six training sessions and supervised practice, those numbers increased dramatically.

    Mays is also a trainer with Upstream USA, an organization that goes into community health clinic settings to train staff on LARC stocking, billing, education and insertion. It’s a pretty cool organization.

    Ready to join #TeamIUD (or Team Implant)? Check out some of these training tools to see how they might help your clinic offer patients the care they need!

    Original Article: Public Health Newswire

  • November 02, 2016 11:58 AM | Deleted user

    By Julie Steenhuysen | CHICAGO

    A study of mice infected with Zika showed the virus caused lasting damage to key cells in the male reproductive system, resulting in shrunken testicles, lower levels of sex hormones and reduced fertility, U.S. researchers said on Monday.

    So far, the findings are only in mice, but the result is worrisome enough to warrant further study because of possible implications for people, said Dr. Michael Diamond of Washington University in St. Louis, whose research was published in the journal Nature.

    "It has to be corroborated," Diamond, a professor of pathology, immunology and molecular microbiology, said in a telephone interview.

    Much of the global effort to fight Zika has focused on protecting pregnant women from infection because of the grave implications for their unborn children.

    Zika infections in pregnant women have been shown to cause microcephaly, a severe birth defect in which the head and brain are undersized, as well as other brain abnormalities.

    Previous studies have shown that Zika can remain in semen for as long as six months. But little is known about whether prolonged exposure to the virus in the testes can cause harm.

    To study this, Diamond and colleagues injected male mice with Zika. After a week, the researchers recovered infectious virus from the testes and sperm, and they found evidence of viral genes in certain cells of the testes. But overall, the testes appeared normal compared with other lab mice.

    After three weeks, however, the differences were stark. The testes in the Zika-infected mice had shrunk to a tenth of their normal size, and the internal structure was destroyed.

    "We saw significant evidence of destruction of the seminiferous tubules, which are important for generating new sperm," Diamond said.

    The researchers also found that Zika infects and kills Sertoli cells, which maintain the barrier between the bloodstream and the testes and foster sperm growth. Sertoli cells do not regenerate.

    That raises the specter of long-lasting damage.

    "The virus is infecting a site which doesn't really renew if it gets damaged. That is the problem," Diamond said.

    Tests of testicular function showed sperm counts, sex hormones and fertility had dropped. Infected mice were four times less likely to impregnate a healthy female mouse than healthy males.

    "This is the only virus I know of that causes such severe symptoms of infertility," added Dr. Kelle Moley, a fertility specialist at Washington University and a study co-author.

    There is no vaccine or treatment for Zika.

    (Reporting by Julie Steenhuysen; Editing by Will Dunham)

    Original article click here

  • November 02, 2016 11:57 AM | Deleted user

    Clinicians should screen children and adolescents for obesity, and promote comprehensive behavioral interventions to improve their weight status, according to the U.S. Preventive Services Task Force (USPSTF).

    There is adequate evidence (B grade) that body mass index (BMI) screening and lifestyle-based weight loss interventions for children and adolescents, ages 6 to 18 years, can effectively lead to improvements in weight status and certain related cardiometabolic factors after 6 to 12 months, according to a task force draft statement.

    The statement follows a 2010 recommendation to screen all children ages 6 and older for obesity. Task force member Alex R. Kemper, MD, MPH, of Duke University in Durham, N.C., told MedPage Todaythat "childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years" and the new draft recommendation is an effort to address the growing issue.

    "Both recommendations are largely consistent, reaffirming the importance of screening children and adolescents for obesity and offering or recommending behavioral health interventions, if needed. While the B grade remains unchanged, there was a slight adjustment in adding the word 'adolescents' to further clarify the population included in the recommendation," he told MedPage Today.

    The updated recommendation also falls in line with obesity screening guidance from other health organizations such as the American Academy of Family Physicians, the National Academies Health and Medicine Division, and the National Association of Pediatric Nurse Practitioners.

    The task force chose BMI measurement as the recommended screening measure due to its feasibility, acceptable accuracy in identifying young individuals with excess weight, and evidence linking it to cardiovascular risk factors.

    They suggested that all children ages 6 to 18 should be screened for obesity, but noted that children with obese parents, poor nutrition, low levels of physical activity, inadequate sleep, sedentary behaviors, and low family income may be at an increased risk, therefore requiring screening.

    "Parents do not always recognize when their children are overweight," stated Kemper said in a press release. "Looking at BMI as part of usual health care provides an opportunity to identify children who have obesity and refer them to a comprehensive program, leading to improved health outcomes."

    Task force members examined 45 trials (n=7,099) of behavioral interventions for obesity -- 42 trials (n=6,956) used multicomponent interventions targeting lifestyle change -- and found that the net benefit of intensive behavioral interventions was moderate.

    Seven trials with 52 contact hours or more demonstrated benefits of treatment, with a pooled standardized mean difference in change of -1.10 (95% CI -1.30 to -0.89), and nine trials with 26 to 51 contact hours showed smaller effects, with a pooled standardized mean difference in change of -0.34 (95% CI -0.52 to -0.16).

    Cardiometabolic outcomes were consistently reported in studies with 52 contact hours or more and pooled reductions in systolic -6.4 mm Hg (95% CI, -8.6 to -4.2) and diastolic blood pressure -4.0 mm Hg (95% CI, -5.6 to -2.5) were statistically significant.

    Of the findings, task force co-chair David C. Grossman, MD, MPH, of Group Health in Seattle, explained that "behavioral interventions can help children improve their health, manage their weight, and prevent future obesity-related health problems."

    However, lower adherence in clinical practice could decrease the overall benefit of these interventions.

    Kemper told MedPage Today that effective comprehensive, behavioral interventions are "those that last at least 26 hours, and may include sessions that target both the parent and child."

    Interventions should offer information on healthy eating and safe exercise, discuss the use of stimulus control, such as limiting access to tempting foods and restricting television and computer time, and include supervised physical activity.

    The recommendation also looked at pharmacotherapy interventions such as orlistat and metformin. The drugs yielded small amounts of weight loss, but the magnitude of this benefit is of uncertain clinical significance due to inadequate evidence regarding the effectiveness of metformin and orlistat, they noted.

    The USPSTF is supported by the Agency for Healthcare Research and Quality.

    • Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner


  • November 02, 2016 11:55 AM | Deleted user

    DeSilva M, et al. JAMA. doi:2016:10.1001/jama.2016.14432.

    Women who received the tetanus-diphtheria-acellular pertussis vaccine while pregnant were not more likely to have a child with microcephaly than those women who did not receive the vaccine, according to research published in the Journal of the American Medical Association.

     “These results expand upon what is known about maternal [tetanus-diphtheria-acelluar pertussis (Tdap)] vaccination safety to include information about structural birth defects and microcephaly in offspring,” Malini DeSilva, MD, MPH, of HealthPartners Institute in Minneapolis, and colleagues wrote. “The findings support recommendations for routine Tdap administration during pregnancy.”

    Researchers analyzed data from 324,463 live births from January 2007 through September 2013 to compare the prevalence of structural birth defects between offspring of women who received the Tdap vaccine and those who did not. Overall, there were 41,654 live births following maternal vaccination, with no increase in the rate of microcephaly (APR = 0.86; 95% CI; 0.60-1.24). These findings were consistent among women who received vaccination at the two discrete time periods researchers studied: fewer than 14 weeks gestation (3,321 births; adjusted prevalence ratio [APR] = 0.96; 95% CI, 0.36-2.58) or between 27 and 36 weeks gestation, the period recommended in 2012 by the U.S. Advisory Committee on Immunization Practices (20,568 births; APR = 1.01; 95% CI; 0.63-1.61).

    Researchers wrote that their findings could be limited by the lack of information regarding birth defects that caused pregnancy loss or termination, wrongly identifying a woman’s immunization status, fragmental data on the Tdap vaccine and random variables such as the mother’s use of alcohol and diagnosed structural birth defects. – by Janel Miller

    Disclosures: The researchers report no relevant financial disclosures.


  • October 25, 2016 8:40 AM | Deleted user

    Revenues generated by physician assistants (PAs) and NPs in clinics and hospitals create employment opportunities and wages, salaries, and benefits for staff, which in turn are circulated throughout the local economy. An input-output model was used to estimate the direct and secondary effects of a rural primary care PA or NP on the community and surrounding area. This type of model explains how input/output from one sector of industry can be the output/input for another sector. Given two example scenarios, a rural PA or NP can have an employment effect of 4.4 local jobs and labor income of $280,476 from the clinic. The total effect to a community with a hospital increases to 18.5 local jobs and $940,892 of labor income.

    Read the full article here


  • October 21, 2016 9:41 AM | Deleted user
    Resveratrol also decreases fasting insulin level and increases Insulin Sensitivity Index

    THURSDAY, Oct. 20, 2016 (HealthDay News) -- For patients with polycystic ovary syndrome (PCOS), resveratrol is associated with significant reductions in ovarian and adrenal androgens, according to a study published online Oct. 18 in the Journal of Clinical Endocrinology & Metabolism.

    Beata Banaszewska, M.D., Ph.D., from the Poznan University of Medical Sciences in Poland, and colleagues evaluated endocrine and metabolic effects of resveratrol on PCOS in a randomized placebo-controlled trial conducted over a three-month period. Thirty-four patients were enrolled in the trial and 30 completed the trial.

    The researchers observed a significant 23.1 percent decrease in total testosterone with resveratrol (P = 0.1). Resveratrol also induced a 22.2 percent decrease in dehydroepiandrosterone sulfate, a 31.8 percent decrease in fasting insulin level, and a 66.3 percent increase in the Insulin Sensitivity Index (P = 0.01, 0.007, and 0.04, respectively). There were no significant alterations in the levels of gonadotropins, lipid profiles, and markers of inflammation and endothelial function.

    "Resveratrol significantly reduced ovarian and adrenal androgens," the authors write. "This effect may be, at least in part, related to an improvement of insulin sensitivity and a decline of insulin level."

    RevGenetics provided resveratrol for this study. The Adamed Group partially supported the study and produced the placebo pills.

    Abstract
    Full Text



    Copyright © 2016 HealthDay. All rights reserved.


  • October 21, 2016 9:39 AM | Deleted user

    Two doses of a vaccine that protects against cervical and several other types of cancer are enough for 11-to 12-year-olds, rather than the previous three-shot regimen, the U.S. Centers for Disease Control and Prevention said on Wednesday.

    Vaccines against the human papillomavirus, or HPV, Merck & Co Inc's Gardasil and GlaxoSmithKline Plc's Cervarix, have been available for years, but acceptance by the public has been slow.

    "Safe, effective, and long-lasting protection against HPV cancers with two visits instead of three means more Americans will be protected from cancer," CDC Director Tom Frieden said in a statement. "This recommendation will make it simpler for parents to get their children protected in time."

    The CDC now recommends that 11- to 12-year-olds receive two doses of HPV vaccine at least six months apart. Adolescents aged 13 and 14 can also receive the two-dose schedule, but teens and young adults who start the series later, at ages 15 through 26 years, will continue to need three doses, the agency said.

    HPV is among the most common sexually transmitted diseases. Most infections do not cause symptoms and go away on their own, but the virus is still a leading cause of cancer deaths among women worldwide. Since the virus can also cause genital warts and cancers of the anus and mouth/throat, the vaccine is recommended for both sexes.

    In the United States, the HPV vaccine is recommended for children aged 11 or 12, with the goal of protecting them against the virus before they become sexually active, and also for teens and young adults who may not have previously been vaccinated.

    (Reporting by Deena Beasley; Editing by Peter Cooney)


  • October 21, 2016 9:37 AM | Deleted user

    Last year, more STDs were reported in the United States than ever before, a troubling rise that federal health officials say is partly a result of budget cuts in state and local health departments.

    Annual surveillance data from state and local levels showed an increase in all three nationally reportable STDs, the CDC announced. In total, there were 1,946,233 cases of chlamydia, gonorrhea and syphilis reported in 2015 around the country — a record high.

    Jonathan Mermin

    The burden was particularly high in young people and gay and bisexual men.

    “We have reached a decisive moment for the nation,” Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a news release. “STD rates are rising, and many of the country’s systems for preventing STDs have eroded. We must mobilize, rebuild and expand services — or the human and economic burden will continue to grow.”

    STDs cost the U.S. health care system nearly $16 billion each year, according to the CDC. Many cases of chlamydia, gonorrhea and syphilis are undiagnosed and unreported. Further, several STDs such as HPV and herpes simplex are not routinely reported at a national level, meaning the annual CDC captures only a fraction of the actual STDs cases around the country each year.

    According to the CDC, in 2015:

    • Patients aged between 15 and 24 years accounted for nearly two-thirds of the more than 1.5 million cases of chlamydia and half of the nearly 400,000 cases of gonorrhea.
    • Men who have sex with men accounted for the majority of new gonorrhea and primary and secondary syphilis cases, and may face a higher risk of antibiotic resistant gonorrhea.
    • The rate of syphilis diagnosis among women rose more than 27% since 2014, and there was a 6% increase in congenital syphilis to 487 cases.

    All three reportable diseases are curable with antibiotics and widespread access to screening and treatment can limit their spread. But budget cuts in over half of state and local STD programs have resulted in more than 20 health departments closing, the CDC said.

    The rates of all three reportable diseases increased by at least 6%, including a 19% rise in primary and secondary syphilis.

    “STD prevention resources across the nation are stretched thin, and we’re beginning to see people slip through the public health safety net,” Mermin said. “Turning the STD epidemics around requires bolstering prevention efforts and addressing new challenges — but the payoff is substantial in terms of improving health, reducing disparities and saving billions of dollars.” – by Gerard Gallagher

    Reference:

    CDC. Sexually transmitted disease surveillance. 2015. http://www.cdc.gov/std/stats15/std-surveillance-2015-print.pdf. Accessed Oct. 19, 2016.

    Disclosures: Mermin reports no relevant financial disclosures.

    Read the full article here.

  • October 20, 2016 9:27 AM | Deleted user
    Concentrations suggest higher fetal exposure to metabolites than the drug

    WEDNESDAY, Oct. 19, 2016 (HealthDay News) -- In pregnant women taking the antidepressant bupropion, the drug and its active metabolites cross the placenta to the fetal circulation, according to a study published in the October issue of the American Journal of Obstetrics & Gynecology.

    Valentina M. Fokina, from the University of Texas Medical Branch in Galveston, and colleagues investigated the transfer of bupropion and its major pharmacologically active metabolites (hydroxybupropion and threohydrobupropion) across the placenta in 22 women taking bupropion during pregnancy. Samples included maternal blood (22 subjects), umbilical cord venous blood (22 subjects), and amniotic fluid (nine subjects).

    The researchers found that the levels of hydroxybupropion and threohydrobupropion in umbilical cord venous plasma were lower than the corresponding concentrations found in maternal plasma. For the majority of the maternal-cord blood pairs, concentrations of bupropion in umbilical cord plasma were lower than in maternal plasma. Bupropion and its metabolites were detectable in amniotic fluid; however, the concentrations of threohydrobupropion were higher than those in the corresponding umbilical cord venous plasma.

    "The biological consequences of fetal exposure to maternally administered bupropion and/or its active metabolites via placental transfer and recirculation of the amniotic fluid are yet to be determined," the authors write.

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