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  • November 10, 2016 9:15 AM | Deleted user
    NOVEMBER 9, 2016

    BY INES MARTINS, PHD IN NEWS.

    Researchers are working to develop a new breast-friendly, radiation-free method that may replace the unpleasant mammogram currently used to detect breast cancer.

    The new method, described in the study “Towards Dynamic Contrast Specific Ultrasound Tomography,” and published in Scientific Reports, uses ultrasounds to provide 3-D images of the breast, and is meant to reduce not only a woman’s discomfort during the procedure, but also the number of false-positive results seen frequently with current mammogram methods.

    Currently, women are screened for breast cancer through a mammogram, where the breast is squeezed tight between two plates to generate 2D X-ray images. The method is not only physically unpleasant and one of the reasons women choose to skip screening, it also comes with the risk that the radiation used in the mammograms can contribute to the development of cancer.

    In addition, mammograms generate large numbers of false-positive results. In more than two-thirds of cases where doctors find an abnormal tissue that is recommended for biopsy, it turns out that the abnormal regions are not cancer. In the meantime, women are subjected to high levels of unnecessary worrisome stress.

    Researchers have been trying to develop alternatives to this method that provide more accurate results and that reduce women’s discomfort. Recently, a team at Eindhoven University of Technology has been working on a possible alternative for mammograms.

    According to a press release, the new technology requires patients to lie on a table with their breast hanging freely in a bowl. Using ultrasounds, a 3-D image of the breast is generated and scanned for tumors. The researchers believe this method will generate far fewer false negative results.

    The technology builds up on a patient-friendly prostate cancer detection method also developed at the Eindhoven University of Technology. The approach takes advantage of the distinct vessel architecture found in tumors and healthy tissues. Tiny micro-bubbles that can be precisely monitored with an echoscanner are injected in the prostate blood vessels, allowing doctors to precisely identify the presence and location of the tumor.

    Although this method is now being tested for prostate cancer in hospitals worldwide, breast motion and size have largely limited its application in breast cancer screening.

    But researchers may have developed a new variant of the echography method that is suitable to be used in breast cancer. Libertario Demi, Ruud van Sloun and Massimo Mischi developed the Dynamic Contrast Specific Ultrasound Tomography, which uses the same micro-bubbles, but under a different principle. They use the fact that bubbles vibrate in the blood at the same frequency as the sound produced by the echoscanner, and at twice that frequency — the second harmonic.

    When the scanner captures that vibration, it knows where the bubbles are located. Similar to the micro-bubbles, the body tissue also generated harmonics, which limited the researchers’ observations. But the researchers found that, contrary to the body tissues, the gas bubbles delayed the second harmonic. And the more bubbles the sound-waves encountered, the bigger the delay.

    This, however, can be detected only if the sound is captured on the other side, which makes the technology ideal for the breast tissue.

    The researchers are now starting a collaborative effort to conduct preclinical studies with the new tool, and hope it will be included in clinical practice within 10 years, possibly in combination with other methods that will generate high-quality images that allow for highly accurate diagnoses.


  • November 08, 2016 11:00 AM | Deleted user

    Global Health

    By DONALD G. McNEIL Jr. 
    NOV. 7, 2016

    Women should see a doctor, nurse or trained midwife at least eight times during each pregnancy, with five of those visits in the last trimester, the World Health Organization said Monday as it issued 49 recommendations to prevent deaths in childbirth.

    Previously, the agency had advised women to visit clinics four times per pregnancy. It also acknowledges the important role of local midwives in poor countries where mothers must travel long distances to see doctors or nurses.

    But each visit should be with someone with at least two years’ medical training, “not a traditional birth attendant or a community health worker trained for a few weeks,” said Dr. Metin Gülmezoglu, W.H.O’s coordinator of maternal and perinatal health.

    About 300,000 women die in pregnancy or childbirth each year, the agency said, and more than six million babies die in the womb, during birth or within their first month. Many of those deaths can by prevented through simple interventions.

    Another recommendation is that every pregnant woman have one ultrasound scan before the 24-week mark to detect fetal defects and twin or triplet pregnancies and determine accurate gestational ages. Many clinics lack ultrasound machines and even electricity, Dr. Gülmezoglu said.

    The agency also recommended that all women get:

    ■ Daily iron and folic acid pills to prevent anemiasepsis and premature birth.

    ■ A tetanus shot to prevent neonatal tetanus.

    ■ Blood-sugar testing to detect diabetes.

    ■ Antibiotics when bacteria are detected in the urine.

    ■ Counseling about what affordable local foods contain vitamins and minerals, about the dangers of alcohol and tobacco, and about the need for exercise.

    Other recommendations directed to women at higher risk for problems included calcium to prevent pre-eclampsia; vitamin A to prevent night blindness; deworming drugs; and prophylactic doses of drugs to prevent malaria or H.I.V.

    The W.H.O. also recommended a spate of home remedies, like bran for constipation, compression stockings for leg swelling, antacids for heartburn and exercise or acupuncture for back pain.



  • November 08, 2016 10:56 AM | Deleted user

    by MAGGIE FOX

    Researchers reported two steps toward fighting the Zika virus Monday — one from a team that has found a potential way to protect unborn babies from the virus, and a second from a team that announced the start of human trials of a new vaccine.

    Neither offers immediate relief against the epidemic of Zika that has swept across the Americas and the Caribbean and parts of Asia, but they both provide hope of eventually being able to protect pregnant women and their babies from the infection.

    A researcher holds a tray of Zika virus growing in cells at Washington University School of Medicine in St. Louis. No treatments exist to block Zika virus in a pregnant woman from infecting her fetus and potentially causing severe birth defects. But now, researchers report that they have identified a human antibody that prevents -- in pregnant mice -- the fetus from becoming infected and damage to the placenta. The antibody also protects adult mice from Zika disease. 

    The treatment is based on the body's own defenses — an immune system particle called a monoclonal antibody that homes in specifically on the virus. In mice, it helped decrease the damage that the virus causes to developing fetuses and it also helped protect adult mice against infection in the first place.

    "This is the first antiviral that has been shown to work in pregnancy to protect developing fetuses from Zika virus," said Dr. Michael Diamond at Washington University School of Medicine in St. Louis, who helped lead the research.

    "This is proof of principle that Zika virus during pregnancy is treatable, and we already have a human antibody that treats it, at least in mice," Diamond added.

    Zika virus doesn't cause serious disease in most people, but it causes profound birth defects in babies infected in the womb. The virus, transmitted by mosquitoes and through sex, can also cause rare neurological syndromes in a few adults.

    "THIS IS PROOF OF PRINCIPLE THAT ZIKA VIRUS DURING PREGNANCY IS TREATABLE, AND WE ALREADY HAVE A HUMAN ANTIBODY THAT TREATS IT, AT LEAST IN MICE."

    Mice don't naturally catch Zika, so the study is not completely able to predict what would happen in people. But lab mice bred to be susceptible to Zika show some of the same effects that humans do, with the virus going into the brains of developing fetuses and causing extensive damage.

    The team scanned blood samples from people who had been infected with Zika, looking for antibodies that appeared especially effective against Zika. They found one that looked especially effective and named it ZIKV-117.

    "Even a single ZIKV-117 dose given five days after infection protected mice against lethal infection," they wrote in a report published in the journal Nature.

    When they gave the antibody to pregnant female mice either just before or just after infection, it reduced how quickly the virus invaded tissue.

    "These naturally occurring antibodies isolated from humans represent the first medical intervention that prevents Zika infection and damage to fetuses," said Dr. James Crowe of Vanderbilt University School of Medicine in Tennessee, who also worked on the study.

    The antibodies did not appear to be dangerous to the developing mouse pups, said Indira Mysorekar at Washington University. "The anti-Zika antibodies are able to keep the fetus safe from harm by blocking the virus from crossing the placenta."

    It's still a long way from testing in people. Pregnant women would be the No. 1 target for any Zika therapy, and doctors will need to be very sure that a treatment is both safe and effective before trying it in pregnant women.

    But the researchers say their findings also increase hope that a vaccine might be effective.

    A second team started human trials of a Zika vaccine Monday. It's an unusual trial — they will first vaccinate two-thirds of the volunteers against other, related viruses to see if that makes a difference.

    That's because Zika belongs to an unusual family of viruses that includes dengue virus and the yellow fever virus. Doctors have long known that dengue virus has unusual effects on the human immune system.

    People who are infected with dengue once don't usually get very sick. But if they get infected with a second strain of dengue, their risk of dangerous dengue hemorrhagic fever goes up.

    There are some indications that Zika may be affected by previous dengue infections.

    So Dr. Kayvon Modjarrad, who helps lead the Zika program at the Walter Reed Army Institute of Research, says volunteers will have to be free of any previous infection with or vaccination against yellow fever, dengue or Japanese encephalitis.

    Those getting Zika vaccines will be divided into three groups. One will just get a Zika vaccine.

    "One of the groups is going to be given the Japanese encephalitis virus first and then wait a period of time and then get the Zika vaccine," Modjarrad said. "Another group will get a yellow fever vaccine, wait a few months and then get a Zika vaccine."

    Military personnel often get yellow fever and Japanese encephalitis vaccines, so the researchers want to make sure a previous vaccination doesn't interfere with the new Zika vaccine.

    Later, teams will test people who've had natural dengue, yellow fever or other viral infections to see if their immune response to those infections affects how the Zika vaccine works.

    The vaccine has shown good effects in monkeys. It's made using Zika viruses inactivated by chemicals, and is based on an existing vaccine that protects against Japanese encephalitis.

    The volunteers will be tested to see if their bodies produce a healthy response that would be expected to protect them against infection.

    Florida reports more than 200 home-grown cases of Zika, caused by locally-infected mosquitoes.

    Overall, more than 1,000 cases of Zika have been reported in the state, most in people who traveled from other Zika-affected regions. The state says 133 cases involve pregnant women.

    The U.S. Centers for Disease Control and Prevention reports more than 30,000 cases in U.S. territories such as Puerto Rico, and more than 4,000 in the U.S., but says there are almost certainly many times more cases that have not been reported.

    "We urgently need a safe and effective vaccine to protect people from Zika virus infection as the virus continues to spread and cause serious public health consequences, particularly for pregnant women and their babies," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said. 

    Original article: http://www.nbcnews.com/storyline/zika-virus-outbreak/antibody-might-protect-fetus-zika-study-finds-n679161


  • November 04, 2016 8:21 AM | Deleted user

    (HealthDay)—Three injections of a therapeutic vaccine may control genital herpes as effectively as daily pills for at least a year, a new study suggests.

    Researchers tested the experimental vaccine in 310 people with herpes from 17 centers around the United States. The three shots, administered three weeks apart, appeared to reduce patients' genital lesions and the process of "viral shedding" in which they can spread the disease through sexual contact.

    Infectious disease experts hailed the vaccine as a promising development in the treatment of genital herpes. The incurable disease affects about one in every six people ages 14 to 49 in the United States, according to the U.S. Centers for Disease Control and Prevention.

    "In general terms, people receiving [the vaccine] have greater than 50 percent fewer days in which virus is present in their genital tracts, which in theory may reduce transmission," said study author Jessica Baker Flechtner. She's chief scientific officer at Genocea Biosciences, the Cambridge, Mass., manufacturer of the vaccine.

    "However, this would need to be proven in a well-powered clinical trial," she added. "Our trials have included both men and women, and to date, we have not seen a difference in the vaccine impact between genders."

    Currently named GEN-003, the vaccine is believed to work by prompting a type of white blood cell known as a T-cell to recognize and kill cells in which the virus lives, Flechtner explained.

    Patients were randomly split into seven dosing groups, including a placebo group.

    Testing was repeated periodically for 12 months after dosing and included analyzing genital swab samples for the presence of the herpes virus. The days when genital lesions were present were also recorded.

    Current herpes treatment involves taking antiviral pills that can control the length and severity of symptoms and reduce patients' outbreaks. But many patients struggle with taking their treatments regularly, infectious disease experts said.

    "The antiviral drugs available for use orally are pretty good and very safe, but they don't work on everybody, and some find it very hard to take on a daily basis," said Dr. Lawrence Stanberry. He is chair of pediatrics at Columbia University Medical Center/New York-Presbyterian Morgan Stanley Children's Hospital in New York City.

    "Some patients aren't very good about taking medication every day, and some don't like to for herpes because they say it's intrusive and reminds them they have genital herpes," added Stanberry, who was involved in herpes research for many years. "Regrettably, there's still a stigma... but some say a vaccine wouldn't remind them on a constant basis about their illness."

    Stanberry agreed with Dr. Matthew Hoffman, of Christiana Care Health System in Wilmington, Del., that it would take at least several years until the experimental vaccine might become widely available. The U.S. Food and Drug Administration has yet to approve the vaccine, a process that requires additional successful clinical trials.

    The most common side effects patients experienced after vaccination included muscle aches, fatigue and pain or tenderness at the injection site. No patients experienced life-threatening reactions, Flechtner said.

    Hoffman called the vaccine "an exciting, novel approach" to genital herpes treatment, noting that it enables patients' own immune systems to "come to the rescue and create chronic suppression."

    It could also positively influence patients' intimate relationships, he said, which can be dramatically affected by herpes flare-ups.

    "Herpes is an uncomfortable, embarrassing disease," Hoffman said. "This [vaccine] offers the opportunity to protect people going into new relationships.

    "As you can imagine, if one partner has six to 10 episodes of herpes per year and the other partner is unaffected, it can really change the nature of the relationship," he added. "But if that number goes down to one to two episodes per year based on immunization, it can help protect the other partner."

    Stanberry predicted that future research would look at combining the vaccine with antiviral pills to gauge the impact on reducing sexual transmission. On its own, the vaccine "is likely to reduce the risk, but the likelihood of eliminating the risk is exceedingly small," he said.

    The study was presented at the Infectious Disease Society of America's annual meeting in New Orleans that ended Oct. 30. Research presented at conferences typically hasn't been peer-reviewed or published, and results are considered preliminary.

     Copyright © 2016 HealthDay. All rights reserved. 


  • 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


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