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  • 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.

    Full Text

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  • 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


    CDC. Sexually transmitted disease surveillance. 2015. 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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    Copyright © 2016 HealthDay. All rights reserved.

  • October 20, 2016 9:25 AM | Deleted user
    Younger patients, having proximal stones, needing IV narcotics more likely to return

    WEDNESDAY, Oct. 19, 2016 (HealthDay News) -- Among patients with ureteral stones, those who are younger, have proximal stones, and require intravenous narcotics for pain control are more likely to return to the emergency department within 30 days, according to a study published in the November issue of The Journal of Urology.

    Vishnu Ganesan, from the Cleveland Clinic, and colleagues reviewed the 2010 to 2013 records for 1,510 emergency department patients at a single institution with a diagnosis of urolithiasis and an associated computed tomography scan. Images were reviewed to confirm stone size, location, and degree of hydronephrosis.

    The researchers found that 164 patients (11 percent) revisited the emergency department within 30 days. The presence of a proximal ureteral stone, age less than 30 years, and the need for intravenous narcotics in the emergency department remained independently associated with an emergency department revisit, according to multivariable analysis.

    "Consideration should be given for early follow-up or intervention for these patients to prevent costly emergency department returns," the authors write.

    Full Text (subscription or payment may be required)

    Copyright © 2016 HealthDay. All rights reserved.

  • October 20, 2016 9:24 AM | Deleted user

    After bariatric surgery, women with polycystic ovary syndrome (PCOS) not only lost weight but also experienced decreases in both ovarian volume and markers of androgen excess, according to data presented at the American Society for Reproductive Medicine (ASRM) 2016 Scientific Congress & Expo.

    Researchers conducted a retrospective chart review of 33 women with PCOS who underwent bariatric surgery at the Cleveland Clinic Foundation from 2009 to 2015. Information on pre- and postoperative weight, testosterone levels, dehydroepiandrosterone (DHEAS), HbA1c, fasting glucose, BMI, weight, and ovarian volume were gleaned from medical records.

    Weight and BMI were significantly lower after bariatric surgery than before the procedure (95.7 kg vs 126.3 kg and 37.4 vs 47.5, respectively; P <.0001 for both). Similar results were seen for ovarian volume (7.7 mL vs 14.0 mL; P =.036), as well as a trend toward decreases in total testosterone (38.4 ng/dL vs 56.1 ng/dL), free testosterone (4.5 pg/mL vs 10.3 pg/mL), and DHEAS (132.9 mcg/dL vs 196.3 mcg/dL).

    “These results suggest that weight loss associated with bariatric surgery may result in resolution of the key characteristics associated with PCOS including androgen excess and ovarian enlargement,” the researchers concluded.

    “Women with PCOS experience a large set of painful, discouraging, and uncomfortable manifestations of the syndrome,” Owen K. Davis, MD, president of ASRM, said in a press release. “The study showing reduction in symptoms after bariatric surgery is encouraging, but such surgery is an extreme remedy and only appropriate for a few.”



    1. Christ J, Falcone T. Abstract O-82. Changes in ovarian morphology associated with bariatric surgery among women with polycystic ovary syndrome (PCOS). Presented at: ASRM 2016 Scientific Congress & Expo; October 15-19, 2016; Salt Lake City, UT.
    2. Polycystic ovary syndrome increases risk of eating disorders, PCOS symptoms diminish after bariatric surgery [press release]. Washington, DC: ASRM Office of Public Affairs; October 17, 2016.
      . Accessed October 17, 2016.

  • October 20, 2016 9:22 AM | Deleted user

    The PA Foundation IMPACT Grant Program provides funding to encourage and support PA and PA student involvement in programs that improve health, consistent with the mission, values and vision of the PA Foundation. Through the program, the Foundation seeks to support patient-focused, community-based health projects that demonstrate an impact on patient health outcomes.

    2016 Timing and Availability of Funds

    The PA Foundation will offer two grant cycles in 2016, one opening in February and the other in October.
    The second cycle will open October 15.

    Add the cycle open date to your calendar.

    October 2016 Grant Cycle – Mental Health Focus

    The PA Foundation seeks to support patient-focused, community-based health projects in the area of mental health that demonstrate an impact on patient health outcomes.

    Read the qualifications and requirements document.

    Who Can Apply?

    All grant applications must be submitted by one or more PAs or PA students who are members in good standing of AAPA. Applications must be made in conjunction with a 501(c)(3) sponsoring organization, such as a nonprofit hospital or nonprofit community organization, an accredited PA Program, or an AAPA Constituent Organization. Depending upon the specific project and the potential liability it may involve, the PA Foundation reserves the right to condition approval of an application on affiliation with a sponsoring organization. In the evaluation process, preference will be given to those applicants who have not already been awarded a grant from the PA Foundation within the preceding 12 months (including both IMPACT Grants and Global Outreach Grants).

    October 2016 Evaluation Criteria

    Preference will be given to:

    1. Projects/programs focused on mental health patient education, screening/referral, and patient outcomes.
    2. Projects/programs that test new PA-led models of care in mental health, which may include screening/referral methods, and/or thatintegrate mental health education into clinical visits.
    3. Projects/programs focused on reducing stigma associated with mental health disorders.

    Proposals will be evaluated based on the following criteria:

    1. Clarity of the goals and activities of the project and alignment with designated mental health focus
    2. Demonstration of PA leadership and involvement
    3. Impact on the health of the target population

    Please note that grant funds may not be used to pay salaries or to reimburse organizations for salaries. Grant funding will not be provided to cover any indirect/administrative costs.

    2016 IMPACT Grants Requirements & Application

    Please read the grant requirements before applying for the IMPACT Grants.

    A written proposal (maximum 3 pages) addressing the following questions is required:

    1. How does this project address the mental health crisis, particularly in the areas of screening/referral, patient education, and stigma reduction?
    2. What are the characteristics of the patient population this project will serve?
    3. What points of data do you anticipate collecting during this project to measure impact?
    4. Show how other PAs or PA students will be involved in this program/project. How many will be involved and what are their roles?
    5. Indicate how PA value and/or PA utilization is critical in attaining the project objectives.
    6. Briefly summarize how the IMPACT Grant funding will improve or enhance population health of the community.
    7. What impact will this grant funding have on the success of this program/project?

    In addition to the written proposal, the following supporting materials are also required:

    1. Detailed project budget
    2. Letter of support signed by an official of the sponsoring organization

    Open date: October 15, 2016
    Deadline: November 18, 2016


    Special Funding Opportunity

    This grant cycle also includes a special opportunity to apply for an award in the area of substance use disorders (SUD), with a focus on enhancing knowledge of SUD treatment research and promoting adoption of evidence-based SUD treatment practices.

    Learn more and apply>>

    IMPACT Grant Recipients

    Learn more>>


    Questions? Contact Caroline Pierce at or 571-319-4510.

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