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  • September 28, 2016 12:31 PM | Deleted user

    On September 27, 2016 APAOG hosted a webinar called "Let's Talk about Sex: Addressing reproductive health with patients who are LGBT." This webinar was presented by Lis Shell, PhD, MPAS, PA-C from the University of Texas Medical Branch, Galveston, Texas. The presentation was well received by attendees.

    A webinar recording of this presentation is available to members here.

    APAOG's next webinar is on November 10, 2016 and will cover Zika. Register today!

  • September 27, 2016 9:24 AM | Deleted user

    If you’re a pregnant woman and have a backache or headache, or a fever, your options for over-the-counter treatment basically boil down to one medication: the pain reliever acetaminophen, better known as Tylenol. Doctors advise against using nonsteroidal anti-inflammatories, like ibuprofen and aspirin, during late pregnancy because they can compromise fetal circulation and have other adverse consequences.

    But evidence has accumulated that, when taken during pregnancy, acetaminophen may increase the risk that children will develop asthma or attention deficit hyperactivity disorder. The elevated risk in most studies is small, and whether the drug itself is really to blame is debatable. But considering that more than 65 percent of pregnant women in the United States use acetaminophen at some point during their pregnancy, the number of children with problems stemming from it could be substantial.

    The odd thing about acetaminophen is that even after decades of widespread use, no one knows precisely how it blunts pain. But it has earned a reputation for strange side effects. Experiments indicate that it impedes people’s ability to empathize. It may undercut the brain’s ability to detect errors. When taken after a vaccine, it may suppress the immune system. Why might the drug affect both asthma and A.D.H.D. rates? Scientists have variously speculated that it could tweak the immune system during pregnancy, or disrupt hormones, or change growth factors in the developing brain. In short, no one knows.

    The prevalence of asthma doubled between 1980 and 2000. At the same time, worries over Reye’s syndrome, a rare complication in children who take aspirin, led to a rise in the popularity of acetaminophen. On the basis of this circumstantial — and rather weak — evidence, 16 years ago, scientists at King’s College London proposed a link between rising acetaminophen use and the so-called asthma epidemic. Their reasoning was that acetaminophen depleted the body’s native antioxidant, called glutathione, spurring inflammation of the lungs.

    Numerous studies followed showing an association with asthma, but they often relied on mothers’ potentially unreliable memories of what they took, or simply compared one group — mothers of asthmatic children, say — to a control group, a suboptimal study design.

    Recently, however, much stronger studies showing a link have emerged. A study of Norwegian women and children published this year in the International Journal of Epidemiology found that prenatal acetaminophen use increased 7-year-olds’ risk of asthma by 13 percent.

    Then, in August, a JAMA Pediatrics study on a British cohort noted that a mother’s use of the pain reliever in midpregnancy increased 7-year-olds’ risk of hyperactivity by 31 percent.

    Of course, some familial trait may push people to reach for acetaminophen, and this quality, as opposed to the drug itself, may explain the increased risks. But that doesn’t seem to be the case. A mother’s use after she gave birth wasn’t associated with more problems in the British and Norwegian studies. Nor was a father’s.

    Still, the authors are the first to note that perhaps they missed something. They don’t always know how much of the drug women take, or why they’re taking it. And there are reasons to think that the infections whose symptoms women might be treating with the pain reliever could themselves increase the risk of asthma and developmental problems. And yet these and some previous studies controlled for infections, and the association remained.

    Not all of the research has confirmed the relationship. But at this point, the number of strong studies that do find a link are hard to overlook, and are unnerving.

    Moreover, there’s evidence that the drug interacts more strongly with certain genotypes. Some of us carry gene variants that naturally alter the activity of the antioxidant glutathione, reducing its ability to detoxify. A 2010 study by Columbia University scientists found that, at age 5, the children with this variant, whose mothers had taken acetaminophen while pregnant, had double the risk of wheezing compared with children without the gene. In fact, without the gene, children had no increased risk of wheezing. So perhaps only a subset of people are vulnerable to the drug’s harmful effects.

    Petra Arck, a professor of fetal-maternal medicine at the University Medical Center Hamburg-Eppendorf, and colleagues gave the pain reliever to pregnant mice, and found it stressed the liver, altered the placenta and increased the pups’ vulnerability to wheezing.

    During pregnancy, the immune system must tolerate the fetus, which is half foreign, while also retaining enough firepower to fend off pathogens. Professor Arck argues that the drug can interfere with this balancing act.

    But two other mouse studies found no such effect on asthma or behavior. A major difference is the amount of acetaminophen given to the animals. Professor Arck used a big dose. The other two studies used less.

    Antonio Saad, a researcher at the University of Texas Medical Branch at Galveston whose own study failed to produce A.D.H.D.-like symptoms in mice, thinks that Professor Arck used an unrealistically high amount. But the dose was intentional, Professor Arck told me. Acetaminophen is in hundreds of medications, making it easy for pregnant women to take too much. Professor Arck thinks some women overdose without knowing it.

    Last year, the Food and Drug Administration reviewed evidence on acetaminophen and developmental outcomes and deemed it “inconclusive.” That was before the more recent studies appeared. When I asked, an F.D.A. spokeswoman told me that the F.D.A. was “actively reviewing” the new research. A spokeswoman for Johnson & Johnson, the maker of Tylenol, said the company wasn’t aware of evidence showing a “causal link” between prenatal use and later problems, but recommended discussing risks and benefits with a doctor.

    The greater problem is that the kind of study that would definitively answer the prenatal acetaminophen question — a trial on pregnant women — is unlikely to happen, because such studies are generally considered unethical.Top of Form

    This leaves mothers-to-be awash in uncertainty when contemplating a drug that’s widely recommended. So what to do? No one I spoke with proposed they avoid acetaminophen outright. There’s nothing else to take. And untreated fever during pregnancy can have severe consequences, premature birth among them.

    Instead, experts suggested that women use the minimum amount possible. Augusto Litonjua, a pulmonologist at Harvard Medical School who follows the research, noted that if women found themselves taking lots of acetaminophen, maybe they should consider non-pharmacological approaches to pain management, like acupuncture or meditation. For what it’s worth, in the recent JAMA Pediatrics study, the No. 1 reason for taking acetaminophen wasn’t infection or more severe problems, but backache. So maybe women’s partners should offer more massages, although that’s unlikely to help women dealing with serious pain.

    The broader takeaway, said Evie Stergiakouli, lead author on the JAMA study, is that just because acetaminophen is easy to acquire doesn’t mean it’s not a drug, and that it doesn’t have potential side effects.

    Moises Velasquez-Manoff, the author of “An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases,” is a contributing opinion writer.

    Follow The New York Times Opinion section on Facebook and Twitter (@NYTOpinion), and sign up for the Opinion Today newsletter

    A version of this op-ed appears in print on September 25, 2016, on page SR5 of the New York edition with the headline: The Trouble With Tylenol. Today's Paper|Subscribe


  • September 27, 2016 9:22 AM | Deleted user

    Date: September 26, 2016
    Source: University of East Anglia

    Summary: Researchers using DNA sequencing to profile antibiotic resistance in infection have achieved a turnaround time from 'sample to answer' of less than four hours for urinary tract infections (UTIs). 

    The nanopore MinION device is being researched by the University of East Anglia (UEA) as a way to speed up investigation of infection including UTIs -- one of the most common reasons patients are prescribed antibiotics.

    Traditional culture methods take two to three days to characterise bacteria and test their antimicrobial resistances from a urine sample. Early results from the UEA group's method showed that the Oxford Nanopore Technologies device can characterise bacteria and predict their antimicrobial resistances in just 12 hours from a urine sample.

    This has now been shortened to as little as four hours, as published in the Journal of Antimicrobial Chemotherapy.

    While most UTIs are mild, serious cases can lead to hospitalisation. At worst, bacteria can enter the bloodstream causing urosepsis, a life-threatening condition. In this case antibiotics are vital and must be given urgently.

    Faster prediction of whether the UTI is caused by a highly-resistant type of bacteria will allow precise tailoring of treatment. The patient will get an antibiotic that is sure to be active against their pathogen, and society's limited antibiotic resource will be better managed. This will help in the fight against increasing antibiotic resistance, one of the biggest challenges facing society today.

    As highlighted in the O'Neill report in May of this year, overuse of antimicrobials and the resulting increase in antibiotic resistance could -- if all antibiotics fail -- lead to the loss of 10 million lives a year by 2050 if no action is taken. This government-commissioned report stresses the potential of rapid diagnostics to improve both treatment and antibiotic stewardship and called on the governments of the richest countries to "mandate now that by 2020, all antibiotic prescriptions will need to be informed by up-to-date surveillance information and a rapid diagnostic test wherever one exists."

    Prof David Livermore from UEA's Norwich Medical School said: "Identifying specific pathogens and resistance to antibiotics as quickly as possible is the key to reducing the number of patients who are 'over treated' with broad-spectrum antibiotics while waiting for results to come through from the micro lab -- a process that presently takes a couple of days'.

    "This 'carpet-bombing' approach -of giving a broad spectrum antibiotic whilst you wait for results -leads to poor antibiotic stewardship. It's vital that we move beyond it. The way to do so lies in accelerating lab investigation. That way, treatment can be refined earlier. This will benefit the patient, who gets an effective antibiotic, and society, whose diminishing stock of antibiotics is better managed."

    The findings published today showed the MinION nanopore sequencing can significantly accelerate diagnosis and resistance profiling, identifying pathogens and acquired resistance genes correctly, without culture.

    Dr Justin O'Grady from Norwich Medical School said: "This study is the first to use MinION sequencing to rapidly diagnose pathogens and antimicrobial resistance in clinical samples, without growing them. Improvements in the sequencing technology, data analysis and sample preparation mean we've reduced the turnaround time to four hours.

    "Getting results this fast would allow clinicians to adjust antimicrobial very early, even before the second dose is given -- most antibiotics are given around once every eight hours."

    In the study, human cells were removed from patients' urine samples, then the bacteria were recovered and their DNA was sequenced by MinION. Sequences were analysed and the results compared with standard culture and antibiotic susceptibility testing.

    Dr O'Grady said: "Both the type of bacteria and the acquired resistance genes were identified reliably, agreeing with conventional laboratory testing.

    "Challenges remain, though. The approach is currently best suited to difficult cases, but improving hospitals' antibiotic stewardship requires new diagnostics to be deployed widely.

    "Our method currently requires heavily-infected urine and our rapid analysis can't yet predict those resistances that arise by mutation -- changes to existing genes. But the technology is developing rapidly and we expect to overcome these limitations in the near future."


    Story Source:

    Materials provided by University of East AngliaNote: Content may be edited for style and length.


    Journal Reference:

    1. K. Schmidt, S. Mwaigwisya, L. C. Crossman, M. Doumith, D. Munroe, C. Pires, A. M. Khan, N. Woodford, N. J. Saunders, J. Wain, J. O'Grady, D. M. Livermore. Identification of bacterial pathogens and antimicrobial resistance directly from clinical urines by nanopore-based metagenomic sequencingJournal of Antimicrobial Chemotherapy, 2016; dkw397 DOI: 10.1093/jac/dkw397

    University of East Anglia. (2016, September 26). UTI testing technology cuts screening time to four hours. ScienceDaily. Retrieved September 27, 2016 from www.sciencedaily.com/releases/2016/09/160926100125.htm


  • September 26, 2016 11:25 AM | Deleted user

    By John Pope, Kaiser Health News

    The Zika virus has struck fear throughout the Americas, but determining whether people have been infected can be difficult.

    Here’s why: Most infected people don’t display symptoms or they choose to tough out what may seem like nothing more than influenza instead of seeking medical help. Moreover, infected people don’t have much detectable virus, and what’s in the body doesn’t linger.

    There is no commercial test approved by the Food and Drug Administration to detect Zika infections, but the agency has given emergency-use authorization for 10 tests to be used by health officials in the meantime. But processing these tests takes time because they must be shipped to laboratories. In addition, there are concerns about accuracy — one test, developed by the federal Centers for Disease Control and Prevention, which looks for antibodies to the virus, has been plagued by false-positives. It often shows infection by the Zika virus when the culprit is really a closely related microorganism from the same family.

    Researchers are seeking to streamline the process. Among them is Robert Garry, a Tulane University virologist who has been working for the past six months to develop a test that doesn’t look for the virus but, like the CDC-developed process, searches for the immune system’s reaction to it. Unlike the existing procedures, he said, “we’re trying to put together a test that anybody could use” and process within 20 minutes without having to use a lab.

    The procedure Garry and his colleagues want to develop will look for antibodies because, Garry said, they stay in the body longer, especially in urine.

    “The virus goes away quickly, but the damage can be done,” said Garry, a professor of microbiology and immunology.

    According to the CDC, Zika antibodies show up in the blood four to five days after the onset of illness and can last 12 weeks — or longer.

    Garry said the CDC’s test looks for immunoglobulin M, or IgM, antibodies that show up relatively early in an infection.

    “They wouldn’t detect a longer-term infection,” said Garry, adding that the test he and his colleagues want to develop would find antibodies that appear later.

    The Zika virus, which now has a toehold in the United States after sweeping through Brazil and other Latin American countries, is most commonly spread by mosquitoes but can also be transmitted via blood, sexual contact and by mother to fetus.

    The CDC has logged more than 2,900 cases in the United States and since July reported cases in Florida that were likely caused locally by mosquito bites. Nearly 16,000 cases have been reported in U.S. territories, primarily Puerto Rico.

    In California, there have been no reported cases of Zika contracted locally from mosquito bites. However, there were 282 known cases of travel-associated Zika in the state as of Friday, according to the most recent data from the California Department of Public Health.

     Advertisement

    On Thursday, the chairman of the state Senate’s Health Committee, Sen. Ed Hernandez (D-West Covina) convened a town hall in Los Angeles, where experts discussed what Californians can do to minimize the public health risk Zika poses.

    “The Zika virus does not discriminate against county, state or country borders and we must do everything in our power to ensure our communities are aware of Zika and protected against its negative impacts,” Hernandez said. “While Zika has not reached epidemic proportions in the state, it is vital that the public be equipped with knowledge and resources to effectively combat anything in the future.”

    In addition to avoiding travel in parts of the world where Zika is prevalent, especially if you are pregnant, “you can prevent mosquito breeding in your neighborhood by eliminating standing water and reporting mosquitoes to your local vector control office,” said Jeffrey Gunzenhauser, Interim Health Officer for Los Angeles County, who spoke at the town hall.

    Zika symptoms can include fever, rash, joint and muscle pain, and nausea, but most infected people may not realize they have the virus. There is no specific medicine or vaccine. The CDC recommends rest and plenty of fluids.

    The virus is most dangerous when transmitted to a pregnant woman because it can cause microcephaly, a condition in which the brain does not develop properly in the fetus, resulting in a smaller-than-normal head.

    In addition to the CDC’s antibody-detection test, which is known as Zika MAC-ELISA, another test from the CDC is designed to distinguish the Zika virus from closely related microorganisms that cause dengue and chikungunya.

    In both, a specimen of blood, urine or other fluid from the body is put onto a plastic plate and subjected to several hours of incubation and washing, followed by the addition of a reagent that will produce a color pattern. An instrument that measures colors is then used to confirm the presence of the virus, said Randall Kincaid, the senior scientific officer at the National Institute of Allergy and Infectious Diseases.

    The turnaround time on each should be about a day, he said.

    “It isn’t my favorite or anyone’s favorite type of an assay,” Kincaid said, “but it’s what the CDC had available as a template for evaluating infections by endemic virus.”

    Acknowledging that this takes time, Kincaid said, “If your concern is knowing that you’ve been infected, you’re willing to sacrifice a day to get the most reliable answer.”

    The other procedures also use blood and other body fluids to look for the Zika virus’ RNA, a molecule that is important to genetic expression. Each test, Kincaid said, teases out the virus — if it’s there. The result should be available within hours.

    The confidence in these tests is “quite different, based on the virological truths that underlie these tests,” Kincaid said.

    The research is still relatively new, Garry said, so it may take time for articles to appear in peer-reviewed journals.

    Like other Zika-detection tests, Garry said the device he is working on would be similar to a pregnancy test. Blood or urine would be put on a plastic sheet or in a cassette that would show the results.

    Results would be ready within 20 minutes without resorting to a lab, he said.

    So far, results have been “promising,” according to Garry, but he and his colleagues are still working to rule out what is known as cross-reactivity, in which the test reacts to a virus similar to the one that causes Zika.

    The Zika virus is a flavivirus, a member of a gene that includes the viruses that cause West Nile fever, dengue fever and yellow fever.

    Garry said he hopes to have a test ready in a few months and then apply for emergency-use authorization from the FDA.

    He said he is aiming for a test that would provide results quickly and could be used in what he called “low-resource settings,” where a clinic or laboratory might not be available.

    “That’s something we’d love to have access to in the best of worlds,” Kincaid said, because it would become easier to administer the tests in areas where the virus is endemic but access to health care is, at best, scarce.

    This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.



  • September 26, 2016 9:52 AM | Deleted user

    Mosquitoes can spread viruses like Zika, chikungunya, and dengue.This flipbook gives basic information about mosquito control activities and how to protect from mosquito bites. Mosquito control approaches that incorporate community education, and mosquito surveillance and control are often called “integrated vector control.” A vector is an insect, like a mosquito, that can spread viruses.

    Download here

  • September 26, 2016 9:44 AM | Deleted user

    THURSDAY, Sept. 22, 2016 -- An experimental DNA-based vaccine protected monkeys from infection with the birth defects-causing Zika virus, and it has proceeded to human safety trials, researchers report.

    "The vaccine universally elicited antibodies from all primates, but for the animals that got a full dose of vaccine, 17 of 18 were protected from infection," said study co-author Ted Pierson. He is chief of the Viral Pathogenesis Section at the U.S. National Institute of Allergy and Infectious Diseases.

    Based on these findings, researchers have begun clinical safety trials in healthy human beings, Pierson said. These trials will show whether the vaccine is safe in humans, and whether it prompts an immune system response as it did in monkeys.

    "When a vaccine is effective in a lower primate species, it is a good signal that it will be effective in humans," said Dr. Amesh Adalja, a senior associate at the University of Pittsburgh's UPMC Center for Health Security in Baltimore. "The NIH vaccine candidates have cleared an important hurdle, and we are awaiting results from phase 1 human studies."

    However, animal research does not always pan out in humans.

    Zika is the first mosquito-borne virus known to cause terrible birth defects, most of them brain-related. The most common defect is microcephaly, in which a child is born with an abnormally small brain and skull. Thousands of babies have been born with Zika-linked microcephaly, most of them in Brazil, since an outbreak began in South America in April 2015.

    Zika infections have been occurring in south Florida, with 43 cases as of Sept. 21, according to the federal Centers for Disease Control and Prevention. There have been no reports of microcephaly in the state.

    Because of the ongoing transmissions, a Zika vaccine is important to prevent future birth defects, Adalja and Pierson said.

    This potential vaccine contains a piece of DNA created synthetically in the laboratory from the Zika virus, Pierson said.

    When introduced into the body, the DNA causes small virus-like particles to be secreted from cells, Pierson explained. These particles are not full-fledged Zika, but are similar enough to the virus that the immune system might produce an antibody response that will also protect against Zika.

    "This kind of vaccine, which we call a DNA vaccine, there's precedent for this," Pierson said, noting that similar technology was used years ago to create a candidate vaccine for West Nile virus.

    To test the potential effectiveness of the Zika vaccine, researchers provided a single dose to six rhesus monkeys and two shots to 18 monkeys.

    None of the monkeys that received a single dose was protected from Zika infection, but the vaccine did appear to create an antibody response, the researchers found.

    Their blood contained less Zika virus than animals who did not receive the vaccine.

    The two-dose vaccine series protected 17 out of the 18 monkeys against exposure to Zika, and provided researchers with an idea of how much antibody response is needed to protect against infection.

    "The DNA vaccines leading the way in the Zika vaccine rush are an important innovative development, and would represent the first commercially available DNA vaccines if proven to be effective and safe," Adalja said.

    This vaccine could protect fetuses against Zika by creating an immune response in pregnant women that prevents a full-fledged viral infection, Pierson said. The vaccine is not expected to cause Zika-like birth defects itself, because it does not cause Zika infection.

    "The reason why there are Zika-associated neurodevelopmental defects is because the virus is actually infecting the fetus and attacking developing neurons in the fetus, causing direct harm," Pierson explained. "The neurodevelopmental defects are a result of what the viral infection is doing, not a result of the body's immune response."

    It's unclear when this or some other Zika vaccine will be available for use. Any vaccine candidates will have to be tested during a future Zika outbreak, to see whether it is able to protect people against active viral transmission, Pierson said.

    Adalja added that other potential Zika vaccines are in earlier stages of development, including an inactivated virus approach at Walter Reed National Military Medical Center in Bethesda, Md., and RNA vaccines under development by two private companies.

    The findings on the DNA vaccine were published Sept. 22 in the journal Science.

    More information

    The U.S. Centers for Disease Control and Prevention provides more information onmosquito-borne diseases.

    This Q & A will tell you what you need to know about Zika.

    To see the CDC list of sites where Zika virus is active and may pose a threat to pregnant women, click here.

    Copyright © 2016 HealthDay. All rights reserved.


  • September 23, 2016 9:39 AM | Deleted user

    By Lena H. Sun September 21 at 4:54 PM 

    Drug-resistant Neisseria gonorrhoeae diplococcal bacteria, which causes gonorrhea, the second most common infectious disease in the United States. (James Archer/CDC)

    U.S. health officials have identified a cluster of gonorrhea infections that show sharply increased resistance to the last effective treatment available for the country's second most commonly reported infectious disease.

    The findings from a cluster of Hawaii cases, presented Wednesday at a conference on prevention of sexually transmitted diseases, represent the first cluster of cases in the United States that have shown such decreased susceptibility to the double-antibiotic combination used when other drugs have failed. If the bacteria continue to develop resistance, that end-of-the-line therapy ultimately will fail, and an estimated 800,000 Americans a year could face untreatable gonorrhea and the serious health problems it causes, health officials said.

    This latest news about antibiotic resistance came as world leaders gathered at an unusual meeting at the United Nations to address the rising threat posed by superbugs, microbes that can’t be stopped with drugs. Leaders adopted a joint declaration committing them to address the root causes of antimicrobial resistance, especially in human health, animal health and agriculture.

    Nations called for better use of existing tools to prevent infections in humans and animals, including farmed fish. Norway's prime minister spoke about how her country has been vaccinating every single "baby salmon, just like small kids," and as a result, has cut antibiotic use in one of its principal foods and exports to virtually zero.

    One form of Staphylococcus aureus bacteria known as methicillin-resistant Staphylococcus aureus, causes a range of potentially deadly illnesses. (National Institute of Allergy and Infectious Diseases)

    In the United States, drug-resistant gonorrhea already is one of the country's three most urgent superbug threats, according to the Centers for Disease Control and Prevention. In each case, as with other diseases such as pneumonia and tuberculosis, overexposure to antibiotics has allowed the particular germ to more rapidly develop resistance.

    CDC warned this summer that evidence of gonorrhea's diminished vulnerability to one of the last-resort drugs, azithromycin, was emerging nationwide. But it said the other antibiotic, ceftriaxone, was still effective.

    That's why the latest findings are so distressing for health officials. It means current treatment options are in jeopardy, said Gail Bolan, director of CDC's division of STD prevention. "What's unique about this cluster now identified in Hawaii is that these strains, we've really never seen before," she said.

    Laboratory tests of the gonorrhea samples collected from seven people in Honolulu in April and May showed resistance to azithromycin at "dramatically higher levels" than typically seen in the United States, according to researchers from Hawaii's state health department. Five of the seven samples also showed increased resistance to ceftriaxone.

    Hawaii is on the front line for antibiotic-resistant gonorrhea, health officials say, and monitors resistance patterns closely. So the state was able to catch this cluster of cases early. Although the patients were treated successfully with the recommended two drugs, and no other cases were identified, officials are worried that the resistance pattern and cluster indicate the strain was able to spread.

    Many people don't actually know they're infected with gonorrhea because they have no symptoms. As a result, the disease goes undetected and untreated, which can cause a range of problems. Women risk chronic pelvic pain, life-threatening ectopic pregnancy and even infertility. And for both women and men, infection also increases the risk of contracting and transmitting HIV.

    History has shown that gonorrhea bacteria have been able to outsmart and become resistant to a long list of antibiotics that includes penicillin, tetracycline, and fluoroquinolones. CDC has been closely monitoring early warning signs of resistance not only to azithromycin but also to cephalosporins, the class of antibiotics that includes ceftriaxone.

    But officials now say there are no back-up options that are highly reliable, widely available, affordable and well tolerated. An oral antibiotic under development might offer a possible new treatment, researchers from Louisiana State University said at the CDC-sponsored conference in Atlanta. The drug was generally safe and effective in treating gonorrhea in a phase 2 clinical trial; those results will need to be confirmed in a large-scale clinical study.

    The experimental drug works differently from any currently marketed antibiotic. It is a single-dose oral therapy and could be used as an alternative to a ceftriaxone injection. In the randomized controlled trial reported Wednesday, researchers treated 179 people with gonorrhea using the experimental drug alone (at two different dosages) or ceftriaxone alone. Virtually all the patients receiving the experimental drug were cured, they said. Every patient given ceftriaxone also was cured.

    At the UN meeting in New York, antibiotic use in animals was a major focus. Norway long depended on antibiotics to protect farmed salmon from a bacterial fish disease, and the fish industry was concerned that "you couldn't have growth if you don't use antibiotics," Prime Minister Erna Solberg said.

    But that turned out not to be the case, she said. In the late 1980s, scientists there developed an effective vaccine that has no side effects in humans. By 1994, fish farmers had made the switch from antibiotics to vaccination. For 15 years, farmers vaccinated the baby salmon by hand until better technology was developed, she said.

    "We need an international ban on using antibiotics as growth improvement," she said. "To combat illness, yes, but not as growth improvement."

    Participants welcomed what everyone agreed was long overdue attention to antimicrobial resistance. But several said declarations and "action plans" aren't enough without measurable goals and concrete targets.

    At a fundamental level, antimicrobial resistance is a public health failure, some experts said. Governments need to accept that responsibility, stressed Joanne Liu, international president of Doctors Without Borders, which is known by its French acronym, MSF. "I am running out of options," she said. Too often, MSF doctors are treating children injured by war wounds who "end up dying from a bone infection weeks later," she said.

    Martha Tellado, president and chief executive of Consumer Reports, said countries need to launch high-profile public awareness campaigns, and institutions such as hospitals need to be more transparent so consumers can be informed about drug-resistant outbreaks.

    Martin Khor, executive director of the South Centre, an intergovernmental organization of developing countries, said there have been similar declarations to fight antimicrobial resistance in the past.

    "For 40 years, governments have not stepped up enough to take a leadership role," he said. Developing countries need to be convinced of the seriousness of the issue, and their civil societies need to become engaged to exert pressure on elected officials. "If it comes from society, and society says to politicians, 'This is what we want you to do,' then it will create a political will," he said.

    Original Post: The Washington Post

  • September 23, 2016 9:28 AM | Deleted user

    CDC’s 2016-2017 seasonal influenza vaccination campaign will kick-off September 29 with a press conference hosted by the National Foundation of Infectious Diseases (or NFID) in partnership with CDC. CDC director, Dr. Tom Frieden, will join a panel of experts to discuss the upcoming flu season.

    What you should know for the 2016-2017 Flu Season

    An annual flu vaccine is the first and best way to protect you and your family from the flu. People should be vaccinated before flu activity begins. CDC recommends that people get vaccinated by the end of October, if possible.  A few things to note for this flu season:

    • Only injectable flu vaccines (flu shots) are recommended for use this season.
    • Flu vaccines have been updated to better match circulating viruses.
    • There will be some new vaccines on the market this season, including an adjuvanted vaccine for people 65 and older.
    • The recommendations for vaccination of people with egg allergies have changed.

    Learn more about what’s new for the 2016-17 flu season by visiting, https://www.cdc.gov/flu/about/season/flu-season-2016-2017.htm.

    You can join the effort to fight the flu by getting your flu vaccine and encouraging people to protect themselves and their family by doing the same.  Join the conversation online with the hashtag #FightFlu, and show your support by joining CDC’s #FightFlu Thunderclap.


    Original Post: ASPPH


  • September 22, 2016 10:41 AM | Deleted user

    Students in the program will train alongside medical students in clinical care and coursework, as well as pursue an area of scholarly concentration.

    The Stanford University School of Medicine will for the first time offer a master of science program designed to train physician assistants as both clinicians and future leaders in health care.

    “As health-care access improves, we need to equip medical practitioners with the skills to meet growing demand,” saidLloyd Minor, MD, dean of the School of Medicine. “This new master of science program for physician assistants helps health-care teams navigate that complexity and provide precision health: personalized treatment when disease strikes and proactive and preventive care that keeps people from getting sick in the first place.”

    To be considered for admission to the program in the fall of 2017, applications are due Nov. 1.

    “This program will set itself apart from many other physician assistant programs by combining excellence in clinical training with scholarly projects that will help our graduates to become future leaders in their field,” said Charles Prober, MD, senior associate dean of medical education.

    Designed for a class of 25 to 30 students, the 30-month program will emphasize training alongside medical students in coursework and clinical care. It will also require students to choose an area of scholarly concentration within one of four areas: community health, health services and policy research, clinical research or medical education.

    “With the increasing emphasis on coordinated, team-based care as supported by the Affordable Care Act, it is critical that the School of Medicine be able to create an integrated, team-learning environment to educate the biomedical scientists and clinicians of the future,” said Robert Harrington, MD, professor and chair of medicine.


    Replaces associate degree program

    The master’s degree program replaces the associate degree program to train physician assistants that began in 1971 as a partnership between the School of Medicine and Foothill College, a two-year community college in Los Altos. The associate degree program will no longer be offered once its current students have graduated.

    The new program is designed to meet the expanding role of PAs in today’s changing health-care environment, said Susan Fernandes, PA, clinical professor of pediatrics and of medicine.

    “Today’s PAs practice in all areas of medicine,” Fernandes said. “They are leading community health centers, they are front stage in the health-care policy arena, leaders in the classroom and changing health-care delivery through innovation and research.”

    The role of PA, one of the fastest growing professions, has expanded in part due to a shortage of physicians nationwide and the need to meet the growing demands of an aging population, Fernandes said. She and Rhonda Larsen, PA, clinical assistant professor of pediatrics, worked as consultants to help design the new program.

    “We are trying to educate the next generation of PA leaders,” Larsen said. “No other program sets out to do this.”


    ‘New direction for Stanford’


    PAs treat patients as part of a health-care team, collaborating with physicians and other providers, Fernandes said. They often provide a broad range of health-care services that may include conducting physical exams, ordering and interpreting medical tests, diagnosing illnesses, developing treatment plans, prescribing medication and assisting in surgery.

    We are trying to educate the next generation of PA leaders.

    “This is a new direction for Stanford, which has been traditionally a very research-heavy medical school,” said Andrew Nevins, MD, clinical associate professor of medicine and medical director of the new program. “There is little training of advanced practice providers such as PAs. There is no school of nursing, no pharmacy school. This is an opportunity for Stanford to make a mark on this rapidly growing field.”

    The curriculum will emphasize training in the foundational sciences during the five quarters, followed by a year of clinical clerkships. There will be clerkships in obstetrics and gynecology, internal medicine, ambulatory family medicine, pediatrics, surgery, psychiatry and emergency medicine. In addition, students will have several elective rotations that allow them to specialize in their area of interest. For example, a student interested in a career as a surgical PA can complete up to 12 weeks of clerkship in that area.

    Currently there are about 150 accredited training programs nationwide for PAs, almost all master’s programs, with about 70 to 80 new programs on the horizon, Larsen said. The number of practicing PAs has grown from 14,000 in 1990 to about 100,000 today, according to the American Academy of Physician Assistants. The average salary is about $98,000 a year.

    Employment of physician assistants is projected to grow 30 percent between 2014 and 2024, much faster than the average for all occupations, according to the U.S. Bureau of Labor Statistics.

    Original Post: Stanford Medicine News Center

  • September 21, 2016 10:54 AM | Deleted user

    Depression during and after pregnancy may be linked to gestational diabetes, a new government study found.

    Women in the study who reported feeling depressed early in pregnancy were more likely to develop gestational diabetes later in pregnancy compared with those who did not report depression early in pregnancy, according to the study, from researchers at the National Institute of Child Health and Human Development (NICHD).

    The findings suggest that "depression and gestational diabetes may occur together," Stefanie Hinkle, a population health researcher at the NICHD and the lead author of the study, said in a statement. [9 Uncommon Conditions That Pregnancy May Bring]

    In addition, the researchers found that having gestational diabetes may increase women's risk for developing depression after pregnancy: Women in the study who had gestational diabetes were more likely to develop postpartum depression compared with those who did not have gestational diabetes, according to the study.

    Gestational diabetes is a type of diabetes that occurs during pregnancy. When a person has diabetes, the body cannot properly control blood-sugar levels. During pregnancy, diabetes can put both the mother and the baby at risk; women can develop a high blood-pressure condition called preeclampsia, which can become life-threatening, and babies can grow too large within the uterus, which can make birth difficult.

    In the U.S., 9.2 percent of women develop gestational diabetes, and postpartum depression affects 10 to 15 percent of mothers within a year of giving birth, according to the Centers for Disease Control and Prevention.

    In the study, the researchers looked at data from about 2,800 women who were enrolled in the NICHD Fetal Growth Studies-Singleton Cohort, a long-term study that tracked women's health and the health of their babies, during and after pregnancy.

    The women in the study filled out questionnaires in the first and second trimesters of pregnancy and at six weeks postpartum, indicating if they had any symptoms of depression. Based on these responses, the researchers calculated each woman's "depression score." In addition, the researchers reviewed the women's medical records to see if they had gestational diabetes.

    Results showed that women with the highest depression scores in the first and second trimesters were three times more likely to have gestational diabetes than those women with lower depression scores.

    In addition, women who had gestational diabetes were four times more likely to go on to develop postpartum depression compared with women who didn't have gestational diabetes, the researchers found.

    The researchers noted that more research is needed to firmly establish the link between depression and gestational diabetes. The findings did not prove cause and effect, Hinkle said. However, previous studies have suggested that depression may have an effect on how the body breaks down sugar, which could lead to higher blood-sugar levels.

    Until there's more information, doctors may want to keep an eye out for signs of gestational diabetes in pregnant women who have symptoms of depression, Hinkle said. "They may also want to monitor women who have had gestational diabetes for signs of postpartum depression," she added.

    The study was published today (Sept. 19) in the journal Diabetologia.

    Originally published on Live Science.


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