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  • September 13, 2016 9:56 AM | Deleted user

    On August 11, NCCPA announced that effective immediately self-assessment CME and PI-CME are no longer required for certification maintenance. 

    However, NCCPA also announced that PAs will receive an additional 50 percent weighting for self-assessment credits logged with NCCPA and the first 20 PI-CME credits logged during every two-year cycle will now be doubled when logged with NCCPA. PAs should be aware that the extra weighting for self-assessment and PI-CME activities is only relevant to NCCPA certification. States that require CME for license renewal purposes do not apply any additional weighting for self-assessment or PI-CME, and PAs must claim those credits exactly as awarded on their CME certificates. 

    Please see our FAQs for additional information. 

  • September 08, 2016 2:47 PM | Deleted user

    Date: September 6, 2016

    Source: European Society for Medical Oncology

    Summary: Deaths from ovarian cancer fell worldwide between 2002 and 2012 and are predicted to continue to decline in the USA, European Union and, though to a smaller degree, in Japan by 2020, according to new research. The main reason is the use of oral contraceptives and the long-term protection against ovarian cancer that they provide.

    Deaths from ovarian cancer fell worldwide between 2002 and 2012 and are predicted to continue to decline in the USA, European Union (EU) and, though to a smaller degree, in Japan by 2020, according to new research published in the leading cancer journal Annals of Oncology today.

    The main reason is the use of oral contraceptives and the long-term protection against ovarian cancer that they provide, say the researchers, who are led by Professor Carlo La Vecchia (MD), from the Faculty of Medicine, University of Milan (Italy). They say the decline in hormone replacement therapy (HRT) to manage menopausal symptoms and better diagnosis and treatment may also play a role.

    Using data on deaths from ovarian cancer from 1970 to the most recent available year from the World Health Organization, the researchers found that in the 28 countries of the EU (minus Cyprus due to the unavailability of data) death rates decreased by 10% between 2002 and 2012, from an age standardised death rate per 100,000 women of 5.76 to 5.19.*

    In the USA the decline was even greater, with a 16% drop in death rates from 5.76 per 100,000 in 2002 to 4.85 in 2012. In Canada ovarian cancer death rates decreased over the same period by nearly 8% from 5.42 to 4.95. In Japan, which has had a lower rate of ovarian cancer deaths than many other countries, the death rate fell by 2% from 3.3 to 3.28 per 100,000. Large decreases occurred in Australian and New Zealand between 2002 and 2011 (the most recent year for which data were available); in Australia the death rate declined by nearly 12% from 4.84 to 4.27, and in New Zealand they dropped by 12% from 5.61 to 4.93 per 100,000 women.

    However, the pattern of decreases was inconsistent in some areas of the world, for instance in Latin American countries and in Europe. Among European countries, the percentage decrease ranged from 0.6% in Hungary to over 28% in Estonia, while Bulgaria was the only European country to show an apparent increase. In the UK, there was a 22% decrease in death rates, which fell from 7.5 to 5.9 per 100,000 women. Other EU countries that had large decreases included Austria (18%), Denmark (24%) and Sweden (24%).

    The Latin American countries tended to have lower rates of deaths from ovarian cancer. Argentina, Chile and Uruguay showed decreases between 2002 and 2012, but Brazil, Colombia, Cuba, Mexico and Venezuela all showed increases in death rates.

    Prof La Vecchia said: "The large variations in death rates between European countries have reduced since the 1990s when there was a threefold variation across Europe from 3.6 per 100,000 in Portugal to 9.3 in Denmark. This is likely to be due to more uniform use of oral contraceptives across the continent, as well as reproductive factors, such as how many children a woman has. However, there are still noticeable differences between countries such as Britain, Sweden and Denmark, where more women started to take oral contraceptives earlier -- from the 1960s onwards -- and countries in Eastern Europe, but also in some other Western and Southern European countries such as Spain, Italy and Greece, where oral contraceptive use started much later and was less widespread.

    "This mixed pattern in Europe also helps to explain the difference in the size of the decrease in ovarian cancer deaths between the EU and the USA, as many American women also started to use oral contraceptives earlier.

    "Japan, where deaths from ovarian cancer have traditionally been low, now has higher rates in the young than the USA or the EU -- again, reflecting infrequent oral contraceptive use."

    Another researcher, Dr Eva Negri, Head of Epidemiologic Methods at the IRCCS Istituto di Ricerche Farmacologiche Mario Negri in Milan, added: "Women in countries such as Germany, the UK and the USA were also more likely to use hormone replacement therapy to manage menopausal symptoms than in some other countries. The use of HRT declined after the report from the Women's Health Initiative in 2002 highlighted the increased risk of cardiovascular disease, as well as breast and ovarian cancer, and so this may also help to explain the fall in death rates among middle-aged and older women in these countries."

    The researchers predicted the age-standardised ovarian cancer death rates for France, Germany, Italy, Poland, Spain and the UK, and for the whole of the USA, the EU and Japan up to 2020. They expect there will be a 15% decline in the USA and a 10% decline in the EU and Japan. Of the six European countries, only Spain showed a slight increase from 3.7 per 100,000 women to 3.9. "This is possibly due to the fact that women who are middle-aged or elderly now were less likely to use oral contraceptives when they were young," concluded Prof La Vecchia.

    Professor Paolo Boffetta (MD), the Annals of Oncology associate editor for epidemiology and Associate Director for Population Sciences at the Tisch Cancer Institute of the Icahn School of Medicine at Mount Sinai in New York (USA), commented: "The findings of Professor La Vecchia and his colleagues are important as they show how past use of hormone treatments has an impact on the mortality from ovarian cancer at the population level. As our understanding of preventable causes of this major cancer progresses, early detection strategies are being developed and novel therapeutic options become available, we enhance our ability to reduce ovarian cancer mortality."


    * Age-standardised rates per 100,000 of the population are adjusted according to the proportions of women in different age groups in the overall population.

    Story Source:

    The above post is reprinted from materials provided by European Society for Medical OncologyNote: Content may be edited for style and length.

    European Society for Medical Oncology. (2016, September 6). Deaths from ovarian cancer decline worldwide due to oral contraceptive use. ScienceDaily. Retrieved September 8, 2016 from

  • September 08, 2016 2:33 PM | Deleted user

    Take full advantage of your member benefits, register now for the upcoming webinar!

    September 27th, 2016 - Register Now

    8pm eastern/ 5pm pacific
    Topic: Let’s talk about sex:  Addressing reproductive health with patients who are LGBT

    Presentation Objectives:

    • To become familiar with the history and terminology as it relates to the LGBT community
    • Provide a foundation for delivering excellent sexual healthcare for LGBT patients
    • Identify STIs that pose a specific concern for LGBT patients
    • Recognize sexual dysfunction disorders in LGBT patients

    This program has been reviewed and is approved for a maximum of 1.00 AAPA Category 1 CME credits by the PA Review Panel. PAs should claim only those hours actually spent participating in the CME activity. 

    This program was planned in accordance with AAPA's CME Standards for Live Programs and for Commercial Support of Live Programs.

  • September 02, 2016 8:07 AM | Deleted user

    THURSDAY, Sept. 1, 2016 (HealthDay News) -- Where there's a Zika outbreak, there will likely be an accompanying increase in cases of Guillain-Barre syndrome, a new analysis shows.

    The latest finding strengthens a suspected link between infection with the mosquito-borne virus and the syndrome, which causes temporary paralysis in its victims.

    While the Zika virus doesn't pose a significant health threat to most people, it can cause a devastating birth defect called microcephaly, which leads to babies born with abnormally small heads and brains.

    The vast majority of Zika infections have been in Latin America and the Caribbean, with Brazil the epicenter.

    In areas where Zika outbreaks were reported, the researchers behind the new study documented a significant increase in Guillain-Barre cases. Guillain-Barre is known to be caused by infection with other viruses, the scientists noted in their report.

    More than 164,000 confirmed and suspected cases of Zika and almost 1,500 cases of the Guillain-Barre syndrome were reported from April 2015 to March 2016 in Brazil, Colombia, the Dominican Republic, El Salvador, Honduras, Suriname and Venezuela. The jump in Guillain-Barre cases followed peaks in Zika infection, the analysis found.

    The researchers, from the Pan American Health Organization in Washington, D.C., and the health ministries of the affected countries, concluded "that [Zika] infection and the Guillain-Barre syndrome are strongly associated. Additional studies are needed to show that [Zika] infection is a cause of the Guillain-Barre syndrome."

    The report was published Wednesday in the New England Journal of Medicine.

    Meanwhile, on Tuesday the head of the U.S. Centers for Disease Control and Prevention said that federal funds to combat the Zika virus are nearly exhausted and there will be no money to fight a new outbreak unless Congress approves more funding.

    As of Friday, the CDC had spent $194 million of the $222 million it was given to fight the virus, said agency director Dr. Thomas Frieden, The New York Times reported.

    Congress broke for its summer recess without approving additional funding. With Zika circulating in Florida, Frieden said the need for new funding was urgent.

    The CDC has sent about $35 million to Florida -- which has several dozen cases of locally transmitted Zika infections -- and much of that has been spent, Frieden said. But, he added, if another cluster of Zika cases occurs in Florida, or if there is an outbreak in a second state, the agency would not be able to send emergency funds, according to The Times.

    "The cupboard is bare, there's no way to provide that," he said at a briefing with reporters in Washington, D.C.

    Senate Republicans have scheduled a vote on $1.1 billion in Zika funding for next Tuesday, when Congress comes back into session, according to a spokesman for Senate majority leader Mitch McConnell, Republican of Kentucky.

    But Democrats oppose that package because it would exclude Planned Parenthood from the list of providers that would get new funding for contraception to combat the spread of Zika, which also can be transmitted sexually.

    Public health experts say the funding issue is critical because the Gulf Coast, where theAedes mosquito that transmits Zika mostly lives, is only halfway through peak mosquito season. There's a high risk that Zika could start circulating in New Orleans or Houston, the newspaper reported.

    The danger of mosquito-borne Zika infection for pregnant American women became more imminent this month, with two neighborhoods in the Miami area reporting cases of locally acquired infection. The CDC is now advising that pregnant women avoid traveling to these areas of Miami to reduce their risk of contracting Zika.

    The CDC also is advising pregnant women not to travel to an area where active Zika transmission is ongoing, and to use insect repellent and wear long pants and long-sleeved shirts if they are in those areas. Partners of pregnant women are advised to use a condom to guard against sexual transmission during pregnancy.

    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.

    SOURCES: Aug. 31, 2016, New England Journal of Medicine; Aug. 30, 2016, Morbidity and Mortality Weekly Report, U.S. Centers for Disease Control and Prevention; The New York Times

    -- E.J. Mundell

    Last Updated: Sep 1, 2016

    Copyright © 2016 HealthDay. All rights reserved.

  • September 01, 2016 12:58 PM | Deleted user

    Growing resistance to antibiotics has complicated efforts to rein in common sexually transmitted diseases like gonorrhoea, chlamydia and syphilis, the World Health Organization warned Tuesday as it issued new treatment guidelines.

    "Chlamydia, gonorrhoea and syphilis are major public health problems worldwide, affecting millions of peoples' quality of life, causing serious illness and sometimes death," Ian Askew, head of WHO's reproductive health and research division, said in a statement.Globally, more than one million people contract a sexually transmitted disease (STD) or infection (STI) every day, WHO said.

    WHO estimates that each year, 131 million people are infected with chlamydia around the globe, 78 million with gonorrhoea and 5.6 million with syphilis.

    More than one million people contract a sexually transmitted infection (STI) every single day, WHO medical officer Teodora Wi said.

    Until recently, the three diseases, which are all caused by bacteria, had been fairly easy to treat using antibiotics, but increasingly those drugs are failing, WHO said.

    "Resistance of these STIs to the effect of antibiotics has increased rapidly in recent years and has reduced treatment options," the UN agency said.

    Resistance is caused, among other things, by doctors overprescribing antibiotics, and patients not taking the correct doses.

    Injected into the buttock or thigh

    Strains of multidrug resistant gonorrhoea that do not respond to any available antibiotics have already been detected, while antibiotic resistance also exists in chlamydia and syphilis, though it is less common, it said.

    When left undiagnosed and untreated, the three diseases can have serious consequences, causing pelvic infamatory disease and ectopic pregnancy in women, and increasing the chances of miscarriage, stillbirth and newborn death.

    They can also greatly increase the risk of being infected with HIV, and untreated gonorrhoea and chlamydia can leave both men and women infertile.

    To rein in resistance, WHO on Tuesday presented new guidelines aimed at ensuring that doctors prescribe the best antibiotics, and the right doses, for treating each specific disease.

    To reduce the spread of the diseases, national health services will need to "monitor the patterns of antibiotic resistance in these infections within their countries," Askew said.

    For gonorrhoea for instance, WHO recommends that health authorities study local resistance patterns and advise doctors to prescribe the most effective antibiotic with the least resistance.

    For syphilis, meanwhile, WHO recommended a specific antibiotic—benzathine penicillin—that is injected into the buttock or thigh muscle.

    It stressed that condom use was the most effective way to protect against STD infection.

    Source: Medical Express

  • September 01, 2016 12:50 PM | Deleted user

    As the PA profession evolves, so does the language used to talk about it. The explosive growth of the profession, coupled with the continued modernization of PA laws, is rapidly changing the way PAs practice and the language we use to describe what they do. This is a reference guide for how to communicate about the profession in a way that reflects the realities of modern PA practice. If you have any questions, please contact Janette Rodrigues, Editorial Director, (571.319.4382, 

    The PA Abbreviation Use “PA” as the title of the profession in all copy, not “physician assistant.” We do not use “physician assistant” any longer to refer to the profession as the name does not adequately depict the medical services PAs provide to patients every day. If you must spell it out to aid in external audience awareness, only use “physician assistant” once in parentheses after the first PA reference, i.e., PA (physician assistant). Use PA for all subsequent references. The PA Honorific To promote uniformity of address in clinical and other settings, use PA as the honorific before the person’s name, i.e., PA Pam Smith or PA Smith. Encourage the adoption of PA [surname] as the recommended address for PAs among staff and external audiences, unless a more suitable formal address is appropriate, such as military rank or academic role. 

    Who are PAs? 

    PAs are nationally certified and state licensed to practice medicine and prescribe medication in every medical and surgical specialty and setting and in all 50 states, the District of Columbia and all U.S. territories, with the exception of Puerto Rico. PAs are educated at the graduate level, with most PAs receiving a master’s degree or higher. In order to maintain national certification, PAs are required to complete 100 hours of continuing medical education every two years and to recertify as medical generalists every 10 years. 

    What do PAs do? 

    • PAs practice medicine. 

    • PAs practice in every medical and surgical specialty and setting. 

    • PAs manage the full scope of patient care, often handling patients with multiple comorbidities. 

    • PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, assist in surgery, coordinate care, counsel on preventive healthcare, prescribe medications and more. 

    How do PAs work? 

    PAs’ scope of practice is determined by their education and experience. Scope of practice is also subject to state laws and facility policy. In optimal settings, PAs practice at the top of their education, training and experience, and the scope is determined at the practice level. 

    • PAs practice medicine in teams with physicians and other healthcare professionals. 

    Why are PAs unique? 

    • PAs increase access to healthcare. 

    • PAs provide quality care and have been shown to positively impact patient outcomes. 

    • PAs are educated, to seamlessly work in a team-based model of care. 

    • PAs are educated as medical generalists and recertify as medical generalists. 

    • PAs are one of the most versatile healthcare providers; during the course of their career, most PAs will have worked in two to three specialties. 

    • PAs manage patient care coordination and provide clinical preventive services. 

    • Four out of five PAs report high job satisfaction. 

    Phrases to Avoid 

    • Inaccurate Terminology: 

    “PAs are mid-level providers, physician extenders, non-physician providers, advanced practice providers or advanced practice clinicians.” 

    • These terms are often misunderstood by consumers and do not accurately portray or describe how PAs practice medicine to other providers or patients. Nor do they reflect their license or legal title. 

    If PAs need to be referenced as part of a larger group, use “healthcare provider”, “healthcare practitioner,” or “clinician” but the preferred reference would include simply the title name of each profession (e.g., “PAs and NPs”). 

    • Inaccurate Terminology: “PAs work on physician-led teams.” or “PAs are supervised by a physician.” 

    It is no longer the case that physicians have to be at the helm of the care team. Today’s PAs collaborate with physicians. Supervision should only be referenced when required by legal and regulatory documentation. For example, patient-centered medical homes allow for various health professionals to function as leaders of care teams, including PAs. In practice, a PA’s scope typically grows over time with clinical experience. It is common for a PA to serve as the lead on care coordination teams and see patients in all settings without a physician present. In fact, in many rural and underserved areas, a PA may be the only provider, with PA-physician collaboration occurring via telecommunication.

  • September 01, 2016 11:54 AM | Deleted user

    FRIDAY, Aug. 26, 2016 (HealthDay News) -- U.S. health officials report that the Zika virus can be spread sexually even when a partner shows no signs of infection.

    A Maryland woman who had not traveled to an active Zika area was diagnosed with the virus in June after having condomless sex with a man who had been to the Dominican Republic, according to the U.S. Centers for Disease Control and Prevention.

    The mosquito-borne virus is circulating in the Dominican Republic, but the man had experienced no Zika symptoms, such as fever, pink eye or rash. Although he had felt tired, he blamed that on traveling.

    Testing, however, confirmed that he had been exposed to Zika, researchers said.

    "As more is learned about the incidence and duration of seminal shedding of Zika virus in infected men, recommendations to prevent sexual transmission of Zika virus will be updated if needed," the CDC researchers said.

    Zika can cause severe brain damage in babies whose mothers are exposed to it during pregnancy. It is also tied to a rare autoimmune disorder called Guillain-Barre syndrome.

    Only one other case of sexual transmission of Zika without symptoms is known to the CDC. But in that case a mosquito bite -- the usually source of Zika -- couldn't be ruled out because both partners had traveled to an active Zika region outside the United States.

    This new twist in the myriad ways Zika can spread should strengthen warnings to couples hoping to start a family if either one plans to travel anywhere the virus is active, health officials said. Currently, it's circulating in South and Central American countries and the Caribbean. Parts of Florida have also experienced local Zika transmission.

    Regardless of whether Zika symptoms surface, if one partner travels to a Zika region, couples should wait at least eight weeks before attempting to start a family, the CDC reiterated.

    Also, men with a Zika diagnosis should wait at least six months before trying for pregnancy and women with Zika should wait at least eight weeks before trying to conceive, the agency says.

    Couples not trying to have children should use reliable birth control and condoms to help prevent transmission of the virus. They also might consider abstaining from sex, the CDC says.

    A second CDC report adds to knowledge about the link between Zika and Guillain-Barre, which is characterized by weakness and paralysis.

    Since Puerto Rico's first Zika diagnosis last December, cases of Guillain-Barre there have dramatically increased, the CDC reported. Fifty-six suspected cases of Guillain-Barre were reported the first seven months of 2016, of which 34 were linked to infection with Zika or an unspecified flavivirus. (Zika is the chief flavivirus now active in Puerto Rico.)

    "Overall, the number of persons with suspected [Guillain-Barre] and evidence of Zika virus or flavivirus infection was 2.5 times greater than the number of persons with suspected [Guillain-Barre] and no evidence of Zika virus infection," the report says. Most of the Guillain-Barre patients were older than 50, and one died.

    Both reports were published Aug. 26 in the CDC publication Morbidity and Mortality Weekly Report.

    More information

    The World Health Organization has more about Zika virus.

    SOURCE: Aug. 26, 2016, U.S. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report

    -- Margaret Farley Steele

    Last Updated: Aug 28, 2016

    Copyright © 2016 HealthDay. All rights reserved.

  • September 01, 2016 11:53 AM | Deleted user

    By Dennis Thompson
    HealthDay Reporter

    MONDAY, Aug. 29, 2016 (HealthDay News) -- Three already existing drugs may offer pregnant women and their developing fetuses protection against the damaging effects of Zika virus, a new multicenter study reports.

    Researchers identified these three potential Zika treatments in the laboratory by screening 6,000 different compounds that included already-approved drugs and clinical trial drug candidates.

    "We specifically in this screen tried to take advantage of compounds that are already FDA-approved or in some stage of clinical development," said study co-author Emily Lee. She's a graduate student of molecular biology at Florida State University in Tallahassee.

    One of the drugs, sold as Niclosamide, is already on the market as a treatment for tapeworm. But it appears to also have antiviral properties that inhibit Zika from replicating, the researchers reported.

    Another antiviral drug potentially effective against Zika is PHA-690509. This is a medication that is currently in development that works by interfering with gene expression, the study authors said.

    And finally, investigators identified a third medication awaiting U.S. Food and Drug Administration approval that doesn't directly act against Zika, but may be able to protect the brain cells of developing fetuses against viral damage. The drug, Emricasan, inhibits a natural process that causes programmed cell death.

    "This compound wouldn't necessarily be good for treating infections by itself, because it can't stop the infection, but maybe we can use it to buy time and protect the cells against the infection," Lee said.

    Zika virus is mainly spread via mosquito bites. Infection poses significant risks to pregnant women, because it can cause a birth defect called microcephaly, which results in babies born with undersized heads and underdeveloped brains.

    The virus is currently being actively transmitted in two areas of metropolitan Miami, according to the U.S. Centers for Disease Control and Prevention. Zika has achieved epidemic status in the U.S. territory of Puerto Rico, and is widespread throughout Central and South America.

    The new drug research moved at breakneck pace, identifying the three compounds in a couple of months thanks to a large-scale collaboration between the U.S. National Institutes of Health, Johns Hopkins University in Baltimore, Florida State University, the Icahn School of Medicine at Mount Sinai in New York City, Emory University in Atlanta, and Zhejiang University in China, Lee said.

    Researchers already have started testing the drugs in mice, but much work needs to be done before they'll be available to humans, Lee noted.

    For example, researchers have to test in mice and primates whether the drugs are effective at all against Zika in living creatures, and whether they are safe to take during pregnancy, she explained.

    "It could be very fast, or it could take a long time," Lee said of the process. "If that works really well in mice, with no problems, it would be much easier to move it into primates right away and then into clinical trials right away. But if there are any problems, it could extend the process out."

    For women who are not pregnant and males, testing the compounds in clinical trials will take a minimum of 1 to 2 years, said study co-author Dr. Wei Zheng.

    "However, for the pregnant women, the timeline will be much longer because we need additional preclinical toxicology studies to make sure the drugs are safe," added Zheng, who is a researcher at National Center for Advancing Translational Sciences at the U.S. National Institutes of Health.

    Infectious disease expert Dr. Amesh Adalja said the "possible repurposing of existing compounds that may be already in use for another indication is an important part of developing a rapid response to an emerging infectious disease outbreak such as Zika."

    According to Adalja, a senior associate with the UPMC Center for Health Security in Baltimore, "This new data is very promising and may lead to effective antiviral therapies against Zika. However, it will be equally important to develop a concept for how these drugs could be used."

    Most people with Zika don't have any symptoms ("asymptomatic") and are unlikely to realize they're infected, according to the CDC.

    "It is extremely difficult to effectively intervene on asymptomatic patients given that they have no symptoms and thus no signal that they are harboring the virus," Adalja said.

    Lee suggested that if the antiviral drugs prove effective, public health officials might choose to deploy them in areas with active Zika infection.

    "If people are being used as reservoirs for the virus, we might want to start proactively treating populations where Zika is in circulation, to stop the circulation," she said.

    However, she warned people against buying Niclosamide, the only one of the three drugs already on the market, for off-label use against Zika at this point.

    "Even if we think it's going to work, we don't want to take a chance with people," Lee said. "We just don't know enough about it yet. Wait and see what our groups come up with."

    The study was published Aug. 29 in Nature Medicine.

    More information

    For more on the Zika virus, visit the U.S. Centers for Disease Control and Prevention.

    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.

    SOURCES: Emily Lee, graduate student, molecular biology, Florida State University, Tallahassee, Fla.; Amesh Adalja, M.D., senior associate, UPMC Center for Health Security, Baltimore; Wei Zheng, Ph.D., researcher, National Center for Advancing Translational Sciences, U.S. National Institutes of Health; Aug. 29, 2016, Nature Medicine

    Last Updated: Aug 29, 2016

    Copyright © 2016 HealthDay. All rights reserved.

  • September 01, 2016 10:54 AM | Deleted user

    When Delaware Gov. Jack Markell took office in 2009, he vowed to bring more opportunities to residents of his state. What was standing in their way, the governor found, was a higher rate of unintended pregnancy than anywhere else in the U.S. So he took actions to reduce unintended pregnancies in the state.

    Delaware is making long-acting reversible contraception available at low or no cost to women of childbearing age, thanks in part to a partnership with the nonprofit organization Upstream USA, which trains health care providers and health centers to offer intrauterine devices and birth control implants.

    Markell told The Nation’s Health that in his eyes, all other types of opportunities — such as pursuing education, building a career, saving money to buy a home and having healthy birth outcomes — were influenced by whether or not people were able to decide when and how to build their families. A March Guttmacher Institute fact sheet showed that in 2010, Delaware had 62 unintended pregnancies for every 1,000 women ages 15-44 in 2010. The rate was the highest in the nation and accounted for 57 percent of all births in the state.

    “I pretty quickly came to the conclusion that this is the most important thing that we can do to help more Delawareans reach their potential,” Markell said.

    So with the help of Upstream, Delaware invested $1.75 million in state funding, as well as $13 million in philanthropic giving, to reshape the way Delaware residents access family planning. The initiative, called Delaware Contraceptive Access Now, started not with community education, but with billing.

    For many women, one of the best and easiest times to insert an intrauterine device is right after delivering a baby. However, in Delaware, as with many states, the medical reimbursement system did not cover IUD insertion after delivery. Instead, providers had to schedule insertion for their patients’ follow-up well-woman visits, four to six weeks after delivery. The drop-off in seeing patients was substantial, as it cost more money for the women seeking care and there was no medical reason for it.

    “These are barriers we find in health care all around the entire country,” Mark Edwards, co-founder of Upstream, told The Nation’s Health. “Health centers were worried about losing money. When you help them understand how to bill and code properly, they break even at a minimum, maybe even make a little money.”

    In the last two years or so, Upstream staff have been training Delaware health care workers in all aspects of providing IUDs and implants. Licensed medical providers are taught proper insertion and removal of the devices. Front-of-office staff and health care providers learn best practices on how to counsel patients about their birth control options. And billing staff are advised on coding and billing in order to keep the devices affordable. The coverage is not limited to Medicaid patients or certain insurance providers; all providers in the state are covered, from community health centers to private practice and hospitals. As of late July, Edwards said more than 550 Delaware health care staff had received Upstream training.

    Staff at Nemours Alfred I. DuPont Hospital for Children in Wilmington, Delaware, were trained by Upstream staff in February. Krishna White, MD, MPH, chief of the hospital’s division of adolescent medicine and pediatric gynecology, said that the hospital has already seen the positive effects of offering LARC to its adolescent patients.

    The American College of Obstetricians and Gynecologists recommends LARC as a first line of defense for teens looking to prevent pregnancy. IUDs and implants are the most effective forms of reversible birth control, according to the Centers for Disease Control and Prevention. However, short-acting contraceptives such as condoms and birth control pills are both more popular with teens and less effective.

    An April 2015 study from CDC found that less than 5 percent of teens using birth control choose LARC, and many of them know little about the option.


    Delaware health center workers practice inserting and removing IUDs during an Upstream USA training earlier this year. IUDs and implants are the most effective forms of reversible birth control, according to CDC.

    Photo courtesy Upstream USA

    “The majority of patients we see are young women coming in for reproductive concerns,” White told The Nation’s Health. “It’s critically important for teens, who may not be able to make it into another office, or might change their mind. It’s best to provide it for them at the moment they want it.”

    While Delaware is working to make LARC available to residents, it is not alone. Colorado’s Family Planning Initiative, which helps Title X clinics offer low- to no-cost IUDs to teens and women who want them, helped lower the state’s teen birth and abortion rates by 48 percent each from 2009 to 2014, according to the Colorado Department of Public Health and Environment. The program has also been associated with better birth outcomes, according to a study published in the September 2015 issue of APHA’s American Journal of Public Health.

    Thanks to the program, one in three patients of Title X clinics, which are federally funded to provide family planning options, now uses long-acting reversible contraceptives for their family planning methods, said Jody Camp, MPH, family planning section manager at the Colorado Department of Public Health and Environment.

    Along with state support and funding from both state and philanthropic donations, Camp said the media helped in making the program successful in Colorado.

    “It’s been so helpful in normalizing our work,” Camp told The Nation’s Health.“They can speak to people on both sides of the aisle. It’s really helped to gain a better understanding about LARC, not necessarily as a tool for birth control, but a tool for economic self-sufficiency. I do believe that’s what (worked) in our favor when we asked the legislature for additional funding.”

    Another contributing factor to success, however, is the financial payoff for states. Colorado estimated that its LARC program saved the state $49 million to $111 million in Medicaid birth-related costs. While Delaware’s program is still new, Markell noted that healthy Medicaid births cost the state approximately $12,000, and unhealthy births cost even more.

    Upstream’s Edwards said he hopes that more states, cities and clinics will enact programs to make LARC more accessible to those who want it.

    “This is really an opportunity to demonstrate that this kind of investment can reduce unintended pregnancies and improve birth outcomes…improve opportunities and also save a lot of money,” he said.

    To learn more about the Delaware program, visit

  • August 31, 2016 12:32 PM | Deleted user

    Why Talk to My Family?

    Your family members can benefit from knowing about your BRCA1or BRCA2 mutation.  Talk to your family members about your mutation, so they will know that

    • BRCA1 and BRCA2 mutations are passed through families.
    • A person with a BRCA1 or BRCA2 mutation is more likely to get breast, ovarian, and other cancers.
    • Genetic counseling and testing for BRCA1 and BRCA2 mutations can provide information about their risk.
    • If they choose to be tested, they should be tested for the same mutation that you have.
    • Steps can be taken to prevent breast and ovarian cancer or find it earlier.

    View the full resource here.

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