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  • July 25, 2016 9:05 AM | Deleted user

    This question originally appeared on QuoraAnswer by Tirumalai Kamala, Immunologist, Ph.D., Mycobacteriology.

    Primarily because its intended target is the healthy population, the economics of vaccines are unlike those for other medicines.

    • Most governments already factor in this difference and have specific policy guidelines and even laws to help fund mass immunizations campaigns.
    • An international two-tier pricing structure ensures that vaccine costs in poorer countries are far lower than those in their wealthier counterparts.
    • Vaccine cost is also fundamentally different between countries with a publicly funded national health care system. [For example, in Canada it's lower versus other countries like the United States, where it's higher.]
    • [The] difference between childhood and adult vaccination programs is another element that influences vaccine cost: While the former are the intense focus of governments and therefore have robust public-private partnerships to defray costs, adult vaccinations can be fee for service. [This is to say a] healthcare provider [will purchase] vaccines upfront and get reimbursed after administering them.

    Whether a future Zika vaccine will be available for free, or free to everyone, depends on whether Zika presents an epidemic or pandemic threat (circumstance one) or not (circumstance two), if and when such a vaccine becomes available

    Zika virusAedes aegypti mosquitoes are seen at the Laboratory of Entomology and Ecology of the Dengue Branch of the U.S. Centers for Disease Control and Prevention in San Juan, March 6, 2016.Reuters/Alvin Baez/Files


    When a vaccine becomes finally available, if Zika presented an epidemic or pandemic threat, affected governments would likely support mass immunizations campaigns, meaning vaccine cost would be heavily subsidized or even free. Though the particulars of how vaccines are funded differ in different countries, by and large most governments heavily subsidize costs of vaccination. For example, in the U.S., vaccine costs were brought under a common umbrella through the 1962 Vaccination Assistance Act (Section 317 of the Public Health Service Act). Section 317 has been continuously reauthorized since 1962. Thus, it's now a mainstay of immunization support in the U.S.

    The US Vaccine Assistance Act ended up doing several things,

    One, it allowed the Centers for Disease Control and Prevention (CDC) to support mass immunizations through the National Immunization Program.

    Two, it provided financial assistance 'in lieu of cash' to state and local health departments to in turn support mass immunization programs. Specifically, Section 317 allows the U.S. federal government to provide vaccines and personnel, such as CDC Public Health Advisors and epidemiologists to assist local and state health departments in managing these programs.

    Three, through Section 317, the U.S. federal government is able to negotiate down vaccine prices with manufacturers. Factors relevant to cost reduction include sales volume, limited distribution points, no-return policy, to name a few.

    Four, in addition, the U.S. 1993 Vaccines for Children (VFC) Act ensures free vaccines to uninsured children, those on Medicaid or American Indian or Alaska Natives. Thus, in the U.S., most recommended vaccines are covered by either private health insurance plans or government subsidies.


    If, on the other hand, Zika threat in a particular country is so low that it would not be cost-effective for its government to subsidize it, then an individual may have to pay for it out of pocket, similar to the way they do now for travel-related vaccines not covered by health insurance. Intended to protect against a mosquito-borne viral disease like Zika, the yellow fever vaccine is a helpful guide for the cost of a travel-related vaccine in the U.S. See below.

    Yellow feverYellow fever vaccine costs in the United States.Quora

  • July 25, 2016 8:58 AM | Deleted user

    Research has shown no evidence that replacing fat with carbohydrates reduces cardiovascular disease. In fact, the opposite is true: researchers now know that dietary cholesterol is not a cause of clinical cardiovascular disease.3 With both dietary fat and dietary cholesterol exonerated as causes of cardiovascular disease and type 2 diabetes, much recent research has focused on the role of fructose as a cause of these modern-day epidemics.4


    The first US dietary guidelines were issued in 1977 by a commission chaired by Sen. George McGovern (D-S.D.).5 The commission recommended that Americans receive no more than 30% of their energy requirements from fat and no more than 10% of their calories as saturated fat.

    At the time, Robert Olson, MD, PhD, professor of medicine and chairman of the biochemistry department at St. Louis University and an expert on nutrition science, argued that the recommendations were not supported by the available science, and asked for “more research on the problem before we make announcements to the American public.”5 Sen. McGovern, speaking for the commission, stated that “senators don't have the luxury the research scientist does of waiting until every last shred of evidence is in.”5

    Sen. McGovern's comment concerning “every last shred of evidence” was widely off the mark. It was never a question of having supportive but incomplete evidence. There simply was no convincing scientific evidence in support of the commission's recommendations.

    At the time the commission issued its dietary guidelines, only 2,500 people had been studied in randomized control trials that compared different macronutrient content. No study included women. No study showed that a low-fat diet was superior to a diet higher in fat content in any measure of health outcome. In fact, in the one study that compared a 10% saturated fat intake with a diet with unrestricted saturated fat, the patients in the low-fat group had a greater risk of glucose intolerance, insulin resistance, and inflammation. The patients on the low-fat diet also developed atherogenic dyslipidemia with an increase in small dense low-density lipoprotein (LDL) particles and a decrease in protective high-density lipoprotein (HDL) cholesterol.4 Yet, without any study recommending the dietary guidelines, and without any science to back up the guidelines, and with some evidence that the contrary was in fact true, 220 million Americans were advised to lower their saturated fat intake. And Americans have been following that advice for the last 40 years.

    Unfortunately these recommendations were not only wrong, they were dangerously wrong. They have helped lead the way to the present epidemics in coronary heart disease and type 2 diabetes.


    When the food manufacturers started removing the fat from food, the taste went with the fat. The solution: Add sugar and lots of it. This worked well economically, as the introduction of high-fructose corn syrup made cheap sugar plentiful.6

    It didn't work so well metabolically. The huge increases in sugar intake have exceeded patients' physiologic limits.7,8 The result is the pathophysiology that healthcare providers see all around us. Although added sugar seems to be the worst culprit, refined grains appear to share the blame. The 2015 DGAC report explains that more than 70% of the US population eats too much processed grain.

    The medical community is beginning to acknowledge that the old paradigm is crumbling.

    A recent review article titled “Added Fructose: A Principal Driver of Type 2 Diabetes Mellitus and Its Consequences” states that Americans on average consume 30 times more added sugar than they did when the Declaration of Independence was written.8 This added sugar, according to the article, is a major cause of today's diabetes epidemic.

    Another article, with the provocative title “Carbohydrate Intake and Nonalcoholic Fatty Liver Disease: Fructose as a Weapon of Mass Destruction,” states that excessive fructose intake leads to fatty liver disease.9 This initiates a cascade of events resulting in metabolic syndrome and its related illnesses: coronary heart disease, type 2 diabetes, hypertension, and obesity.9


    The liver is the only organ in the human body capable of metabolizing fructose. When the liver is presented with a large fructose load, it converts some to energy through the Kreb cycle, and some to glycogen. The remaining fructose is shunted to the de novo lipogenesis pathway for conversion to fat. The greater the fructose load, the more fat produced. This fat is stored throughout the body, leading to obesity. Fat also is stored in the liver, causing nonalcoholic fatty liver disease.

    A fatty liver is unable to perform normal hepatic functions and loses the ability to respond to insulin. This insulin resistance, in turn, provokes pancreatic beta-cell overactivity, as the pancreas attempts to meet the increased insulin requirements. Eventually the pancreatic beta cells wear out from the overwork, and type 2 diabetes results.

    The fats produced by the liver in response to a high fructose load include triglycerides and small, dense LDL particles. A fatty liver also decreases production of protective HDL cholesterol. This combination of triglyceride and small, dense LDL particle elevation coupled with HDL reduction predisposes patients to coronary heart disease.10-12

    One of the leaders in this field of nutrition science, James J. DiNicolantonio, PharmD, put it this way: “The global epidemic of atherosclerosis, heart disease, diabetes, obesity, and the metabolic syndrome is being driven by a diet high in carbohydrate/sugar as opposed to fat, a revelation that we are just starting to accept.”4

    Now, the so-called French paradox makes sense. Frenchmen and women with their high intake of fatty foods do not have a correspondingly high incidence of coronary artery disease. Now we know why: Dietary fat isn't the cause of coronary artery disease.13,14

    We also now understand how the Inuit could exist on caribou and seal meat, each with high saturated fat content, without developing coronary artery disease. They ate no sugar.15,16 Old paradigms die hard. Galileo spent the last 6 years of his life under house arrest for the heresy of believing that the earth was not the center of the universe. During Galileo's time, the Catholic Church was all powerful. The church found Galileo's ideas heretical.17

    Today, we take for granted that the planets revolve around the sun and find it hard to imagine that this was once viewed as heretical. There will come a time when people will be surprised that we ever doubted that added sugars and refined carbohydrates were driving the coronary heart disease and type 2 diabetes epidemics. In order to reverse these epidemics, a new paradigm will need to be accepted by both the medical community and the lay public.

    This will not be an easy task. A 2014 Gallup Poll shows that the erroneous dietary advice we have been giving has taken hold.18Nearly twice as many Americans try to avoid fat in their diet as opposed to avoiding carbohydrates. Fewer Americans now avoid fat compared with our intake a decade ago. Removing the harmful sugars and refined carbohydrates from our diets is a major challenge for the healthcare industry. PAs are in a unique position to help facilitate this necessary shift.


    Most physicians are undereducated on matters of nutrition. The paradigm implicating dietary fat as the cause of coronary heart disease has reigned supreme for so long that physicians are not aware that their scant dietary knowledge is out of date. PAs can disseminate the correct dietary information to the physicians with whom they are working.

    Research shows that PAs are in an excellent position to provide health education to patients.19 Some physicians may find that they lack the skills, time, and interest to be effective health educators. These physicians may prefer to empower PAs on their teams to provide health education directly.

    PAs are trained in general medical practice. Many PA programs train primary care providers who will work in underserved regions. These are the very same areas that suffer a high prevalence of metabolic syndrome and its tragic sequelae: coronary heart disease and type 2 diabetes. This appears to be due, at least in part, to food industry advertising campaigns, which preferentially target Hispanic and black youth.20 PAs can deliver a different message.

    The desire and ability to educate and guide patients toward healthy lifestyle choices, coupled with an emphasis on providing primary care in underserved areas, place PAs in an ideal position. Training programs must prepare future PAs to understand the biochemistry, pathophysiology, and nutrition science related to excess fructose ingestion.

    With this knowledge, PAs can lead the charge in reversing the devastating epidemics of coronary artery disease and type 2 diabetes.

    See full list of resources here.

    Journal of the American Academy of Physician Assistants:
    July 2016 - Volume 29 - Issue 7 - p 1–3
    doi: 10.1097/01.JAA.0000484299.50943.55

    Ritterman, Jeffrey MD

    Free Access

    Article Outline

    Author Information

    Jeffrey Ritterman is an associate professor and assistant clinical coordinator of the joint master of physician assistant studies/master of public health program at Touro University in Vallejo, Calif. The author has disclosed no potential conflicts of interest, financial or otherwise.

    Every 5 years, following an expert panel's systematic review of the literature on diet, the US Department of Agriculture and the Department of Health and Human Services issue dietary guidelines. The 2015 Dietary Guidelines Advisory Committee (DGAC) report has two startling changes: The 30% upper limit on fat consumption has been eliminated and dietary cholesterol is no longer listed as a nutrient of concern.1 Lifting these restrictions on fat and cholesterol intake reverses 4 decades of dietary advice. This is nothing short of a scientific revolution.2

    Figure. No caption a...

    Image Tools

  • July 25, 2016 8:21 AM | Deleted user

    The health risks that come with smoking cigarettes has been well documented over the decades, with lungs being especially susceptible to smoke inhalation. But a new study has found another key part of the human anatomy could lopsidedly affect women who smoke: The brain. 

    In particular, women who smoke are more likely to experience bleeding on the brain, a condition that is medically known as a stroke called subarachnoid hemorrhaging. In fact, researchers from Finland found, women who smoke at least one pack of cigarettes a day are eight times more likely than their male counterparts to suffer from subarachnoid hemorrhages. 

    The study's lead researcher wanted to make it known that there are a host of adverse health effects that come with smoking cigarettes regardless of gender, but subarachnoid hemorrhages account for 3 percent of all strokes, Health24 reported. 

    "The message for policymakers is that by implementing effective strategies against smoking, they can considerably reduce the burden of subarachnoid hemorrhage," said Dr. Joni Lindbohm, who works at the University of Helsinki with a specialties in neurosurgery and public health. 

    Studies have shown that most strokes are preventable, with an obvious first step for smokers being to quit the habit to reduce chances of suffering from brain bleeding. 

    Most recently, researchers found this week that a risk of having a stroke would be reduced by 12 percent by quitting smoking alone, science news outlet EurekAlert reported. DNA: Smoking dips 10% in 2 yrs, but women smokers up sharply in India.

    "Our findings will inform the development of global population­level interventions to reduce stroke, and how such programs may be tailored to individual regions," said Dr. Salim Yusuf, a professor of medicine of McMaster's Michael G. DeGroote School of Medicine in Ontario, Canada, who co­authored the report. 

    "This includes better health education, more affordable healthy food, avoidance of tobacco and more affordable medication for hypertension and dyslipidaemia." 

    Compounding the new study is the fact that an increasing number of women are apparently smoking cigarettes while they're pregnant, according to research findings released this month and reported on by CBS News. 

    "We have long suspected that smoking status during pregnancy is under­reported," said Dr. Jim Greenberg, director of the Perinatal Institute at Cincinnati Children's Hospital and author of the report. 

    "But now we know just how many women struggle to quit smoking when they are pregnant."

  • July 25, 2016 8:18 AM | Deleted user

     by MAGGIE FOX 

    Florida health officials said Thursday they were investigating a second possible case of Zika spread locally, and Brazilian scientists said they feared they may have found a second species of mosquito can transmit the virus. The two Florida cases — one in Miami­Dade county and another in Broward county — both appear to have no connections to travel to Zika­affected areas, and neither appears to have had sexual contact with a Zika­infected patient, but Florida officials are still checking both possibilities. They're also looking for mosquitoes infected with Zika near both homes, and testing people in both areas to see if anyone else may have been infected with Zika and not known it. 

    "Residents and visitors are urged to participate in requests for blood and urine samples by the department in the areas of investigation. These results will help the department determine the number of people affected," the Florida Department of Health said in a statement. 


    The Centers for Disease Control and Prevention says it has official reports of 1,404 cases of Zika in the continental United States — all travel related. But the CDC says it's very likely that some travelers will be bitten by mosquitoes while still actively infected and that this could cause local Zika outbreaks. That's what Florida officials are checking for now. But it takes two factors for a local outbreak: An infected patient, and an Aedes mosquito that bites the person and then lives long enough for the virus to build up in its body before it bites someone else. 

    Finding infected mosquitoes isn't necessarily easy, said Dr. Peter Hotez, dean of tropical medicine at the Baylor College of Medicine in Houston. "It's a needle in a haystack," Hotez said. 

    Mosquitoes don't transmit the virus to one another, so to find Zika­affected mosquitoes, workers must catch a mosquito that actually bit someone who was infected. "Just because they don't find Zike in an Aedes mosquito doesn't mean there is no transmission," he said. Florida is one of 26 U.S. states where Aedes aegypti mosquitoes have been found. "Now if they get lucky and find it, that's entirely confirmatory," Hotez added. 

    At the same time, officials are making sure that there's no other possible way the two Florida patients could have been infected. 

    "WE CONTINUE TO INVESTIGATE AND HAVE NOT RULED OUT TRAVEL OR SEXUAL TRANSMISSION AT THIS TIME." "We continue to investigate and have not ruled out travel or sexual transmission at this time," a department spokesperson told NBC News. 

    Separately, Brazilian researchers said they'd found that a much more common mosquito, a species called Culex quinquefasciatus, has been infected with Zika. The same team of researchers, at Brazil's Oswaldo Cruz Foundation, reported in March that they had infected Culex mosquitoes with Zika in the lab. 

    If Culex can spread Zika, that would be more troubling. Culex mosquitoes are far more common in temperate zones, such as in the United States. But just this week another team, led by Scott Weaver at the University of Texas Medical Branch, said they had tried and been unable to infect Culex mosquitoes with Zika. 

    "Without access to the methods and data (it is not published in a peer­reviewed journal yet) there is not much that I can say about this Brazilian study," Weaver told NBC News by email. 

    "An effective vector requires not only susceptibility to infection and ability to transmit (virus replication in salivary glands) but a high rate of biting humans in the case of Zika virus." 


    Hotez also says he doubts Culex mosquitoes play a big role in spreading Zika. 

    "If they found Zika in the Culex mosquitoes, it could be they had taken a blood meal from someone with Zika and then you would find the virus. It doesn't mean they transmit the virus," Hotez said. 

    And everywhere so far that Zika has spread have been areas where Aedes aegypti mosquitoes abound. Different mosquito species spread different diseases. Culex mosquitoes can spread West Nile virus, but so far are not known to spread Zika. Aedes aegypti mosquitoes spread yellow fever, dengue, chikungunya and Zika viruses, which are all closely related and biologically adapted to these mosquitoes. 

    And malaria, caused by a parasite called Plasmodium, is spread by entirely different species of mosquito, mostly Anopheles. The big danger from Zika is to pregnant women. It causes severe birth defects in babies if the mother is infected while pregnant. 

    The CDC says it knows of 400 pregnancies affected by Zika in the continental U.S. and another 378 in territories such as Puerto Rico. Of these, 12 babies have been born with birth defects caused by Zika and another six have died, miscarried or been aborted because of severe defects.

  • July 21, 2016 8:43 AM | Deleted user

    Hello. I am Sarah Kidd, medical officer in the Division of STD Prevention at the Centers for Disease Control and Prevention (CDC) and coauthor of "Increase in Incidence of Congenital Syphilis—United States, 2012-2014," which was published in the Morbidity and Mortality Weekly Report in November 2015.[1]

    Over the next few minutes, I will provide you with information about congenital syphilis, including the latest data trends and the critical steps that healthcare providers can take to protect pregnant women and their babies.

    Our recent CDC report finds that after years of decline, the number of congenital syphilis cases reported in the United States increased between 2012 and 2014. Rates in our country are now higher than they have been in nearly 15 years. The increases occurred across all races and ethnicities, and in every region. Without a doubt, the data are very concerning. The resurgence of congenital syphilis points to missed opportunities for prevention within the public health and healthcare systems.

    Syphilis infection during pregnancy can result in significant health problems for an infant. Historical data indicate that up to 40% of pregnancies in women with untreated syphilis will result in miscarriage, stillbirth, or infant death. Infants who live may develop severe illness, including skeletal abnormalities; hepatosplenomegaly; jaundice; anemia; optic atrophy; interstitial keratitis; sensorineural deafness; or meningitis, which can cause developmental delays and seizures. And yet, congenital syphilis is preventable.

    We are calling on clinicians to get back to the basics of syphilis prevention for pregnant women. There isn't a new method to reverse this growing problem. We just need everyone to do what we know works—what has always worked. Here are actions you can take:

    • Screen all pregnant women for syphilis at their first prenatal visit. Some women may be in the asymptomatic stage of syphilis. Women who are asymptomatic can still spread the infection to their unborn babies.

    • Women at high risk should be rescreened early in their third trimester and again at delivery. This includes women with a history of syphilis infection, incarceration, drug use, [or] multiple or concurrent partners, and those who live in areas with high rates of syphilis.

    • If your patient is diagnosed with syphilis, take immediate action. Pregnant women diagnosed with syphilis should be treated with penicillin immediately.[2] Treatment at least 30 days prior to delivery is likely to prevent congenital syphilis. Also, all cases of syphilis and congenital syphilis should be reported to your state or local health departments right away. CDC recommends reporting within 24 hours.

    • Advise your patient to tell her sex partner or partners about the infection and encourage them to get tested and treated to avoid reinfection.

    • Before discharging any newborn infant from the hospital, make sure that the mother has been tested for syphilis at least once during her pregnancy or at delivery. If the test is positive, ensure that the mother and baby are evaluated appropriately before discharge and, if necessary, treated.[2]Also, if a woman delivers a stillborn infant, she should be tested for syphilis.

    • Keep in mind that the same tenets of quality sexually transmitted disease prevention apply to pregnant women, too. Take a sexual history throughout the course of your patient's pregnancy, and talk with her about prevention methods.

    • Partner with health departments, prenatal care providers, and other local organizations to address barriers to obtaining early and adequate prenatal care for the most vulnerable pregnant women in your community. Women who are uninsured or underinsured, and women with substance use issues, have been found to be at increased risk of receiving inadequate or no prenatal care, placing their unborn babies at risk for congenital syphilis.

    For more information, please see CDC's Sexually Transmitted Diseases (STDs) website.

    Web Resources

    Syphilis During Pregnancy—2015 Sexually Transmitted Diseases Treatment Guidelines

    Congenital Syphilis—2015 Sexually Transmitted Diseases Treatment Guidelines

    Congenital Syphilis "Dear Colleague" Letter

    Congenital Syphilis—CDC Fact Sheet

    Sarah Kidd, MD, MPH, is a medical epidemiologist on the Surveillance Team in the Division of STD Prevention at CDC. Her primary responsibilities include monitoring, analyzing, and reporting trends in syphilis morbidity in the United States. A board-certified pediatrician, Dr Kidd is a graduate of the University of Washington School of Medicine and the Boston Combined Residency Program in Pediatrics. She also holds a Master of Public Health degree from the Harvard School of Public Health. Before coming to CDC, Dr Kidd worked as a primary care pediatrician in the United States and in southern Africa.

  • July 21, 2016 7:33 AM | Deleted user

    Bacteria are found on everything we touch - a fact that, unfortunately, is forgotten far too often because we can't see them. So what would happen if people were shown magnified images of the actual bacteria they encounter on a daily basis?

    This is exactly what infection prevention and control specialists Ashley Gregory and Eman Chami did in a study at Henry Ford Hospital in Detroit. Like many hospitals across the country, Henry Ford incorporates hand hygiene as a routine, daily practice and uses continuing education to remind healthcare workers of the importance of cleansing their hands both before and after interacting with patients.

    "Hand hygiene is important because it is the simplest thing that can be done to help prevent infection," Gregory said. "It's something that we all do within our every day, but I don't think people realize the complexity of it in healthcare. Therefore, it lends itself to increased infection rates within hospitals and can also lend itself to bringing home illnesses that workers might not realize they've been carrying on them."

    The 'Yuck Factor'
    For this study, Gregory and Chami wanted to determine whether or not bacteria's "yuck factor" would influence hand hygiene compliance in four units with low hand hygiene compliance rates. Having a background working in a microbiology lab, Gregory has seen firsthand people's reactions upon witnessing what bacteria actually looks like up close. "I knew that would often bring up a feeling of disgust, so I thought that would be a good place to start," Gregory explained.

    A Picture is Worth a Thousand Words
    Using an adenosine triphosphate (AT) meter, Gregory and Chami swabbed surfaces that are frequently touched by healthcare workers - such as mouse pads, doorknobs, keyboards, and other people's hands. They then cultured the bacteria and compiled 12 magnified images of the bacterial contamination into a booklet. "They gross you out," Chami said of the images in a June 9 Henry Ford Health System press release. "They really magnify what people can't see."1

    Between July and September 2015, Gregory and Chami visited each of the four units 10 times. During each visit, they showed healthcare workers the images to illustrate what the bacteria would look like under a microscope. After seeing the images, several healthcare workers with higher readings of bacterial contamination on their hands were willing to have the AT reading done again after they had washed their hands. This gave the infection prevention team a tangible way to show how hand hygiene helps decrease the amount of bacteria on their hands.

    Positive Results 
    Compliance rates were tested at the mid-point of the study and a second time once all the visits had been completed - and it turns out the "yuck factor" is quite effective. For each of the four units, compliance rates increased 22.9 percent, 36 percent, 142 percent, and 37.6 percent, respectively - improving on average by nearly 24 percent. Both Gregory and Chami were surprised at the results. "We were expecting a small increase, but we weren't expecting the extent to which we received the increased hand hygiene rates," explained Gregory.

    "Bacteria are gross-looking, and I think people constantly hear 'Oh, you have to wash your hands from contamination, there could be bacteria on them,' and it's all fine when you say it, but until you put a face to it, people don't realize what you're talking about," Gregory said. "I think giving the face to the contamination really helped to increase hand hygiene."

    A New Tool for the Hand Hygiene Toolkit
    "The impact of the study is that it gives a new tool for our hospital and other hospitals to use to increase hand hygiene compliance and awareness," Gregory said. According to Gregory, this method hasn't been utilized before, but she believes the approach might become implemented throughout other hospitals. In fact, Henry Ford has already received several requests from hospitals across the world for copies of the booklet.

    The study was presented in June at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC) in Charlotte, N.C. "Hand hygiene is one of the most important ways to prevent the spread of infection, and yet it can be one of the most difficult benchmarks to improve," stated APIC 2016 President Susan Dolan, RN, MS, CIC, hospital epidemiologist, Children's Hospital Colorado in an APIC June 9 press release. "The visual nature of this approach proved successful for the team at Henry Ford Health System, and it may offer an effective strategy for other healthcare facilities that are looking for ways to change behavior and improve hand hygiene compliance."2

     Kirsten Malenke is a staff writer at ADVANCE. Contact:



    1.      Henry Ford Health System. Yuck Factor May Boost Hand Hygiene Compliance.

    Association for Professionals in Infection Control and Epidemiology. Seeing is believing: Visual triggers increase hand hygiene compliance.

  • July 21, 2016 6:47 AM | Deleted user

    En Español

    TUESDAY, July 19, 2016 (HealthDay News) -- Maternal infection with the mosquito-borne Zika virus can pose serious dangers to the fetus.

    Now, scientists say they've gained new insight into how the virus infects the fetus, and a potential means of preventing infection.

    Zika can cause serious birth defects if a woman becomes infected while pregnant. Thousands of babies have been born in Brazil with abnormally small heads and brains, a condition called microcephaly.

    "Very few viruses reach the fetus during pregnancy and cause birth defects," noted study lead researcher Lenore Pereira, a professor of cell and tissue biology at the University of California, San Francisco.

    Gaining a better understanding of how Zika does this "may be the most essential question for thinking about ways to protect the fetus when the mother gets infected," she said in a university news release.

    Based on work in the laboratory, Pereira's team discovered that Zika infects numerous types of cells in the placenta and amniotic sac, the fluid-filled sac that surrounds and protects the fetus in the womb. The virus also takes two distinct routes to reach a developing fetus.

    There is a placental route, established in the first trimester of pregnancy, or a route across the amniotic sac that only becomes available in the second trimester, the research team reported.

    In their tests, the researchers also found that an older antibiotic called duramycin effectively blocked the virus from replicating in the type of cells that they believe help transmit Zika along both routes.

    In prior lab work, duramycin has been found to help fight off dengue and West Nile viruses, which are flaviviruses -- the same group of viruses that comprises Zika.

    "Duramycin efficiently blocks infection of numerous placental cell types and intact first-trimester human placental tissue by contemporary strains of Zika virus recently isolated from the current outbreak in Latin America," study co-author Eva Harris said in the news release. She is professor of infectious diseases and vaccinology at the University of California, Berkeley's School of Public Health.

    Early science like this often fails to pan out in humans, so more research is necessary. However, Harris believes that "duramycin or similar drugs could effectively reduce or prevent transmission of Zika virus from mother to fetus across both potential routes and prevent associated birth defects."

    The findings were published July 18 in the journal Cell Host & Microbe.

    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.

    SOURCE: University of California, San Francisco, news release, July 18, 2016

    -- Robert Preidt

    Last Updated: Jul 19, 2016

    Copyright © 2016 HealthDay. All rights reserved.

  • July 20, 2016 11:57 AM | Deleted user

    July 19, 2016 by Bruce Goldman in Medicine & Health / Neuroscience

    A new study shows that taking estrogen has a negligible effect on the mental skills of postmenopausal women. Credit: Shutterstock/Africa Studio

    A study led by a scientist at the Stanford University School of Medicine shows that hormone therapy has a negligible effect on verbal memory and other mental skills regardless of how soon after menopause a woman begins therapy.

    The study is the first large, long-term clinical trial to compare the effects of estradiol, a type of estrogen, on the mental capabilities of women who commence treatment soon after menopause versus those who begin after a long delay.

    "Our results suggest that healthy women at all stages after menopause should not take estrogen to improve memory," said the study's senior and lead author, Victor Henderson, MD, professor of health research and policy and of neurology and neurological sciences. "At the same time, they don't need to be overly concerned about negative effects of estrogen on memory."

    The study, published online July 18 in Neurology, addresses one specific aspect of a longstanding controversy concerning the benefits and harms of hormone therapy for postmenopausal women, whose bodies no longer produce estrogens and progesteroneas they did during childbearing years.

    Doubts about benefits

    Hormone therapy was extremely popular in the United States in the latter part of the last century, but its use—while still widespread, with users numbering in the millions—has dropped off considerably since 2002, when findings from the Women's Health Initiative, a large-scale longitudinal study, raised deep doubts about many of what had been believed to be the treatment's broad benefits.

    The evidence since then has been mixed on many counts, with a number of small studies, typically relatively short in duration, continuing to suggest potential benefits from hormone therapy. One question is whether the retention of mental abilities—such as memory, reasoning, planning and selective attention—is improved by starting hormone therapy soon after menopause rather than many years later.

    The new study is part of a recently completed trial, the Early versus Late Intervention Trial with Estradiol, which enrolled large numbers of postmenopausal women to examine hormone therapy's potential for countering atherosclerosis. One thing ELITE sought to determine was whether outcomes for women taking estradiol, the dominant natural sex steroid in premenopausal women, and progesterone, another steroid involved in the menstrual cycle, would be different than that of women who took Prempro, which was used as part of the Women's Health Initiative in the early 2000s. Prempro is a mixture of modified estrogens derived from mares' urine combined with medroxy-progesterone acetate, a substance whose effects approximate but do not duplicate those of progesterone.

    The trial also sought to determine when women should begin hormone therapy to ensure maximal benefits. Depending on the hoped-for clinical outcome, some evidence, mostly from animal studies, suggests that for a woman to benefit from hormone replacement, it may be essential to start soon after menopause, before the rapid postmenopausal decline in estrogen and progesterone availability irreversibly damages hormone-starved cells and tissues.

    Estradiol or placebo

    For the ELITE trial, which took place at the University of Southern California where Henderson's collaborators are based, healthy postmenopausal women were divided into two groups: an "early group," composed of women whose last menstrual period had occurred no more than six years prior to the start of the study, and a "late group," composed of women whose last period had occurred at least 10 years before the start of the study. Women in the two groups were then randomly assigned to daily oral regimens of either estradiol or a placebo. Estradiol-receiving women who hadn't undergone hysterectomies were also given progesterone, which can help protect against estrogens' uterine-cancer-promoting effect. Women receiving placebo instead of estradiol got a progesterone placebo instead of progesterone.

    Henderson and his collaborators received funding to study hormone therapy's effects, over a five-year duration, on these women's cognitive abilities. This adjunct trial, called ELITE-cog, analyzed tests of mental abilities of 567 women between the ages of 41 and 84, representing both the "early" and "late" groups of women. The women's verbal memory; their executive functions, such as judgment, planning, reasoning and focusing attention; and their overall neuropsychological condition were assessed at the beginning of the trial and at 2.5 years and five years later.

    The difference between the two groups of women on any of these measures was negligible, Henderson and his colleagues found. In fact, there was no appreciable difference in test performance between women receiving estradiol and those given a placebo, regardless of how soon after menopause the women began treatment, the study indicated.

    Even when the scientists, in a separate analysis, excluded data from all women in the "early group" who'd begun hormone therapy any later than three years after menopause, they observed neither positive nor negative effects on these women's mental ability compared to that of women initiating treatment more than 10 years after menopause.

    Henderson, who is also the director of the Stanford Alzheimer's Disease Research Center, cautions that because women with cognitive deficits or outright dementia were excluded in this analysis, the study's results apply only to women with good mental skills at the time they begin treatment. Also, the findings cannot be extrapolated to cardiovascular or other health outcomes of hormone therapy, which must be assessed individually, he said. Indeed, Henderson noted that there's now some evidence that hormone therapy, initiated early, may have beneficial cardiovascular effects, while it is clear that late hormone therapy can contribute to heart disease.

    Hormone therapy during the first five years after the onset of menopause is still approved for relief of moderate-to-severe hot flashes and night sweats, and also has beneficial effects on bone density. "If you're considering hormone therapy for those reasons, this study indicates that there's no particular reason to fear harmful effects on cognition over a five-year period of use," said Henderson. "But there's no reason to expect that this treatment, by itself, will result in meaningful improvement of mental abilities, either."

    The work is an example of Stanford Medicine's focus on precision health, the goal of which is to anticipate and prevent disease in the healthy and precisely diagnose and treat disease in the ill.

    More information: Victor W. Henderson et al. Cognitive effects of estradiol after menopause, Neurology (2016). DOI: 10.1212/WNL.0000000000002980 

    Provided by Stanford University Medical Center

    "Hormone therapy for postmenopausal brain performance has no effect, whether started early or late" July 19, 2016

  • July 20, 2016 11:32 AM | Deleted user

    The Centers for Disease Control and Prevention reported Thursday that Neisseria gonorrhoeae ― that is, the bacteria that causes gonorrhea ― could be developing resistance to our last-line antibiotics that treat it.

    The CDC’s current gold standard treatment for gonorrhea is a combination of two drugs, azithromycin and ceftriaxone, to ensure that if one drug doesn’t kill the bacteria, the other will finish the job. Now, a rise in antibiotic resistance among these two bacteria since 2014 has experts worried.

    “History has taught us that this bacteria has the ability to develop resistance to antibiotics, and sometimes it can do it quite quickly,” Dr. Robert Kirkcaldy, a medical epidemiologist in the CDC’s STD prevention division told The Huffington Post.

    “Our ability to cure people of gonorrhea is going to fade unless we take steps now address growing antibiotic resistance.”

    That said, the United States has not encountered any cases of gonorrhea that are untreatable so far, and despite rising antibiotic resistance, overall resistance rates for the combination treatments are relatively low: just 2.5 percent for azithromycin and 0.8 percent for ceftriaxone.

    As it stands, gonorrhea is the second-most common sexually transmitted infection in the United States, with more than 350,000 reported cases of the infection in 2014. And while gonorrhea has traditionally has been easy to cure, if left untreated, it can cause severe reproductive health problems for women, including pelvic inflammatory disease, infertility and ectopic pregnancy.  

    A perfect storm: cunning bacteria, too few drugs

    Our blind faith in innovation and technology is partially to blame for antibiotic-resistant bacteria’s rise. An over-reliance on these medicines, including for infections that are not bacterial, has hastened bacterial mutations and helped contribute to antibiotic resistance.

    To keep up with infectious bacteria’s evolution, we need to discover new antibiotics if we want to battle gonorrhea version 2.0.

    Unfortunately, we’re not keeping up our end of the bargain. Antibiotic discovery peaked in the 1950s, and according to Pew Charitable Trusts, we haven’tdiscovered a registered class of antibiotics since 1984.

    “If there were an unlimited number of drugs, it may not be an issue,” Kirkcaldy said. “But the number of new drugs is dropping at the same time that bacteria continues to evolve and develop new resistance.”

    Discovering new antibiotics is difficult and costly, and there isn’t much incentive for drug companies to invest in it, according to David Payne, head of the Antibacterial Discovery Performance Unit at GlaxoSmithKline. 

    “The problem with this therapy area is that the return on investment on an antibiotic― if you apply the traditional pharmaceutical model ― is very low,” Payne told the podcast Signal in July. As it stands, GlaxoSmithKline is one of the only big drug makers left in antibiotic production. 

    ”When you couple all of the challenges of discovering and developing antibiotics with the fact that the return on investment in the current pharmaceutical model is very low, this becomes a very unattractive area for companies to invest in,” Payne said.

    The rise of superbugs

    Earlier in July, experts confirmed the second case of a superbug resistant to the last-line of antibiotics in a patient who had undergone surgery in a New York hospital in 2015. Following the report, experts expressed fear that antibiotic-resistant infections could become a routine reality in the near future.

    The CDC considers infections acquired in healthcare settings to be among the most urgent and serious antibiotic-resistant bacteria threats, because they can lead to sepsis or death. 

    What many Americans might not realize is how different the strains of antibiotic-resistant bacteria are from one another. “The bugs that affect people who were in the intensive care unit are going to be different than other infections that affect people in the community or other STDs,” Kirkcaldy said.

    Two million people in the United States become infected with antibiotic-resistant bacteria every year, and 23,000 die as a direct result of those infections, the CDC reports.

    How to turn the tide on antibiotic resistance

    “We need to try to prevent these infections from occurring in the first place,” Kirkcaldy stressed.

    To protect yourself from gonorrhea and other sexually transmitted infections, practice abstinence or use condoms correctly every time you have sex. High-risk individuals, including women younger than 25, people who have multiple sexual partners or those with a new sexual partner, should be screened for gonorrhea every year. 

    And if you do become infected, treatment ― for both you and your recent partners ― is paramount. It’s also a step that doctors sometimes overlook. 

    “Not only will that protect their partners, but it will also prevent the spread of the infection in the community and will protect the initial patient, because then he or she has less of a likely chance of getting it again,” Kirkcaldy said.

    Beyond preventing and treating sexually transmitted diseases, the World Health Organization has a few suggestions for things doctors, patients and industry can do to fight back against antibiotic resistance

    Antibiotic use in animals is a particularly pressing problem. The same low-dose antibiotics that protect livestock from infection and allow it to grow faster, can pass resistant bacteria to humans through food.

    In the medical realm, health care workers need to stop prescribing antibiotics unless they are absolutely necessary. In turn, patients shouldn’t ask for them unless they have a confirmed bacterial infection. As it stands, almost one third of antibiotics are currently prescribed unnecessarily.

    From a public health perspective, the U.S. government is already taking action to address the imminent threat of antibiotic resistance. The government’s National Action Plan allocated $160 million for the CDC to ramp up testing, surveillance and drug development, specifically strengthening local health departments to monitor and prevent outbreaks. In addition, the National Institutes of Health received a $100 million budget increase to fight antimicrobial resistance.

    Still, experts aren’t completely reassured by the government windfall.

    “It’s a big deal, I totally agree, but I’m still a little shocked that it hasn’t happened sooner,” Lance Price, a molecular epidemiologist and director of George Washington University’s Antibiotic Resistance Action Center told the Washington Post in December.

    “I would hate for people to think that this is actually sufficient.”

    Source: Huffington Post

  • July 20, 2016 11:31 AM | Deleted user

    Women undergoing in vitro fertilization have long worried that the procedure could raise their risk for breast cancer.

    After all, the treatment requires temporarily increasing levels of certain sex hormones to five or 10 times the normal. Two of those hormones, estrogenand progesterone, can affect the course of certain kinds of breast cancer.

    A series of studies over the past decade suggested that these former patients may have little to worry about. Experts remained cautious, however, because women who had undergone I.V.F. in the 1980s had not yet reachedmenopause by the time of the research.

    But the largest, most comprehensive study to date, published Tuesday, provides further reassurance: It finds no increased risk among women who have undergone I.V.F.

    “The main takeaway is there’s no evidence of an increased subsequent risk of breast cancer, at least in the first couple decades,” said Dr. Saundra S. Buys, an oncologist at the Huntsman Cancer Institute at the University of Utah, who was not involved in the new study.

    The issue has nagged at specialists in reproductive medicine for some time. In 2008, a retrospective analysis of medical records, which the authors called “preliminary,” found a potential increase in breast cancer amongI.V.F. patients older than 40.

    Another small study of participants at a treatment center in Israel reported an increased risk of breast cancer among women who start I.V.F. after 30.

    Maddeningly, later findings went the other way, seeming to suggest the danger — if there was one — may be greater for younger women.

    A study with roughly 21,000 participants, published in 2012, found that women in Western Australia who began I.V.F. at 24 or younger had an increased risk of breast cancer. No such link was found among women in their 30s or 40s.

    In 2013, though, researchers published a meta-analysis of eight smaller studies tentatively suggesting that I.V.F. did not seem to raise breast cancer risk over all.

    But it did not rule out the possibility that breast cancer might turn up in a bigger group of women tracked more closely for an even longer period. Experts also worried that infertility itself, not only its treatment, might somehow be linked to breast cancer.

    Tuesday’s report, published in JAMA, goes a long way toward answering the lingering questions.

    The huge study not only found no increased risk among women receiving I.V.F., but also found no greater risk among women who had various types of less intensive treatments to improve fertility.

    More than 25,000 Dutch women, with an average age of 32.8 when they started treatment from 1980 to 1995, were followed for a median period of 21 years.

    The researchers took into account an exhaustive list of factors linked to higher risk of cancer, including each woman’s age at the time she gave birth to her first child, her overall number of births and the number of I.V.F. attempts.

    Because I.V.F. patients tend to have babies later in life than women who do not need assistance, “you have to take that into account,” said Alexandra van den Belt-Dusebout, the study’s first author and an epidemiologist at the Netherlands Cancer Institute in Amsterdam.

    More than five million babies have been born worldwide through I.V.F. and other assisted reproduction.

    Perhaps the study’s most surprising finding was that breast cancer risk was significantly lower among those women who underwent seven or more cycles of I.V.F., compared with those who received one or two cycles.

    “That’s reassuring, because you would think if you did I.V.F. 10 times, your risk would be higher,” said Dr. Owen K. Davis, the president of the American Society for Reproductive Medicine.

    The study also showed that women who responded poorly to ovarian stimulation in the first I.V.F. attempt also had decreased breast cancer risk.

    Louise M. Stewart, a researcher at the Center for Population Health Research at Curtin University in Perth, Australia, speculated that the finding might explain why women who had I.V.F. at 24 or younger have an increased risk of breast cancer.

    “Young women generally respond well to I.V.F. treatment,” said Dr. Stewart, who was the first author on the Australia study. She suggested the “increased risk we observed in young women may be related to their response to I.V.F. treatment.”

    Mia Gaudet, the strategic director of breast and gynecologic cancer research at the American Cancer Society, applauded the study for adding a “significant amount of evidence that there is no link between I.V.F. and breast cancer.”

    But she warned, “It’s still not conclusive.” For one thing, today’s protocols for I.V.F. differ slightly in the kinds of drugs given and for how long, the researchers noted.

    The researchers have recruited an additional 10,000 Dutch women who had the latest I.V.F. regimen and 5,000 who received other fertility treatments. They will be tracking their health, as well.

    Also, only 14 percent of participants had reached age 60, so this study cannot say much about postmenopausal breast cancer risk.

    “We just may not be seeing breast cancer in these women yet,” Dr. Gaudet said.

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    A version of this article appears in print on July 20, 2016, on page A15 of the New York edition with the headline: In Vitro Fertilization Is Found to Not Increase Chances of Breast Cancer. Order ReprintsToday's Paper|Subscribe

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