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  • September 21, 2016 10:54 AM | Ashley Monson (Administrator)

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

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

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

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

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

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

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

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

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

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

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

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

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

    Originally published on Live Science.


  • September 21, 2016 9:39 AM | Ashley Monson (Administrator)

    The American College of Obstetricians and Gynecologists (ACOG) has published draft guidelines for women's preventive services, keeping in mind women's unique needs at every stage of life. The guidelines are now open for public comment. Submit your comments until September 30.

  • September 20, 2016 11:52 AM | Ashley Monson (Administrator)

    More than 1 in 4 US adults over 50 do not engage in regular physical activity

    Inactivity puts 31 million at risk of heart disease, diabetes, cancer.

    Despite the many benefits of moderate physical activity, 31 million Americans (28 percent) age 50 years and older are inactive - that is, they are not physically active beyond the basic movements needed for daily life activities. This finding comes from a new study from the Centers for Disease Control and Prevention (CDC) published in Morbidity and Mortality Weekly Report.

    "Adults benefit from any amount of physical activity," said Janet E. Fulton, Ph.D., chief of CDC's Physical Activity and Health Branch and one of the authors of the report. "Helping inactive people become more physically active is an important step towards healthier and more vibrant communities."

    Inactivity across the US

    CDC researchers analyzed data from the 2014 Behavioral Risk Factor Surveillance System for all 50 states and the District of Columbia (D.C.) to examine patterns of inactivity among adults ages 50 and older by selected characteristics. The analysis showed:

    • Inactivity was higher for women (29.4 percent) compared with men (25.5 percent).
    • The percentage of inactivity by race and ethnicity varied: Hispanics (32.7 percent), non-Hispanic blacks (33.1 percent), non-Hispanic whites (26.2 percent), and other groups (27.1 percent).
    • Inactivity significantly increased with age: 25.4 percent for adults 50-64 years, 26.9 percent for people 65-74 years, and 35.3 percent for people 75 years and older.
    • More adults with at least one chronic disease were inactive (31.9 percent) compared with adults with no chronic disease (19.2 percent).
    • By region, inactivity was highest in the South (30.1 percent) followed by the Midwest (28.4 percent) and in the Northeast (26.6 percent). Inactivity was lowest in the West (23.1 percent).
    • By states and D.C., the percentage of inactivity ranged from 17.9 percent in Colorado to 38.8 percent in Arkansas.
    • The percentage of inactivity decreased as education increased and also increased as weight status increased.

    "This report helps us better understand and address differences in inactivity among adults 50 years and older," said Kathleen B. Watson, Ph.D., an epidemiologist in CDC's Division of Nutrition, Physical Activity, and Obesity and lead author of the report. "More work is needed to make it safer and easier for people of all ages and abilities to be physically active in their communities."

    Helping older adults to be physically active

    Physical activity reduces the risk of premature death and can delay or prevent many chronic diseases, including heart disease, type 2 diabetes, dementia, and some cancers. As adults grow older, they are more likely to be living with a chronic disease and these diseases are major drivers of sickness and disability.

    Non-institutionalized adults ages 50 years and older account for $860 billion in health care costs each year; yet 4 in 5 of the most costly chronic conditions for this age group can be prevented or managed with physical activity. Non-institutionalized adults are people not living in institutions such as correctional facilities, long-term care hospitals, or nursing homes and who are not on active duty in the Armed Forces.

    Being physically active helps older adults maintain the ability to live independently and reduces the risk of falling and fracturing bones. Active older adults also have a reduced risk of moderate or severe limitations and are less likely to suffer from falls. Being physically active can also improve mental health and delay dementia and cognitive decline.

    Everyone, including federal, state, and local governments, transportation engineers and community planning professionals, and community organizations can play a role in helping communities offer design enhancements and healthy lifestyle programs to create a culture that supports physical activity.

    CDC is working with state health departments to increase physical activity by increasing the number of communities that have pedestrian and bike-friendly master transportation plans.

    CDC is committed to helping adults of all physical ability levels become or remain physically active, including those with chronic conditions such as arthritis and diabetes. CDC recommends several proven programs that can help people with chronic conditions be active and experience the benefits of physical activity despite physical limitations.

    For more information on CDC efforts to promote physical activity: https://www.cdc.gov/physicalactivity/index.html and https://www.cdc.gov/physicalactivity/basics/older_adults/index.htm.


  • September 19, 2016 12:10 PM | Ashley Monson (Administrator)

    Written by Tim Newman

    Published: Friday 16 September 2016

    Researchers from Johns Hopkins Bloomberg School of Public Health in Maryland recently made a surprise discovery during a mouse trial: progesterone appears to reduce the symptoms of influenza infection and help lungs heal at a faster rate.

    Progesterone is a naturally occurring steroid; it is heavily involved in the menstrual cycle, pregnancy, and the growth of the fetus.

    A progesterone analog is the main constituent of the female contraceptive pill and, as such, is taken regularly by an estimated 100 million young adult women throughout the world.

    A seemingly unrelated but similarly common occurrence is influenza. In America, millions of individuals each year are affected by flu, hundreds of thousands are hospitalized, and tens of thousands die.

    Women of reproductive age are twice as likely as men to experience complications related to influenza infection.

    Perhaps surprisingly, despite the high numbers of women taking progesterone-based drugs, little is known about how the hormone interacts with infections, other than sexually transmitted diseases.

    Progesterone and influenza

    Sabra L. Klein, Ph.D., associate professor of molecular microbiology and immunology, set out to investigate the role of progesterone on the symptoms of an influenza virus infection. The results are published this week in PLOS Pathogens.

    The team of researchers placed progesterone implants in some female mice and left others without; they then infected all the mice with the influenza A virus.

    Both groups of mice became ill, but the mice implanted with progesterone showed better lung function, less pulmonaryinflammation, and any damage to the lungs was repaired more swiftly.

    The increased speed of repair was a surprise to the researchers. Medical News Today recently asked Klein about the results and how they matched her expectations.

    "We initially thought that progesterone may make flu worse in females because pregnancy is a known risk factor. Instead, we observed that progesterone significantly protected female mice against severe disease by mitigating inflammation and improving pulmonary function."

    Sabra L. Klein, Ph.D.

    The role of amphiregulin

    Of course, a surprise result merits further inspection, so Klein and her team set about investigating the origins of progesterone's unexpected interaction.

    It seems that progesterone enhanced lung protection by increasing the production of a growth factor - amphiregulin - in the lining of the lungs.

    Klein told MNT that the "observation got us thinking about how the lungs repair themselves after an infection, which brought us to growth factors, like amphiregulin. When we measured amphiregulin, sure enough, it was unregulated in females treated with progesterone."

    Hormones are known to affect a wide array of tissues, but, as Klein explained to MNT, this "was the first time that the hormonal influences on an epithelial growth factor have been observed outside of the reproductive tract."

    To double check the results, the team bred mice that did not produce amphiregulin. As predicted, once infected by influenza, the mice no longer benefited from the protective powers of progesterone.

    When females get sick with the influenza virus, progesterone naturally falls. Any females who are using progesterone-based contraceptives override this reduction and receive a steady stream of progesterone.

    Capturing progesterone and influenza data

    To date, there is no scientific literature providing information about the potential relationship between the severity of flu and progesterone. To this end, researchers at the Johns Hopkins Center of Excellence for Influenza Research and Surveillance, who take questionnaire data about influenza, have started routinely asking about birth control.

    Eventually, responses to these questionnaires will plug the knowledge gap, giving scientists a better idea of how this protective effect might work in humans.

    When MNT asked about any future studies, Klein responded:

    "We are now conducting studies showing that synthetic forms of progesterone, including levonorgestrel, found in hormone contraceptives and hormone replacement therapies also protect against flu, which has farther reaching implications."

    This finding opens an entirely new avenue of research; and, because progesterone-based medication and influenza are widespread across the planet, any discoveries are likely to be far-reaching.

    Learn about current research into a birth control pill for men.

    Written by Tim Newman

    Progesterone-based therapy protects against influenza by promoting lung repair and recovery in females, Olivia J. Hall et al., PLOS Pathogens, published online 15 September 2016.

    Johns Hopkins Bloomberg School of Public Health news release, accessed 14 September 2016 via EurekAlert.

    Additional source: Seasonal Influenza, more Information, accessed 14 September 2016.

    Visit our Infectious Diseases / Bacteria / Viruses category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Infectious Diseases / Bacteria / Viruses.

    Please use one of the following formats to cite this article in your essay, paper or report:

    APA
    Newman, T. (2016, September 16). "Female hormone found to fight flu damage." Medical News Today. Retrieved from
    http://www.medicalnewstoday.com/articles/312900.php.

    Please note: If no author information is provided, the source is cited instead.


  • September 19, 2016 12:01 PM | Ashley Monson (Administrator)

    Data linking Zika virus (ZIKV) infection to fetal death have been reported in only a handful of cases to date.1,2 Here, we present a case of ZIKV infection in a woman who had a miscarriage. ZIKV was detected in the fetal tissue, and ZIKV viremia lasted for at least 21 days.

    In January 2016, a 31-year-old woman who was 10 weeks pregnant visited an outpatient clinic in Rotterdam, the Netherlands, because of a 2-day history of headache, mild arthralgia in both wrists and the left knee, and a pruritic, macular rash. The symptoms had begun the day after her return from a 3.5-week trip to Suriname, which borders on northern Brazil. During her visit, she had not used malaria chemoprophylaxis or personal protective measures, such as insect repellents.

    The patient’s medical history was uneventful, as was her pregnancy. When she was a child, she had received vaccines according to the regular vaccination program in Suriname, where she had lived until her early twenties. She was vaccinated against yellow fever at the age of 5 years.

    A physical examination revealed normal vital-sign measurements and an absence of fever. A discrete macular rash was noted on the patient’s trunk and both arms. The joints were not visibly swollen or warm but mildly painful with movement. Blood and urine samples were obtained at regular intervals after the physical examination.

    The patient’s symptoms resolved spontaneously after 6 days. On day 14 after the onset of symptoms, ultrasonography performed at a routine prenatal screening visit (estimated gestational age, 11 weeks and 4 days) showed no fetal heartbeat.

    One week later, 21 days after the onset of ZIKV-associated disease, amniocentesis was performed, followed by dilation and curettage. Amniotic fluid and fetal and placental tissue were obtained for further laboratory analysis. (A detailed description of the methods is provided in theSupplementary Appendix, available with the full text of this letter at NEJM.org.)

    The amniotic fluid and fetal and placental tissue tested positive for ZIKV on semiquantitative real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays and cell-culture isolation; these results were confirmed by means of whole-genome sequencing (GenBank accession number, KU937936) (Fig. S1 through S4 in the Supplementary Appendix). The viral isolate (reference number, 011V-01621) can be obtained through the European Virus Archive Goes Global catalogue (www.european-virus-archive.com/virus/zika-virus-strain-suriname-2016).

    Serum and urine samples obtained from the patient were positive for ZIKV on semiquantitative RT-PCR at multiple time points. A serum specimen was still positive for ZIKV on semiquantitative RT-PCR 21 days after the onset of clinical symptoms, although no ZIKV was detected in urine specimens after day 12. A more than quadrupling of neutralizing antibody titers against ZIKV was observed between days 2 and 12. On day 28, ZIKV RNA was no longer detected in serum specimens (see Table S1 in the Supplementary Appendix). Possible genetic disorders and other congenital infections were not identified (see Sections 8 and 9 in the Supplementary Appendix).

    The findings on histopathological analysis of placental tissue specimens were consistent with intrauterine fetal death 1 week before curettage was performed. Histopathological and immunohistochemical investigation with the use of CD45 and CD3 antibodies to detect inflammation did not show evidence of increased inflammatory-cell infiltration. In situ hybridization with the use of ZIKV-specific probes, as compared with control probes, revealed that placental amniotic epithelium was positive for ZIKV RNA, whereas fetal chorion and trophoblasts and maternal decidua did not show evidence of ZIKV infection. In addition, positive staining of fetal mesenchymal cells with affinity for perichondrium was observed (Figure 1FIGURE 1Zika Virus (ZIKV) Infection of Amniotic Epithelial Cells and Fetal Mesenchymal Cells Detected with the Use of a Specific ZIKV RNA Probe.). Because of autolysis, no recognizable fetal brain tissue was present. Other fetal tissues, including those from the cartilage, kidneys, adrenal glands, gut, and eyes, were negative for ZIKV. These observations were confirmed on immunostaining of double-stranded RNA in fetal tissues (Fig. S5 in theSupplementary Appendix).

    We found evidence of ZIKV infection in amniotic epithelial cells and in fetal mesenchymal cells with affinity for perichondrium. Our observation indicates that ZIKV replicates in pluripotent (amniotic stem) cells involved in early-stage embryo development. The observation of prolonged viremia until day 21 in the patient is in concordance with the findings of Driggers et al.3 and provides further data for consideration in the ongoing development of testing algorithms in pregnant women. These algorithms are currently based on the assumption that ZIKV viremia can be detected only up to 7 days.

    Annemiek A. van der Eijk, M.D., Ph.D.
    Erasmus Medical Center, Rotterdam, the Netherlands 
    a.vandereijk@erasmusmc.nl

    Perry J. van Genderen, M.D., Ph.D.
    Harbour Hospital, Rotterdam, the Netherlands

    Rob M. Verdijk, M.D., Ph.D.
    Chantal B. Reusken, Ph.D.
    Ramona Mögling, Ph.D.
    Jeroen J.A. van Kampen, M.D., Ph.D.
    Widagdo Widagdo, M.D.
    Georgina I. Aron, B.Sc.
    Corine H. GeurtsvanKessel, M.D., Ph.D.
    Suzan D. Pas, Ph.D.
    V. Stalin Raj, Ph.D.
    Bart L. Haagmans, Ph.D.
    Marion P.G. Koopmans, D.V.M., Ph.D.
    Erasmus Medical Center, Rotterdam, the Netherlands

    Supported by the Horizon 2020 research and innovation program of the European Union (grant agreement no. 643476) and by the European Virus Archive Goes Global project, which received a grant (653316) from the European Union Horizon 2020 Framework Program for Research and Innovation.

    Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

    Drs. van der Eijk, van Genderen, and Verdijk contributed equally to this letter.

    This letter was published on July 27, 2016, at NEJM.org.

    N Engl J Med 2016; 375:1002-1004
    September 8, 2016
    DOI: 10.1056/NEJMc1605898


  • September 14, 2016 2:58 PM | Ashley Monson (Administrator)

    Published: Tuesday 13 September 2016

    New research provides the first clear evidence that the amount of nutrients transported to the foetus by the placenta adjusts according to both the foetal drive for growth, and the mother's physical ability to provide.

    Researchers have shown for the first time how the placenta "umpires" a fight for nutrients between a pregnant mother and her unborn baby. The study suggests that the placenta will adjust the amount of nutrients transported to the foetus for growth in line with the mother's physical ability to supply.

    The findings, published in the journal PNAS, suggest that if the bodily environment that a mother provides for her baby is unfavourable, for example through small body size or metabolic dysfunction, the placenta will change the flow of nutrients to the foetus relative to her own state. This can affect foetal development, resulting in complications at birth.

    It is the first time that scientists have been able to provide clear evidence that the placenta plays the decisive role in this delicate balancing act, rather than merely acting as a passive interface which enables the transfer of nutrients from mother to foetus.

    The study, by researchers at the University of Cambridge, involved making a precise genetic change in mice, which caused poor growth and changed the mother's bodily environment. They then observed how the placenta developed and acted in response, finding that in mothers in which this alteration had been made, the structure of the placenta was different, and fewer nutrients reached the foetus.

    A better understanding of how the placenta manages the trade-off will eventually enable researchers to reduce pregnancy complications in both humans and other mammals.

    The study was led by Dr Amanda Sferruzzi-Perri, a Research Associate at St John's College, University of Cambridge, and is part of a five-year project in the Department of Physiology, Development and Neuroscience examining the relationship between the placenta and pregnancy complications.

    "During pregnancy there is a kind of 'tug-of-war' going on between the mother and the foetus over who gets the nutrients that the mother ingests," Sferruzzi-Perri said. "This work shows for the first time that the placenta is the umpire which controls that fight. Understanding more about the placenta's role is extremely important. If nutrients cannot be divided correctly during pregnancy, it can lead to life-threatening complications for expectant mothers, and long-term health consequences for both mother and child."

    At least one in every eight pregnancies in the UK is affected by complications stemming from impairment of the placenta. In the developing world the rate is even higher, with at least one in every five pregnant women affected. The potential consequences include abnormal birth weight, premature delivery, pre-eclampsia, and maternal diabetes.

    A major cause appears to be the placenta's response to unfavourable biological changes in the mother herself. These may, for example, be the result of poor nutrition, high stress levels, metabolic dysfunction, or obesity.

    How the placenta allocates nutrients in these situations, however, and the hormonal signals that the placenta may be releasing while doing so, is not fully understood. By understanding these processes better, researchers hope to identify both the biological early warning signals that a problem has arisen, and their relationship to specific causes, enabling them to develop therapeutic interventions that reduce the number of complications overall.

    The new study represents a step towards those aims because researchers were able to directly influence the balancing act that the placenta performs and observe it in relation to both the physiology of the mother, and the actual growth and nutrient supply of the foetus.

    To achieve this they used a model system where an enzyme called p110 alpha was genetically modified in mice. In a healthy mother, this enzyme is activated by hormones like insulin and insulin-growth factors (IGFs), kick-starting a relay race within cells which stimulates nutrient uptake and, as a result, normal growth and metabolic function. By altering this enzyme, the team reduced the mother's overall responsiveness to such hormones, creating an unfavourable environment.

    The results showed that in mothers which carried the altered form of p110 alpha, the placenta's growth and structure was impaired. As well as being physically different, it was also found to be transporting fewer nutrients to the unborn offspring.

    Because of the way in which the experiments were set up, the team were also able to see what would happen to the placenta if the foetus carried the altered form of p110 alpha, but the mother was normal. They found that in these cases, the placenta also showed defects, but was able to compensate for this by transporting more nutrients to the foetus, and thus optimising nutrition.

    This shows that the placenta will fine-tune the distribution of nutrients between the mother and foetus, in response to the circumstances in which it finds itself. It also indicates that, because the mother needs to be able to support her baby both during pregnancy and after birth, the placenta will do its best to judge how much nutrition the foetus receives, so that the mother's health is not compromised.

    "The placenta is taking in signals all the time from the mother and the foetus," Sferruzzi-Perri explained. "If the mother has some sort of defect in her ability to grow, the placenta will limit the amount of nutrients it allocates to the foetus to try and preserve her health."

    "What this tells us is that the mother's environment is a very strong, modifiable characteristic to which we should be paying more attention, in particular to see if there are specific factors that we can change to improve the outcome of pregnancies. Being able to influence the mother's environment through changes in p110 alpha gives us a means to study this in a controlled way, and to work out what those critical factors are."

    The next stage of the research will involve examining the signals that the placenta sends to the mother to affect the way she uses the nutrients she ingests, potentially providing important clues about biomarkers which provide an early warning of pregnancy complications.

    Dr Sferruzzi-Perri's research is supported by a Dorothy Hodgkin Fellowship from the Royal Society.

    Article: Maternal and fetal genomes interplay through phosphoinositol 3-kinase(PI3K)-p110α signaling to modify placental resource allocation, Amanda N. Sferruzzi-Perri, Jorge López-Tello, Abigail L. Fowden, and Miguel Constancia, PNAS, doi: 10.1073/pnas.1602012113, published online 12 September 2016.

    Source: University of Cambridge

    Source: AlphaGalileo
    Visit our Pregnancy / Obstetrics category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Pregnancy / Obstetrics.

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    University of Cambridge. (2016, September 13). "Placenta plays pivotal "umpire" role to influence pregnancy outcomes." Medical News Today. Retrieved from
    http://www.medicalnewstoday.com/releases/312882.php.

    Please note: If no author information is provided, the source is cited instead.


  • September 13, 2016 10:01 AM | Ashley Monson (Administrator)
    • by Nancy Walsh 
      Senior Staff Writer, MedPage Today

      September 12, 2016

    Action Points

    Women with gout have a modestly increased risk of hip fracture, a prospective observational study found.

    In an analysis of data from the Nurses' Health Study, a history of gout was associated with a higher risk of hip fracture after adjustment for age, with a relative risk of 1.40 (95% CI 1.16-1.69), according to Julie M. Paik, MD, and colleagues from Harvard Medical School in Boston.

    And in a multivariable analysis that adjusted for numerous factors including body mass index (BMI), race, smoking, physical activity, nutrient intake, medications, and co-morbidities, an association of gout with hip fracture remained significant (RR 1.38, 95% CI 1.14-1.68), the researchers reported online in Arthritis & Rheumatology.

    Previous research has suggested that uric acid can influence bone health either through antioxidant or pro-oxidant mechanisms.

    "When uric acid exists at supersaturated concentrations such as in gout, then its antioxidant properties could be overcome by its pro-oxidant effects and create an environment of high oxidative stress," Paik and colleagues explained.

    "The pro-oxidant role of uric acid can contribute to an inflammatory milieu with increased circulating pro-inflammatory cytokines ... thereby promoting bone resorption and inhibiting bone formation, which could ultimately increase osteoporotic fracture risk."

    Previous studies looking at the relationship between uric acid and bone mineral density or fractures have been limited in design and have had conflicting results, the team explained. There have not been any prospective data evaluating this.

    Therefore, Paik and colleagues analyzed outcomes from the ongoing, prospective Nurses' Health Study, which started 4 decades ago. Participants responded to biennial questionnaires that requested information about lifestyle, including diet, as well as diagnoses and medications. The current analysis included 103,799 women who were enrolled as of 1990.

    A total of 2,225 of the participants reported a history of gout. Those with gout were older (59.6 versus 56 years), had higher BMI (29.2 versus 25.8 kg/m2), lower physical activity (14 versus 15.5 metabolic equivalent task scores), and more often had hypertension, osteoporosis, and diabetes and to be taking thiazide diuretics.

    During 22 years of follow-up that included 1,878,333 person-years, there were 2,147 incident hip fractures, and 14,382 participants had a history of gout. Among the women with gout, there were 117 hip fractures.

    The risks for hip fracture were similar to those for women whose BMI was above or below 25 kg/m2 and whether or not they had diabetes. However, the risk was more pronounced in women younger than age 65 (RR 2.19, 95% CI 1.35-3.56) than in those older than 65 (RR 1.28, 95% CI 1.04-1.58, P for interaction 0.02). The association also was greater in those on thiazide diuretics (RR 1.92, 95% CI 1.37-2.70) compared with those not taking these medications (RR 1.16, 95% CI 0.92-1.48, P for interaction 0.02).

    The researchers also considered whether the risks for wrist fractures were increased. This analysis included 14 years of follow-up (1,296,844 person-years), during which time there were 3,769 incident fractures of the wrist and 8,834 women who reported having been diagnosed with gout. A total of 107 wrist fractures occurred among women with gout.

    Wrist fracture was not associated with gout either on an age-adjusted analysis (RR 1.07, 95% CI 0.88-1.30) or in a multivariable analysis (RR 1.12, 95% CI 0.92-1.36).

    The associations with wrist fracture did not differ according to age, BMI, diabetes, or use of thiazides, the team reported.

    The observation that risks were increased only for hip and not for wrist fracture indicates that the risk for fractures can differ according to the site. "While hip fracture risk increases with age and is associated with markers of poorer health and frailty, including co-morbid conditions, impaired neuromuscular function, and lower physical activity, wrist fracture does not increase with age and often occurs as a result of a fall in women with low bone mineral density who are otherwise relatively healthy and physically active with intact neuromuscular function," the researchers explained.

    They also noted that further studies will be required to clarify the interactions between gout, hip fracture, and age and thiazide diuretic use.

    If the risks are confirmed in other studies, it would be useful to examine the potential effects of urate-lowering treatment on fracture risk, Paik and colleagues suggested.

    Limitations of the study included a lack of information on bone mineral density and a reliance on self-reporting of gout.

    This research was supported by the National Institutes of Health. Some of the co-authors reported financial relationships with AstraZeneca, Lilly, Pfizer, Genentech, Bristol-Myers Squibb, and Takeda.

    • Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

    LAST UPDATED 09.12.2016

    Primary Source

    Arthritis & Rheumatology
    Source Reference: Paik J, et al "Gout and risk of fracture in women: a prospective cohort study" Arthritis Rheum 2016; DOI: 10.1002/art.39852.


  • September 13, 2016 9:58 AM | Ashley Monson (Administrator)

    Current research data and guidelines on reducing maternal thromboembolism risk have been incorporated into a consensus safety bundle from the National Partnership for Maternal Safety, published online September 5 in Obstetrics & Gynecology. However, some specialists express concern that the consensus statement relies too heavily on pharmacologic prophylaxis without sufficient evidence to justify the approach.

    According to Mary E. D'Alton, MD, from the Columbia University College of Physicians and Surgeons, New York City, and colleagues, "the thromboembolism bundle is not a new guideline but rather represents a selection of existing guidelines and recommendations in a form that aids implementation and consistency of practice that is appropriate for the individual birthing facility."

    Venous thromboembolism (VTE) during pregnancy is a leading cause of maternal morbidity and mortality, with pulmonary thromboembolism accounting for an estimated 9.3% of pregnancy-related deaths in the United States.

    Although maternal death from VTE is preventable by implementing comprehensive thromboembolism prevention strategies, prophylaxis guideline recommendations from medical and surgical specialties can differ substantially. In addition, clinical trial data remain lacking for the guidance of thromboprophylaxis in pregnancy.

    In the United Kingdom, guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG) recommend broad, risk-based assessments for antepartum and postpartum women to guide thromboprophylaxis. As a result, many women receive pharmacologic thromboprophylaxis, including, for example, most women who undergo cesarean delivery. Indeed, data have shown a significant reduction in maternal deaths from VTE in the United Kingdom since release of the RCOG guidelines.

    Currently, in the United States, however, only women at highest risk for VTE receive pharmacologic thromboprophylaxis. Data have also shown an increased rate of obstetric VTE in the United States in recent decades, with no change in its associated rate of maternal deaths.

    On the basis of these findings, the National Partnership for Maternal Safety therefore critically reviewed current guidelines and research evidence and made recommendations for prophylaxis. The safety bundle contains recommendations within four major areas.

    Readiness, Recognition, Response, Reporting and Systems Learning

    Readiness: The authors recommend that all pregnant women undergo risk assessment for VTE throughout pregnancy. In particular, clinicians should assess patients during the first prenatal visit, during any antepartum hospitalizations, immediately postpartum during a hospitalization for childbirth, and after they are discharged home after a delivery. Clinicians should use standardized risk-assessment tools such as the Caprini and Padua scoring systems.

    Recognition: On the basis of results of this risk assessment, clinicians should use a patient's modified Caprini or Padua score to identify those who are at high risk for VTE, and who are therefore candidates for thromboprophylaxis. Continue Reading


  • September 13, 2016 9:56 AM | Ashley Monson (Administrator)

    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 | Ashley Monson (Administrator)

    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."

    Note

    * 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 www.sciencedaily.com/releases/2016/09/160906085007.htm

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