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  • February 09, 2017 8:29 AM | Deleted user

    TUESDAY, Feb. 7, 2017 (HealthDay News) -- Women can reduce their risk of cervical cancer through vaccination and screening, the U.S. Food and Drug Administration says.

    In 2016, an estimated 13,000 women in the United States were diagnosed with cervical cancer and more than 4,100 died from the disease, according to the U.S. National Cancer Institute.

    The FDA wants to make women aware of how to protect themselves from cervical cancer, which is caused by the human papillomavirus (HPV).

    An FDA-approved vaccine called Gardasil 9 protects against 9 HPV types and can prevent about 90 percent of cervical, vulvar, vaginal and anal cancer cancers, and also protects against genital warts. The vaccine is approved for use in females and males aged 9 to 26.

    Gardasil 9 is not a treatment for HPV disease or cervical cancer, noted Marion Gruber, director of the FDA's Office of Vaccines Research and Review.

    "Women, including those who have been vaccinated, should continue to get Pap tests because they are essential to detect cervical cancer and precancerous changes," she said in an FDA news release.

    A Pap test (or smear) and HPV test are two ways to spot cervical cancer. If abnormalities are detected on a Pap smear, follow-up testing may include another Pap smear, a HPV test and testing tissue via biopsy from the cervix.

    Cervical cancer often causes no pain, which means a woman can have cervical cancer and not know it. That makes testing for the disease that much more important. The earlier the cancer is detected, the easier it is to treat, the FDA said.

    More information

    The U.S. National Cancer Institute has more on cervical cancer.

    SOURCE: U.S. Food and Drug Administration, news release

    -- Robert Preidt

    Last Updated: Feb 8, 2017

    Copyright © 2017 HealthDay. All rights reserved.

  • February 09, 2017 8:28 AM | Deleted user

    Approximately 500 million people around the world are infected with the genital herpes virus known as herpes simplex virus 2 (HSV2). A vaccine that could bring an end to this global pandemic is needed desperately, yet no candidate vaccine has ever performed well in clinical trials. Now scientists in the Perelman School of Medicine at the University of Pennsylvania have shown that a new type of vaccine provides powerful protection in standard guinea pig and monkey models of HSV2 infection.
    The new "trivalent" vaccine induces antibodies against three different parts of the virus, including two components that normally help HSV2 evade immune attack.

    "It's a novel strategy, and it works beautifully," said senior investigator Harvey M. Friedman, MD, a professor of Infectious Diseases at Penn. "I know of no other HSV2 vaccine candidate with published results that are as promising as this study."

    The findings, reported today in PLOS Pathogens, are likely to lead to human clinical trials of the vaccine.

    The public health burden from HSV2 is enormous. In the United States alone, researchers estimate that approximately one in six people age 15 to 49 have HSV2 infection. In some parts of Africa, more than half the adult population is thought to be infected. Aside from the direct burden on adults, HSV2 can cause devastating and often lethal infections of infants born to infected mothers. HSV2 infection also greatly increases the likelihood of HIV transmission and thus accounts for much of the HIV public health burden as well.

    Candidate HSV2 vaccines developed in recent years have largely targeted gD2, a glycoprotein (a protein coated with sugar-like molecules) that is mounted on the virus's outer envelope and helps it break into host cells. However, vaccines targeting gD2 alone have not shown very robust protection in animal and human trials.
    Friedman and his team, therefore, designed their new vaccine to induce an immune response against not only gD2 but also two other viral glycoproteins, gC2 and gE2. The latter are known to block elements of the immune response, helping HSV2 to survive long-term in its hosts.

    "In essence, we're stimulating the immune system to attack the virus and at the same time preventing the virus from using some of the tools it has to thwart that immune attack," Friedman said.

    Working with the Tulane National Primate Center in Louisiana, Friedman and his group showed that the trivalent vaccine—given three times at monthly intervals—induced a strong immune response in macaque monkeys, whose immune system closely resembles the human version. The response included antibodies against gC2, gD2, and gE2 in both blood and vaginal secretions. In the lab dish, these antibodies potently neutralized HSV's ability to spread from cell to cell. The vaccine also induced a sharp rise in CD4 T-cells, whose job is to mobilize the antibody response and other immune elements against viral infections.

    The researchers also showed that the antibodies induced by the trivalent vaccine potently neutralized four isolates of HSV2 from sub-Saharan Africa, where infection prevalence is very high.

    Macaques do not usually develop genital lesions when infected with HSV2, but in this case, the unvaccinated monkeys showed signs of mild vaginal inflammation soon after exposure to the virus, whereas the vaccinated monkeys showed none.

    In a second set of experiments, guinea pigs, which normally develop a more severe genital infection when infected with HSV2, were almost completely protected from genital lesions by the vaccine. The scientists were still able to detect a small amount of viral DNA in the genital secretions of the animals, but only a tiny fraction of this viral DNA was capable of replicating in cells.

    "We are pleased to have demonstrated such a potent and durable immune response to the vaccine," said the study's lead author, Sita Awasthi, PhD, a research associate professor of Infectious Diseases at Penn. "If found effective in clinical trials, the vaccine will have a huge impact on reducing the overall prevalence of genital herpes infections and could reduce new HIV infections as well, especially in high-burden regions of sub-Saharan Africa."

    "If the vaccine behaves like this in people, it would limit lesions to appearing only about one day in 100, and the virus would be potentially contagious only about two in every 1,000 days," Friedman said.

    In principle, he added, that would virtually shut down HSV2's ability to spread in the population.

    Friedman and colleagues are now in discussions with pharmaceutical companies to move the vaccine, or an optimized version of it, into initial clinical trials.
    If the vaccine does emerge successfully from clinical trials, it would probably be given on a schedule of three inoculations, at 0, 1 and 6 months.


  • February 09, 2017 8:26 AM | Deleted user

    Understanding how to utilize nonphysician providers can maximize the efficiency and profitability of your organization. This report is the most recent addition to MGMA’s Research & Analysis series, and includes the latest tips, guidelines, rules and regulations for utilizing nonphysician providers.

    Read report here.

  • February 06, 2017 9:10 AM | Deleted user

    Wednesday, May 17, 2017, 9-10am
    SPARK Student Session - PAs in OBGYN

    Sessions will give you advice and knowledge for every phrase of your PA student career – and beyond!
    This year, hear from practicing PAs and subject matter experts on surviving clinical rotations, preparing for PANCE, choosing a specialty and acing your interview and contract negotiation. Prepare yourself for life after graduation with sessions on financial advice, volunteering opportunities, global PA developments and professional advocacy.

    Thursday, May 18, 2017, 5-6 pm
    APAOG Meet and Greet ~ no RSVP required

    Come meet the board and members of the Association of PAs in OBGYN (APAOG) to find out all about what APAOG has to offer! APAOG is a constituent organization of AAPA and focuses on PAs practicing in women's health in a variety of specialties including family medicine, internal medicine, GYN, OB, MFM, REI, pediatrics, geriatrics, GYN oncology, and many more! All are welcome!

    Thursday, May 18 2017 6-8 pm
    APAOG Banquet and Annual Meeting - RSVP today!

    Join APAOG in Las Vegas! APAOG is hosting a free event for APAOG members and non members to meet at AAPA in Las Vegas. Light horderves and drinks will be served.

    The event will feature award winners and provide an update to the group from the APAOG board.

    AAPA Conference Sessions Related to Women's Health

    2017's AAPA Conference will feature a number of women's health related presentations and topics. A few APAOG members have also been accepted to present their information at the national conference. 

    • Female Pelvic and Vulvar Pain (Aleece Fosnight, APAOG President)
    • Basic Obstetrics Review (Melinda Blazar, APAOG Director at Large)
    • Preconception Counseling (Heather Adams, APAOG Publications Committee Chair)
    • Genital Ulcer STIs
    • Female Urology Update
    • Zika and Pregnancy
    • Women's Health Issues
    • Breast Cancer Patient Options
    • HPV Vaccination
    • Contraception Update
    • Menopause Management
    • Drug and Alcohol and Sexual Assault

    For more information and to register for the AAPA conference, click here. 

  • January 27, 2017 1:37 PM | Deleted user

    It is now reported that abortion rates in the US in 2014 were recorded at an all-time low. This is largely credited to improved access and use of contraception, including long acting, reversible contraceptive devices. Read the full article published by Guttmacher Institute here

  • January 25, 2017 10:57 AM | Deleted user

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  • January 24, 2017 8:28 AM | Deleted user

    (CNN)The risk of dying from cervical cancer might be much higher than experts previously thought, and women are encouraged to continue recommended cancer screenings.

    Black women are dying from cervical cancer at a rate 77% higher than previously thought, and white women are dying at a rate 47% higher, according to a study published in the journal Cancer on Monday.
      The study found that previous estimates of cervical cancer death rates didn't account for women who had their cervixes removed in hysterectomy procedures, which eliminates the risk of developing the cancer.
        "Prior calculations did not account for hysterectomy because the same general method is used across all cancer statistics," said Anne Rositch, assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore and lead author of the study.
        That method is to measure cancer's impact across a total population without accounting for factors outside of gender, she said.
        There were about 12,990 new cases of cervical cancer in the United States last year and 4,120 cervical cancer deaths, according to the National Cancer Institute.

        'A better understanding of the magnitude'

        For the study, researchers analyzed data on cervical cancer deaths in the United States, from 2000 to 2012, from the National Center for Health Statistics and the National Cancer Institute's Surveillance, Epidemiology, and End Results databases.
        Study: Lifestyle has a bigger role in causing cancer
        Study: Lifestyle has a bigger role in causing cancer 01:41
        The data were limited to only 12 states in the country, but the researchers noted that the data still provided a nationally representative sample of women.
        Then, the researchers collected data from the Behavioral Risk Factor Surveillance System on how many women in 2000 to 2012, 20 and older, reported ever having a hysterectomy. They used that data to adjust the cervical cancer deaths rates.
        Before the adjustment, the data showed that the cervical cancer killed about 5.7 out of 100,000 black women and 3.2 per 100,000 white women. After adjusting for hysterectomies, the rate was 10.1 per 100,000 black women and 4.7 per 100,000 white women.
        The data showed that the racial disparity seen in cervical cancer death rates for black and white women was underestimated by 44% when hysterectomies were not taken into account.
        "We can't tell from our study what might be contributing to the differences in cervical cancer mortality by age and race," Rositch said. "Now that we have a better understanding of the magnitude of the problem, we have to understand the reasons underlying the problem."
        Protecting your kids from HPV
        Protecting your kids from HPV 02:18
        Cervical cancer is highly preventable in the United States because of the availability of screening tests and a vaccine to prevent human papillomavirus, or HPV, which can cause cervical cancer, according to the Centers for Disease Control and Prevention.
        "Racial disparity may be explained by lack of access or limited access to cervical cancer screening programs among black women when compared to whites," said Dr. Marcela del Carmen, a gynecologic oncologist at the Massachusetts General Hospital Cancer Center, who was not involved in the new study.
        "This gap and disparity need to be addressed with initiatives focusing on better access to prevention or screening programs, better access to HPV vaccination programs and improved access and adherence to standard of care treatment for cervical cancer," she said.
        The new findings add to the current understanding of cervical cancer's impact on different communities, said Dr. John Farley, a practicing gynecologic oncologist and professor at Creighton University School of Medicine at St. Joseph's Hospital and Medical Center in Arizona.
        "It lets us know that there is substantial work to do to investigate and alleviate the racial minority disparity in cervical cancer in the US," said Farley, who was not involved in the study but co-authored an editorial about the new findings in the journal Cancer on Monday.
        "Those who get cancer, many times, do not have access to screening," he said.
        Even though cervical cancer mortality rates are higher than previously thought, Farley said that he thinks the current screening recommendations for cervical cancer are still adequate. However, he added, more women should have access to screenings and other preventive measures.
        Rositch said, "It may be that some women are not obtaining screening according to our current guidelines, not necessarily that guideline-based care is insufficient."

        How to prevent and screen for cervical cancer

        The American Cancer Society recommends that women begin cervical cancer screenings at age 21 by having a Pap test every three years. Then, beginning at 30, women should have a Pap test combined with a HPV test every five years.
        Symptoms of cervical cancer tend to not appear until the cancer has advanced, which is why screening and HPV vaccinations are urged.
        "We have a vaccine which can eliminate cervical cancer, like polio, that is currently available, and only 40% of girls age 13 to 17 have been vaccinated," said Farley, co-author of the editorial. "This is an epic failure of our health care system in taking care of women in general and minorities specifically."
        Women over 65 might not need to continue screening if they don't have a history of cervical cancer or negative Pap test results, according to the American Congress of Obstetricians and Gynecologists.
        Join the conversation

        See the latest news and share your comments with CNN Health on Facebook and Twitter.

        Each year, about 38,793 new cases of cancer are found in parts of the body where HPV is often found. The virus has been linked not only to cervical cancer but to cancers of the vulva, vagina, penis, anus or throat.
        A study published in the journal JAMA Oncology last week found that among a group of 1,868 men in the United States, about 45% had genital HPV infections and only about 10% had been vaccinated.
        "Male HPV vaccination may have a greater effect on HPV transmission and cancer prevention in men and women than previously estimated," the researchers wrote in that study.

        Original Article

      • January 19, 2017 11:49 AM | Deleted user

        MedPage Today 
        Ovarian conservation was associated with decreased long-term all-cause mortality in young women with low-grade, early-stage endometrial cancer, according to researchers. Analysis of data from the Surveillance, Epidemiology, and End Results (SEER) program showed that for 9,110 women younger than age 50 with stage I grade 1 tumors, cause-specific survival was similar between ovarian conservation and oophorectomy cases with 20-year rates of 98.9 percent versus 97.7 percent.

        Read more.

      • January 19, 2017 11:47 AM | Deleted user
        • by Molly Walker 
          Staff Writer, MedPage TodayJanuary 18, 2017

        Action Points

        Risk factors such as cervical incompetence, preterm labor, and vaginal infections were strongly associated with a pregnant woman's risk of adverse pregnancy outcomes if she underwent an appendectomy or cholecystectomy, researchers found.

        Researchers led by Adam Sachs, MD, of Hartford Hospital, and colleagues, devised a scoring system to determine the risk categories for pregnant women undergoing these surgeries. Women in the highest risk group were associated with a 21.8% chance of an adverse pregnancy outcome, while women in the lowest risk group had a 2.5% chance of an adverse outcome.

        Writing in JAMA Surgery, the authors said that appendectomies and cholecystectomies are the most common non-obstetric surgeries during pregnancy, the authors noted, with about 2,800 and 2,000 procedures respectively performed annually on pregnant women. They said that as prior research focused on diagnosis and surgical management of appendicitis and cholecystitis instead of pregnancy outcomes.

        "Accurate maternal counseling regarding anticipated outcomes following non-obstetric surgery during pregnancy remain challenging in clinical practice," they wrote.

        The authors examined the Nationwide Inpatient Sample, and used data from 19,926 women (mean age 26 years) who underwent an appendectomy or cholecystectomy during their pregnancy. Overall, there were 1,080 adverse events in 953 pregnant women.

        They used this subset of the cohort to perform a multivariate analysis and derive the adjusted odds ratios for each risk factor contributing to an adverse pregnancy outcome for women undergoing these surgeries:

        • Cervical incompetence (adjusted OR 24.29, 95% CI 7.48-78.81)
        • Preterm labor during current pregnancy (adjusted OR 18.34, 95% CI 4.95-67.97)
        • Vaginitis or vulvovaginitis (adjusted OR 5.17, 95% CI 2.19-12.23, P<0.001 for all)

        The authors said that this was the first study to their knowledge that found these obstetric variables to have the strongest link with adverse obstetric outcomes following these surgeries, instead of "maternal-, surgery- or disease-related variables."

        However, there were notable maternal-, surgery- or disease-related risk factors that increased odds of adverse outcomes. These included sepsis (adjusted OR 3.39, 95% CI 2.08-3.53), multiple gestations (adjusted OR 3.31, 95% CI 1.67-6.58), and open surgery (adjusted OR 3.13, 95% CI 2.59-3.78). Both open surgery and sepsis had been previously reported to increase the risk of obstetric complications during pregnancy, they wrote.

        The authors then assigned points based on these individual risk factors:

        • Cervical incompetence: 16 points
        • Preterm labor: 15 points
        • Vaginitis or vulvovaginitis: 8 points
        • Multiple gestation or sepsis: 6 points
        • Open surgery or peritonitis: 5 points

        Probabilities of adverse obstetrical outcomes were determined by risk group score:

        • ≥9 points: 21.8% probability
        • 5-8 points: 8.2% probability
        • ≤5 points: 2.5% probability

        The authors also examined demographic risk factors associated with these two procedures, and found that both non-white race/ethnicity (adjusted OR 1.55, 95% CI 1.29-1.85, P<0.001) and Medicaid coverage (adjusted OR 1.22, 95% CI 1.02-1.46, P=0.03) were also linked to adverse obstetric outcomes.

        Limitations to the study include that anesthetic modalities were not available in the data, so those factors could not be evaluated. In addition, because the study only looked at ICD-9-CM codes, the data did not include gestational age.

        An accompanying editorial by Roxanne L. Massoumi, MD, and O. Joe Hines, MD, both of the University of California at Los Angeles, suggested that medical management of these conditions may be a better approach for these patients.

        "Although use of antibiotics alone is less popular in patients with acute cholecystitis, treatment of uncomplicated acute appendicitis with antibiotics is a recent, promising, and debated trend," they wrote. "Given the higher surgical risk of pregnant patients secondary to their unique physiological features, nonoperative management of uncomplicated acute appendicitis might be considered in this population."

        The authors disclosed no relevant financial relationships.

        Massoumi and Hines disclosed no relevant financial relationships.

      • January 18, 2017 11:35 AM | Deleted user

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