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  • September 14, 2016 2:58 PM | Deleted user

    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.

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

    APA
    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 | Deleted user
    • 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 | Deleted user

    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 | Deleted user

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

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


    Please see our FAQs for additional information. 

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

    Date: September 6, 2016

    Source: European Society for Medical Oncology

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

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

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

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

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

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

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

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

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

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

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

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

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

    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

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

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

    September 27th, 2016 - Register Now


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


    Presentation Objectives:

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

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

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



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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    More information

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

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

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

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

    -- E.J. Mundell

    Last Updated: Sep 1, 2016

    Copyright © 2016 HealthDay. All rights reserved.


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

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

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

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

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

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

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

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

    Injected into the buttock or thigh

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

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

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

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

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

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

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

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

    Source: Medical Express

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

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

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

    Who are PAs? 

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

    What do PAs do? 

    • PAs practice medicine. 

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

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

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

    How do PAs work? 

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

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

    Why are PAs unique? 

    • PAs increase access to healthcare. 

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

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

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

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

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

    • Four out of five PAs report high job satisfaction. 

    Phrases to Avoid 

    • Inaccurate Terminology: 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    More information

    The World Health Organization has more about Zika virus.

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

    -- Margaret Farley Steele

    Last Updated: Aug 28, 2016

    Copyright © 2016 HealthDay. All rights reserved.


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