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  • 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

        AAPA
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      • January 17, 2017 10:02 AM | Deleted user

        News Medical
        Pelvic organ prolapse occurs when the pelvic organs drop from their normal position in the pelvis. This can have a negative impact on a woman's overall functioning and quality of life. Two of the most common treatments are surgery or pessary, which is a removable device that helps provide support to the pelvic organs. While both surgery and pessary can improve prolapse symptoms, questions remain about patients' functional outcomes and goal attainment between the two forms of treatment. 

        Read more


      • January 16, 2017 10:13 AM | Deleted user

        Now is a critical time for PAs. Will you step up and bring your bold leadership, creative vision, and patient-care experience to AAPA’s Board of Directors? As part of this innovative team of PA leaders, you will help guide the strategic direction of AAPA and the PA profession.

        APPLY NOW 


        You have a unique perspective on how the PA profession can and should move forward in this disrupted healthcare landscape. With your expertise, the Board of Directors will develop strategies to continue to break down practice barriers, demonstrate PA value, maximize that value in an evolving marketplace and position PAs as a powerful force for change.

        There are four open positions in the 2017 election. Apply by February 15!

        To see eligibility requirements, position descriptions and an elections calendar with other dates related to the election process, visit the BOD Elections Web page.


      • January 13, 2017 10:57 AM | Deleted user

        The Clinical Advisor 
        The US Preventive Services Task Force (USPSTF) recommends that all women who are capable of pregnancy or are planning to become pregnant take a daily supplement of 0.4 to 0.8 mg of folic acid, according to its recommendation statement published in JAMA. The USPSTF gave an A grade to its recommendation, which reaffirms its 2009 recommendation of folic acid supplementation for women of childbearing age for prevention of neural tube defects.

      • January 13, 2017 10:56 AM | Deleted user

        Medical News Today 
        Sexual activity is one of the most common ways by which HIV can be passed from one person to another. In a new study, researchers have identified certain types of vaginal bacteria that might increase a woman's susceptibility to sexually transmitted HIV. For their study, the researchers analyzed the data of 236 healthy women aged 18-32 who were a part of the Females Rising through Education, Support and Health study.


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