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  • July 14, 2016 7:32 AM | Ashley Monson (Administrator)

    The 20th Biennial International Perinatal Bereavement Conference is coming up this fall — September 28 – October 1st in Phoenix, Arizona — and its sponsor wants to help you get there. The Pregnancy Loss and Infant Death Alliance (PLIDA) will be awarding 24 scholarships to professional care providers, parent advocates, and researchers to attend the event.

    The conference focuses on care for families who have experienced a perinatal death, as well as research on related topics. This scholarship would be ideal for PAs who work or research in the fields of family practice, obstetrics, maternal fetal medicine, or neonatology.

    The scholarship will cover the cost of the conference, but applicants should note that all other expenses (e.g., food, travel, lodging) are not included. Any member of PLIDA who can show financial need is invited to apply.

    The deadline to apply is August 5. For more information, visit the conference website.


  • July 12, 2016 12:28 PM | Ashley Monson (Administrator)

    AAPA


    In a landmark partnership, the Centers for Disease Control and Prevention (CDC) and AAPA will present a free webinar on Zika and pregnancy on July 28 from 2-3 p.m. EDT. The presentation qualifies as Category 1 CME.

    The World Health Organization declared Zika virus a public health emergency of international concern after local transmission was reported in many other countries and territories. With the likelihood that the Zika virus will continue to spread to new international and domestic areas, this webinar is an opportunity for PAs to be prepared to handle Zika by knowing the facts.

    At the end of the webinar, you will be able to:

    • List the ways pregnant women become infected with the Zika virus;
    • Describe CDC recommendations for testing of pregnant women with possible exposure;
    • Describe CDC recommendations for testing of couples interested in conceiving who reside in an active Zika virus transmission area;
    • Describe the implications of Zika virus infection;
    • And identify the cases that meet criteria for inclusion in the U.S. Zika Pregnancy Registry.
    Don't miss this special opportunity, eligible for free CME for PAs.

    Zika Virus — Implications for Pregnant Women
    Date: Thursday, July 28
    Time: 2–3 p.m. EDT
    Sign up: Pre-register (at no cost) and view the detailed agenda.


  • July 08, 2016 8:19 AM | Ashley Monson (Administrator)

    THURSDAY, July 7, 2016 (HealthDay News) -- Cancers linked to the sexually transmitted human papillomavirus (HPV) keep rising in the United States, even though most cases are preventable, health officials reported Thursday.

    Cervical cancer, and mouth and throat cancers in men, accounted for most of the nearly 39,000 HPV-associated cancers diagnosed annually from 2008 to 2012, according to the U.S. Centers for Disease Control and Prevention.

    HPV vaccination and cervical cancer screening could keep more than 28,000 of these cancers from developing, the agency estimated.

    "Most cervical cancers are preventable with regular screening for precancerous lesions among women aged 21 to 65 years, linked with follow-up for abnormal test results," the CDC researchers wrote in the report.

    But cancer experts said that public perception may have to change first, especially with respect to HPV vaccination.

    "In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer," said Electra Paskett. She is co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer in Columbus.

    "Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes -- and we would have a dramatic decrease in HPV-related cancers across the globe," Paskett added.

    At current rates, these sexually linked cancers are developing in almost 12 of every 100,000 persons, the CDC said. In the previous five-year period, fewer than 33,500 of these HPV-linked cancers were diagnosed annually.

    Using data from national cancer registries, CDC analysts looked for certain cancer types -- cervical, head and neck, and anal, among them -- that have links to HPV. They found an average of 38,793 such cancers annually from 2008 to 2012.

    When looked at closely, researchers confirmed the HPV connection in 79 percent -- or 30,700 -- of cases. This included about 19,200 cancer diagnoses in females and 11,600 diagnoses in males.

    The agency estimates that as many as 28,500 of these were preventable with recommended HPV vaccination.

    In men, the head and neck cancers mainly involved the tongue, tonsils and pharynx -- or "oropharyngeal" cancers, the agency reported. They're often symptom-free, but may include persistent sore throat, earaches and pain when swallowing, according to the CDC.

    Breaking down the figures, whites had higher rates of oral and throat cancers than blacks and Hispanics, the report found.

    However, Hispanics and blacks were more likely to have cervical cancer than whites. The state with the highest cervical cancer rate was West Virginia; Vermont's rate was the lowest, according to the report.

    "Full vaccination coverage of the U.S. population could prevent future HPV-attributable cancers and potentially reduce racial and ethnic disparities in HPV-associated cancer incidence," according to report author Dr. Laura Viens and colleagues.

    The findings were published in the July 8 issue of the Morbidity and Mortality Weekly Report.

    The CDC recommends routine HPV vaccination at ages 11 to 12 for boys and girls, and through age 26 for females and age 21 for males if they were not previously vaccinated.

    Anyone who has ever had sex -- genital or otherwise -- can get HPV, scientists say.

    Oral cancers in particular are HPV-related, said Dr. Jill Rabin of Northwell Health in New Hyde Park, N.Y.

    "This is important since oral-genital contact may be quite prevalent and teens may not consider this as 'true' sexual activity," Rabin said. Oral-genital sex also places teens at risk for penile, rectal and vulvar-vaginal cancers, she said.

    "The reason the vaccine is given to girls (aged 9 to 26) and boys (aged 9 to 21) is that the younger the person is vaccinated, the better they will respond in making antibodies which help fight and prevent the HPV," Rabin explained.

    "We give the vaccine now, in other words, to protect against exposure to HPV later, when they are older," she said.

    More information

    The U.S. National Cancer Institute has more on HPV vaccination.

    SOURCES: Electra Paskett, Ph.D., co-director, Cancer Control Research Program, Ohio State University Comprehensive Cancer Center -- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio; Jill Rabin, M.D., co-chief, division of ambulatory care, women's health programs-PCAP Services, Northwell Health, New Hyde Park, N.Y.; July 8, 2016, Morbidity and Mortality Weekly Report

    -- Margaret Farley Steele

    Last Updated: Jul 7, 2016

    Copyright © 2016 HealthDay. All rights reserved.


  • July 07, 2016 3:40 PM | Ashley Monson (Administrator)

    The USF College of Public Health’s Dr. Arturo Rebollón, a doctoral student based in Panama, says it is time to give the community the empowerment they need to combat Zika in Panama.

    He is working with Esri Panamá, a geographical information systems mapping company, to create a new web application for all things Zika.

    From information about Zika provided in laymen terms to prevention tips and interactive maps, the tool is meant to create a vital link, according to Rebollón.

    Rebollon Zika Application

    [Dr. Arturo Rebollón and Ms. Lismarí Vásquez. (Photo courtesy of: LA PRENSA, Jazmín Saldaña)]

    “The whole idea is to create mobilization from the community site because the health ministry doesn’t have enough people to do it,” he said. “This tool is a link between academia, health organizations and the community.”

    The content of the web application is open source and available to anyone via the web at www.geozika.com. A downloadable app is also in the works.

    Screen Shot 2016-05-24 at 11.49.31

    [The application is currently web-based and available online. (Photo courtesy of Arturo Rebollón)]

    Dr. Rebollón said a unique feature of the app is the ability of users to report mosquito breeding grounds anonymously.

    “People know what Zika is and how to prevent it, but this adds another layer into the community knowledge and gives them empowerment so they feel more prone to report it and take care of themselves,” he said. “That’s the whole idea. They know they have a problem and they can fix it.”

    Ms. Lismarí Vásquez of Esri Panamá is designing the platform for the web application, while Rebollón provides oversight on the clinical information and structure.

    “It’s a very interactive way to tell a story using pictures and geolocation,” Dr. Rebollón said.

    Read more.


  • July 07, 2016 7:32 AM | Ashley Monson (Administrator)

    BY WILL BOGGS MD

    Young women who get the recommended three doses of human papilloma virus (HPV) vaccine have fewer abnormal Pap tests than unvaccinated women and women who only get two doses, Canadian researchers say.

    HPV vaccination is intended to prevent cervical cancer and abnormal cells that can lead to cancer, but how well it’s working among North American women remains unclear.

    “Both HPV vaccination and cervical cancer screening are important to further reduce the incidence, morbidity, and mortality of cervical cancer,” senior study author Dr. Huiming Yang from Alberta Health Services in Calgary told Reuters Health by email.

    The province of Alberta implemented a school-based HPV vaccination program for girls in 2008 and expanded it to include boys in 2014. The HPV vaccination program provides three doses of the vaccine over a six-month period.

    Yang and colleagues studied the impact on Pap test results eight years into this program.

    The researchers analyzed data on 10,204 women, 56 percent of whom were unvaccinated and the rest had received at least one dose of HPV vaccine before having cervical cancer screening.

    Overall, 14.5 percent of women had abnormal Pap tests and 85.5 percent had normal tests. Most abnormal tests, nearly 94 percent, were low-grade abnormalities, but the rest were the high-grade abnormalities that could progress to cervical cancer.

    Less than 12 percent of women who had received at least three doses of the vaccine had abnormal Pap results, whereas 16 percent of unvaccinated women had abnormal tests. This translates into a 28 percent risk reduction with full HPV vaccination.

    The difference was even greater – a 50 percent reduction in risk – when only high-grade abnormalities were included, according to the results published in CMAJ.

    Surprisingly, incomplete HPV vaccination with two or fewer doses of the vaccine was not associated with a lower risk of having an abnormal Pap test.

    "Our study shows that three doses HPV vaccination is very effective in reducing cervical cell abnormalities, particularly for high-grade lesions, but two does not appear to offer similar protection,” Dr. Yang concluded. “It is important to complete all scheduled doses of vaccine.”

    "I found it interesting that young women in this study that received two doses of the quadrivalent vaccine had similar odds of having an abnormal Pap as those who had 0 doses,” said Dr. Jacqueline M. Hirth from the University of Texas Medical Branch, Galveston, who has also studied the effect of HPV vaccination on cervical cancer screening among young women.

    That result should be interpreted with caution, she told Reuters Health by email, since many of the young women in this sample were under 21 years of age and may not have been receiving routine Pap screenings.

    “They may have actually gone to their providers for abnormal bleeding or other symptoms, which may have prompted them to receive Pap tests that would not have met the criteria for ‘routine’ screenings,” Hirth said.

    HPV vaccination in combination with cervical cancer screening according to guidelines is important for the prevention of cervical cancer, Hirth said, because the HPV vaccine does not protect against all high-risk HPV types.

    She added that it's important for women to receive all three doses of the HPV vaccine and to undergo cervical cancer screening regardless of vaccination history in order to reduce their risk of developing HPV-related cancers.

    SOURCE: bit.ly/29ig8pw CMAJ, online July 4, 2016.


  • July 06, 2016 11:20 AM | Ashley Monson (Administrator)

    (Reuters Health) – Breast cancer survivors may not always realize why follow-up care is important, a small study suggests.

    According to the American Society of Clinical Oncology, the purpose of follow up care is to keep patients in good health, manage side effects from treatment, find out if cancer has returned, and screen for other types of cancer, along with providing emotional support.

    Many patients in the study understood this, to some extent. “When patients were asked about the aims of breast cancer follow-up, they most frequently mentioned that follow-up was to detect recurrence or give reassurance,” according to a report in Maturitas.

    But 12 patients said they were somewhat uncertain about the aims of follow-up.

    And some women believed – incorrectly - that breast cancer could not recur after two to five years of follow-up, and that recurrences could not develop directly after or between follow-up appointments.

    Dr. Annette Berendsen and colleagues at University Medical Center Groningen in The Netherlands interviewed 61 women with a history of early-stage breast cancer.

    The women were in their early 60s, on average, and had been diagnosed with breast cancer an average of seven years earlier. All had undergone some type of surgery, and 39 had also received radiation.

    Many of the women reported feeling scared, worried and distressed before follow up visits, and roughly a quarter said the appointments made them felt anxious and as if they were dealing with their breast cancer again. But after receiving news they were cancer-free, most said their worries disappeared.

    Some mentioned “surveillance for metastatic disease” as the reason for follow up while others couldn’t identify different ways the cancer could return. Women also questioned whether physical exams and mammography could detect any signs of their cancer returning, while others valued the tests in their follow up visits.

    Dr. Gary Lyman, who specializes in breast cancer research and treatment at the Hutchinson Institute for Cancer Outcomes Research, told Reuters Health by phone, “This study confirms patients’ misconceptions of what the purpose and goals of follow up care is all about.”

    Lyman, who was not involved with the study, recommends that doctors be clear with their patients as to why certain tests are necessary and others aren’t.

    As for patients, he urges them to ask questions.

    “Have a conversation with your doctor about what follow up work should be done, how often and why,” he said. “Find out why to fully understand the next steps in your care.”

    SOURCE: bit.ly/29IrLrk Maturitas, online June 23, 2016.


  • July 06, 2016 11:17 AM | Ashley Monson (Administrator)

    Consuming higher amounts of unsaturated fats was associated with lower mortality, according to a study from Harvard T.H. Chan School of Public Health. In a large study population followed for more than three decades, researchers found that higher consumption of saturated and trans fats was linked with higher mortality compared with the same number of calories from carbohydrates. Most importantly, replacing saturated fats with unsaturated fats conferred substantial health benefits. This study provides further support for the 2015­2020 Dietary Guidelines for Americans that emphasize the types of fat rather than total amount of fat in the diet. 

    The study is the most detailed and powerful examination to date on how dietary fats impact health. It suggests that replacing saturated fats like butter, lard, and fat in red meat with unsaturated fats from plantbased foods—like olive oil, canola oil, and soybean oil—can confer substantial health benefits and should continue to be a key message in dietary recommendations. The study will be published online July 5, 2016 in JAMA Internal Medicine. 

    "There has been widespread confusion in the biomedical community and the general public in the last couple of years about the health effects of specific types of fat in the diet," said Dong Wang, a doctoral candidate, SD '16, in the Departments of Nutrition and Epidemiology at Harvard Chan School and lead author of the study. "This study documents important benefits of unsaturated fats, especially when they replace saturated and trans fats." 7/6/2016 Higher consumption of unsaturated fats linked with lower mortality  http://medicalxpress.com/print386911677.html 2/2 

    The study included 126,233 participants from two large long­term studies—the Nurses' Health Study and the Health Professionals Follow­Up Study—who answered survey questions every 2­4 years about their diet, lifestyle, and health for up to 32 years. During the follow­up, 33,304 deaths were documented. Researchers from Harvard Chan School and Brigham and Women's Hospital examined the relationship between types of fats in the participants' diets and overall deaths among the group during the study period, as well as deaths due to cardiovascular disease (CVD), cancer, neurodegenerative disease, and respiratory disease. 

    Different types of dietary fat had different associations with mortality, the researchers found. Trans fats—on their way to being largely phased out of food—had the most significant adverse impact on health. Every 2% higher intake of trans fat was associated with a 16% higher chance of premature death during the study period. Higher consumption of saturated fats was also linked with greater mortality risk. When compared with the same number of calories from carbohydrate, every 5% increase in saturated fat intake was associated with an 8% higher risk of overall mortality. Conversely, intake of high amounts of unsaturated fats—both polyunsaturated and monounsaturated—was associated with between 11% and 19% lower overall mortality compared with the same number of calories from carbohydrates. Among the polyunsaturated fats, both omega­6, found in most plant oils, and omega­3 fatty acids, found in fish and soy and canola oils, were associated with lower risk of premature death. 

    The health effects of specific types of fats depended on what people were replacing them with, the researchers found. For example, people who replaced saturated fats with unsaturated fats—especially polyunsaturated fats—had significantly lower risk of death overall during the study period, as well as lower risk of death from CVD, cancer, neurodegenerative disease, and respiratory disease, compared with those who maintained high intakes of saturated fats. The findings for cardiovascular disease are consistent with many earlier studies showing reduced total and LDL ("bad") cholesterol when unsaturated fats replace trans or saturated fats. 

    People who replaced saturated fats with carbohydrates had only slightly lower mortality risk. In addition, replacing total fat with carbohydrates was associated with modestly higher mortality. This was not surprising, the authors said, because carbohydrates in the American diet tend to be primarily refined starch and sugar, which have a similar influence on mortality risk as saturated fats. "Our study shows the importance of eliminating trans fat and replacing saturated fat with unsaturated fats, including both omega­6 and omega­3 polyunsaturated fatty acids. In practice, this can be achieved by replacing animal fats with a variety of liquid vegetable oils," said senior author Frank Hu, professor of nutrition and epidemiology at Harvard Chan School and professor of medicine at Harvard Medical School. 

    More information: "Specific Dietary Fats in Relation to Total and Cause­Specific Mortality," Dong D. Wang, Yanping Li, Stephanie E. Chiuve, Meir J. Stampfer, JoAnn E. Manson, Eric B. Rimm, Walter C. Willett, and Frank B. Hu, JAMA Internal Medicine, online July 5, 2016, DOI: 10.1001/jamainternmed.2016.2417 

    Provided by Harvard T.H. Chan School of Public Health "Higher consumption of unsaturated fats linked with lower mortality" July 5, 2016 http://medicalxpress.com/news/2016­07­ higher­consumption­unsaturated­fats­linked.html


  • July 06, 2016 11:15 AM | Ashley Monson (Administrator)

    Effectiveness drops dramatically after that.

    En Español

    TUESDAY, July 5, 2016 (HealthDay News) -- A flu shot during pregnancy protects newborns against the flu for about two months after birth, a new study finds.

    Previous studies have shown that flu vaccination during pregnancy helps protect newborns. This study shows the length of protection is likely limited to the first eight weeks of life, said Marta Nunes, of the University of the Witwatersrand in Johannesburg, South Africa, and her co-authors.

    Researchers assessed more than 1,000 infants born to women given a flu shot during pregnancy. They found the vaccine's effectiveness was highest (85.6 percent) during the first eight weeks after birth. Effectiveness ranged from about 25 percent to 30 percent at ages 8 to 16 weeks, and 16 to 24 weeks.

    The findings were published online July 5 in the journal JAMA Pediatrics.

    The results are important because infants have high rates of flu, which puts them at risk for hospitalization and death, the study authors said in a journal news release.

    Current vaccines don't work well in infants younger than 6 months and aren't approved for use in that age group, they added.

    More information

    The U.S. Centers for Disease Control and Prevention has more on pregnancy and flu vaccination.

    SOURCE: JAMA Pediatrics, news release, July 5, 2016

    -- Robert Preidt

    Last Updated: Jul 5, 2016

    Copyright © 2016 HealthDay. All rights reserved.


  • July 06, 2016 11:13 AM | Ashley Monson (Administrator)

    Written by Catharine Paddock PhD

    Published: Tuesday 5 July 2016

    Health authorities in the United States and the United Kingdom are alerting hospitals to be on the lookout for an emerging multidrug-resistant yeast in patients that is causing potentially lethal, invasive infections in healthcare settings. First brought to the attention of medical authorities in 2009 in Japan, outbreaks of Candida auris infections have now occurred in nine countries on four continents.

    ICU bed Patients who have been in intensive care for a long time appear to be particularly susceptible to invasive infection by C. auris.

    The Centers for Disease Control and Prevention (CDC) in the U.S. and Public Health England (PHE) in the U.K. have issued alerts to hospitals and testing labs warning that healthcare facilities in several countries have reported that C. auris has been causing severe illness in hospitalized patients.

    Invasive infection - where the yeast enters the bloodstream - with any Candidaspecies can be fatal. Based on information from a limited number of patients, the CDC note that 60 percent of patients with C. auris infection have died. However, many of them had serious illnesses that, on their own, raised their risk of death.

    There are three main reasons to be concerned about C. auris infections, say the CDC. First, it is often multidrug-resistant; second, it is difficult to identify; third, it has caused outbreaks in hospital settings.

    C. auris can enter the bloodstream and spread through the body, causing severe invasive infection. It often does not respond to commonly used antifungal drugs, making infections difficult to treat. The yeast can also cause wound infections and ear infections.

    Recent emergence of C. auris in different places a mystery

    The yeast infection was first identified in 2009 in Japan after being isolated from ear discharge of a patient. Since then, C. aurisinfections that have entered the bloodstream have been reported from South Korea, South Africa, India, and Kuwait.

    Infections have also been identified in Colombia, Pakistan, the U.K., and Venezuela, although these are not detailed in any published reports, note the CDC.

    Sporadic cases have been identified throughout England since 2013. One English hospital has identified more than 40 cases in its adult critical care unit.

    Two other cases have also been identified in another English hospital, and investigations are under way to find if there are any other cases, says Dr. Berit Muller-Pebody, head of the antimicrobial resistance section at PHE.

    So far, however, no multidrug-resistant strains of C. auris have been found in the U.K.

    A review of samples collected in the past has raised the possibility of there having been at least one case of C. auris infection in the U.S. that occurred in 2013.

    Why C. auris has recently emerged in so many different places is somewhat of a mystery. Molecular analysis of strains suggests while they are related within a country or region, they are highly distinct between continents.

    Retrospective testing of samples have revealed that the earliest known infection with C. auris was in South Korea in 1996.

    C. auris identification is difficult, risk factors unclear

    C. auris can only be identified reliably with molecular analysis; conventional lab techniques can mistakenly confuse it with another related fungus.

    Misidentification leads to the wrong treatment and raises the chance of the infection spreading to other patients.

    Unlike its cousin C. albicans - the yeast that causes thrush infections in the genitals and mouth - C. auris has also been found in urine and respiratory samples. However, it is not clear whether it causes infections in the lung or bladder.

    There is not much data on risk factors for C. auris infections, but the CDC say evidence suggests these are much the same as for other types of Candida infections, including recent surgery, diabetes, use of broad-spectrum antibiotics and antifungals, and use of central venous catheter (catheter in a large vein).

    Patients who have been in intensive care for a long time appear to be particularly susceptible.

    More work needed to understand C. auris

    The CDC note it is unlikely that travel to the countries with known outbreaks of C. auris will increase a person's chance of becoming infected with the yeast, as infections have primarily affected patients who were already in the hospital for other reasons.

    Most C. auris infections are treatable with a class of antifungals called echinocandins. However, in some cases, the yeast infections have been resistant to all three main classes of antifungals, making them more difficult to treat. In such cases, the infection is treated with high doses of several classes of antifungal drugs at the same time.

    The authorities say more work is needed to understand how C. auris spreads, but early evidence suggests it could be via contact with surfaces or medical equipment, or from person to person.

    However, certain infection control measures - such as strict hand hygiene and wearing gowns and gloves - are likely to prevent spread. Thorough environmental cleaning of hospital rooms could also help.

    Other measures include screening of patients, isolation of those infected, and temporary closure of affected wards to enable thorough deep cleaning with an approved, fungus-targeting product.

    The CDC say:

    "C. auris may not represent a new organism so much as one that is newly emerging in various clinical settings. Although the causes for such emergence are unknown, they may include new or increasing antifungal selection pressures in humans, animals, or the environment."

    The CDC recently called for more effort to fight superbugs.

    Written by Catharine Paddock PhD

    CDC, Clinical alert, accessed 4 July 2016.

    Department of Health: Public Health England news alert, accessed 4 July 2016.

    Additional source: CDC, Candida auris Questions and answers, accessed 4 July 2016.


  • July 05, 2016 9:38 AM | Ashley Monson (Administrator)
    However, study did not meet primary objective of reducing odds of vasovagal syncope by 40 percent



    FRIDAY, July 1, 2016 (HealthDay News) -- Fludrocortisone is associated with a reduction in the risk of vasovagal syncope, according to a study published in the July 5 issue of the Journal of the American College of Cardiology.

    Robert Sheldon, M.D., Ph.D., from the University of Calgary in Canada, and colleagues examined whether fludrocortisone treatment reduces the risk of recurrent vasovagal syncope by at least 40 percent. A total of 210 patients with a median of 15 syncopal spells over a median of nine years were randomized to fludrocortisone or placebo; 14 patients were lost to follow-up before syncopal recurrence.

    The researchers found that 96 patients had one or more syncope recurrences. The fludrocortisone group had a marginally nonsignificant reduction in syncope (hazard ratio, 0.69; 95 percent confidence interval, 0.46 to 1.03). Fludrocortisone correlated with a significant reduction in the likelihood of syncope in a multivariable model (hazard ratio, 0.63; 95 percent confidence interval, 0.42 to 0.94). There was a significant benefit due to fludrocortisone when analysis was restricted to outcomes after two weeks of dose stabilization (hazard ratio, 0.51; 95 percent confidence interval, 0.28 to 0.89).

    "The study did not meet its primary objective of demonstrating that fludrocortisone reduced the likelihood of vasovagal syncope by the specified risk reduction of 40 percent," the authors write. "The study demonstrated a significant effect after dose stabilization, and there were significant findings in post hoc multivariable and on-treatment analyses."

    Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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