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  • March 30, 2018 9:06 AM | Ashley Monson (Administrator)

    CDC Releases State-Specific Assisted Reproductive Technology Surveillance Report 
    The Assisted Reproductive Technology Surveillance – United States, 2015 summary in CDC’s Morbidity and Mortality Weekly Report (MMWR) released today presents state-specific data on assisted reproductive technology (ART) use and outcomes. 


  • March 30, 2018 8:24 AM | Ashley Monson (Administrator)

    Article link - https://www.npr.org/sections/health-shots/2018/03/26/595387963/birth-control-apps-find-a-big-market-in-contraception-deserts

    Rachel Ralph works long hours at an accounting firm in Oakland, Calif., and coordinates much of her life via the apps on her phone.

    So when she first heard several months ago that she could order her usual brand of birth control pills via an app and have them delivered to her doorstep in a day or two, it seemed perfect. She was working 12-hour days.

    "Food was delivered; dinner was often delivered," Ralph says. "Anything I could get sent to my house with little effort — the better."

    Ralph ordered a three-month supply of pills via the app of a San Francisco-based company called NURX. It's one of several digital ventures, including Maven and Lemonaid Health, that now provide several types of hormonal contraception without requiring a live visit to a doctor or other health care provider.

    NURX is now available in 18 states. It's popular in Texas, where many women live in what some health policy analysts call "contraception deserts" — places that lack easy access to women's health services.Women using these services in cities say they like the speed and no-hassle privacy they get by making a purchase through the app. And in some rural areas where women's health clinics are few and far between, being able to buy prescription contraceptives online — starting at around $15 for a month's supply — can be not only much more private, but much more affordable and less time-consuming than driving an hour or more to the closest clinic, or paying for a doctor's appointment.

    The company's process is pretty simple. After users log in to the NURX app, they fill out a questionnaire.

    "They tell us about their medical history," says Jessica Horowitz, a nurse practitioner with NURX who consults with patients via online chats. "They give us a blood-pressure check."

    A clinician like Horowitz then reviews the answers and, based on that, makes a suggestion about what type of hormonal contraception might be best for that individual; a pill, a ring or a patch are available, as well as emergency contraception. If the patient has a question about the product she's considering, she can send an instant message or call to chat with a provider.

    "It doesn't matter what time of day it is," Horowitz says. "Someone responds."

    Then NURX sends a prescription to a pharmacy and the drugs are mailed out via priority mail, or faster for emergency contraception. The cost of a month's supply of prescription birth control is often free to patients, if they have health insurance, Horowitz says, and otherwise starts at $15 out-of-pocket for a month's supply, depending on the brand.

    For Claire Hammons, who lives and works in Llano, Texas, about 90 minutes outside Austin, the low cost of the pills was as important as the convenience.

    Hammons loves many aspects of life in her small town. "There is a population of 3,000 people," she says. "But we have a lot going on. We are a huge art town. We have the Llano River. We are surrounded by state parks."

    Still, living there has its drawbacks, she says. There's no women's health clinic nearby, and getting prescription contraceptives isn't easy, especially without health insurance. And for Hammons, the main medicine she needs is birth control pills.

    "I've been taking birth control since I was 16 because of endometriosis," she explains.

    If she can't get the pills, Hammons is in a lot of pain every month. A while back, after losing her health plan, Hammons had a particularly hard time getting a prescription. Her out-of-pocket cost for a doctor's visit in Llano would have been $140.

    "I really did not have — literally — have the money to go to the doctor. Period," she says.

    Hammons says she also couldn't afford to pay out of pocket to pick up the pills every month at a pharmacy.

    Then, about six months ago, she went online and found NURX. The cost-savings, she says, was "really amazing and ... saved me a lot."

    Texas has become a big market for the app. Dr. Brook Randal, an emergency medicine physician in Austin who works as a provider for NURX, says her patients come from different backgrounds and use the app for different reasons.

    "A lot of them are low-income women who may not have a low-cost clinic available to them in the communities where they live," she says. "And so we provide an important service for those women."

    In 2013, the state passed an abortion bill that led half of all Texas clinics that performed abortions to close — clinics that often also provided birth control and other medical services to low-income women.

    "Many of those women will tell us that they would have had to drive a really long distance in order to get to a clinic where they can get birth control economically," Randal says.

    And their access to birth control got even worse when Texas lawmakers cut funding for the state's family planning program, says Stacey Pogue, a health policy analyst with the Center for Public Policy Priorities in Austin. The cuts came at a time when the state's population was growing and more women were seeking services, Pogue notes.

    "The ability of our safety net system to meet those needs and deliver health care — to actually get health care to women who are looking for contraceptives and well-woman exams — that has certainly been diminished," she says.

    Apps like NURX that give women access to at least some types of contraceptives are definitely helpful, she says. But they aren't a comprehensive solution.

    Some of the most effective types of birth control — IUDs and implants — aren't available through the apps, Pogue notes, because they require a visit to a health provider. And apps will never substitute for the missing medical clinics — places where, beyond contraception, women could also get life-saving services, such as pap smears, breast exams and cervical cancer screenings.

    Texas is one of two states (Indiana is the other) where minors can't buy prescription birth control through NURX because of laws restricting minors' access to contraception.

    Lesley McClurg covers mental health and consumer health stories for KQED in San Francisco, Calif. Ashley Lopez reports on health care and politics for KUT, in Austin, Texas.

    CorrectionMarch 27, 2018

    In the audio of this story, as in a previous Web version, we incorrectly suggest that Llano, Texas, has only one doctor. In fact, there are about a dozen physicians there, and most of them provide primary care.


  • March 20, 2018 2:10 PM | Ashley Monson (Administrator)

    by Ryan O'Hare16 March 2018

    Girls who start puberty earlier are more likely to be overweight as adults, finds new research from Imperial College London.

    The researchers say their findings, published today in the International Journal of Obesity, strengthen existing evidence of a link between the onset of puberty and a woman’s body mass in adulthood.

    Previous studies have established a link between obesity and puberty, with increased body weight known to be a risk factor for girls starting puberty earlier.

    However, these observational findings can be influenced by situational factors, such as ethnicity, economic background, education level, and diet, making it difficult to determine whether early puberty or these other factors are the cause.

    Previous studies have shown there is an association, but we didn't know whether early puberty caused obesity in adulthood, or was simply associated with it Dr Dipender GillAuthor

    But now this latest research shows that early puberty is itself a risk factor for being overweight, with girls who have their first period earlier more likely to have a higher Body Mass Index (BMI).

    According to the authors of the study, their findings help to untangle these complex external factors and add insight into an underlying causal link, showing that early puberty has a significant impact on a woman’s risk of obesity.

    Dr Dipender Gill, a Wellcome Trust Clinical Research Fellow in the School of Public Health and first author of the study, said: “Previous studies have shown there is an association, but we didn't know whether early puberty caused obesity in adulthood, or was simply associated with it. In our latest study we've generated evidence to support that it is a causal effect.”

    In order to get around the effects of confounding factors, the Imperial team used genetic variants as a tool to look at the effect of the onset of puberty (known as age at menarche), measured as the age of a girl’s first period.

    The genes in every cell of our bodies are randomly gifted to us from our parents when their sperm and egg cells fuse, with the outcome of this random jumble being the genetic basis of the embryo – influencing everything from hair colour to risk of disease for the rest of your life.

    But single ‘letter’ changes to the DNA sequence of a gene can alter its function. In terms of disease risk, these single letter variants (called single-nucleotide polymorphisms, or SNPs) can result in a small increase or decrease in risk. The combination of variants of more than 20,000 genes contribute towards our cumulative genetic risk.

    We're not saying that it's a genetic effect, but rather that by using these genetic variants as a proxy for earlier puberty Dr Dipender Gill

    In the latest study, researchers employed a statistical technique called Mendelian Randomization which uses these genetic variants as a tool to show the causal relationship between earlier puberty and increased BMI.

    Using data from 182,416 women they identified 122 genetic variants that were strongly associated with the onset of puberty – with the women’s age at first period obtained via questionnaire.  

    The team then looked at data from the UK Biobank, which holds biomedical information on hundreds of thousands of people, incorporating physiological measurement data with genetic sequence data and questionnaire responses.

    Specifically, they looked for the effect of the genetic variants related to age at menarche with BMI in a second set of 80,465 women from the UK Biobank, for whom they also had measurements for BMI.

    Initial analysis revealed a link between these genetic variants and BMI, with those women who had variants associated with earlier puberty having an increased BMI. The researchers then tested for this same association in a third group 70,962 women, finding the same association.

    Dr Gill, added: “Some of these genetic variants are associated with earlier puberty and some with later onset, so by taking advantage of this we were able to investigate any association of age at menarche with BMI in adulthood.

    “We're not saying that it's a genetic effect, but rather that by using these genetic variants as a proxy for earlier puberty, we are able to show the effect of earlier puberty without the impact of external factors that might confound our analysis.

    "We performed a range of statistical sensitivity analyses to test the robustness of our findings and they remained strong through this, so within the limitations of the study design, we are confident of findings.”

    Previous research from the group has used the same technique to show that low iron levels are associated with an increased risk of heart disease, as well as showing that girls who start puberty earlier are likely to spend less time in education.

    Future studies will use the same Mendelian Randomization approach to look at genetic variants in relation to drug targets for cardiovascular disease and stroke.

    The technique is not without its limitations, and it is possible that these genetic variants could be influencing bodyweight independently of age at menarche, such as through altering metabolism or fat production. However, even after the team had removed any genetic variants that were also associated with childhood obesity (12 in total), they came to the same finding.

    According to the researchers, it remains unclear how maturing earlier has a direct impact on body weight, but they indicate that differences between physical and emotional maturity may play a role.

    It could be that young women who mature earlier than their peers are treated differently or have different societal pressures than girls of the same age who have not started puberty.

    Another explanation could be the physical effects of hormonal changes during puberty, such as increased fat deposition in breast tissue, which when established earlier may move them to a higher risk profile for higher BMI or obesity in later life.

    “It is difficult to say that changing someone's age of puberty will affect their adult risk of obesity and whether it is something that we can clinically apply – as it would unlikely be ethically appropriate to accelerate or delay the rate of puberty to affect BMI,” added Dr Gill.

    “But it is useful for us to be aware that it's a causal factor– girls who reach puberty earlier may be more likely to be overweight when they are older.”

    Age at menarche and adult body mass index: a Mendelian randomization study’ by Dipender Gill et al, is published in the International Journal of Obesity

    Article text (excluding photos or graphics) available under an Attribution-NonCommercial-ShareAlike Creative Commons license.

    Photos and graphics subject to third party copyright used with permission or © Imperial College London.


  • March 19, 2018 7:47 AM | Ashley Monson (Administrator)

    Kristy Goodman, PA-C presented an STI update on Wednesday, March 14, 2018. Click here to view her presentation in our webinar library. Thank you again Kristy!


  • March 06, 2018 8:45 AM | Ashley Monson (Administrator)

    Strelow, Brittany MPAS, PA-C; Fellows, Nicole MPAS, PA-C; Fink, Stephanie R. MPAS, PA-C; O'Laughlin, Danielle J. MPAS, PA-C; Radke, Gladys MPAS, PA-C; Stevens, Joy MPAS, PA-C; Tweedy, Johanna M. APRN, CNP, DNP

    Journal of the American Academy of PAs: March 2018 - Volume 31 - Issue 3 - p 15–18

    doi: 10.1097/01.JAA.0000530288.83376.8e

    CME: Women's Health

    Abstract

    Postpartum depression, which affects 10% to 20% of women in the United States, can significantly harm the health and quality of life for mother, child, and family. This article reviews the risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment of postpartum depression with specific focus on women of advanced maternal age.

    Read more


  • February 24, 2018 5:32 AM | Ashley Monson (Administrator)

    Public Comment on Draft Research Plan: Screening for Bacterial Vaginosis in Pregnant Women to Prevent Preterm Delivery

    The U.S. Preventive Services Task Force posted today a draft research plan on screening for bacterial vaginosis in pregnant women to prevent preterm delivery. The draft research plan is available for review and public comment from February 22, 2018 through March 21, 2018. To review the draft research plan and submit comments, go here.


  • February 22, 2018 1:42 PM | Ashley Monson (Administrator)

    Now Accepting 2018 APAOG Awards Nominations!

    Nominations are due March 16, 2018. The awards process is the single most important means that APAOG has for recognizing PAs who have made significant contributions in women's health. Awards will be presented at the APAOG Reception at the AAPA National Conference (more information to come). View the 2018 Awards Grid for full award details

    >> Click Here To Submit Your Award Nomination Form  


  • February 08, 2018 7:59 AM | Ashley Monson (Administrator)

    The U.S. Preventive Services Task Force seeks comments on a draft recommendation statement and draft evidence review on screening for syphilis infection in pregnant women. The Task Force found strong evidence of benefit in screening all pregnant women for syphilis. The draft recommendation statement and draft evidence review are available for review and public comment from February 6, 2018 to March 5, 2018 here


  • February 05, 2018 9:43 AM | Ashley Monson (Administrator)

    This week, a first-of-its-kind study examining US women's and teen's interest in over-the-counter (OTC) access to a progestin-only birth control pill (POP) was published in Women's Health Issues. The research, authored by myself and Daniel Grossman (Advancing New Standards in Reproductive Health, UCSF), found 39% of adults and 29% of teens reported likely use of an OTC POP, with interest increasing to 46% for adults and 40% for teens if the pill were covered by insurance. The level of interest was similar to findings from a 2013 study on OTC birth control pills that didn't specify a hormonal formulation, suggesting that the type of pill that goes OTC matters less to people than the increase in access.

    Other notable findings include:

    • Nearly one in four adults and teens not currently using contraception said they would be interested in using an OTC POP.
    • A clear majority of women (85%) reported they would continue to visit their health care provider to obtain gynecologic screenings, such as Pap smears and tests for infection.
    • Among current condom users interested in an OTC POP, a majority of adults (61%) and teens (71%) said they would likely continue to use condoms while using an OTC pill.

    Kate Grindlay Kelly 
    Project Director/Associate
    Ibis Reproductive Health

    The Oral Contraceptives (OCs) Over-the-Counter (OTC) Working Group is a coalition of reproductive health, rights, and justice organizations, nonprofit research and advocacy groups, university-based researchers, and prominent clinicians who share a commitment to providing all women of reproductive age easier access to safe, effective, acceptable, and affordable contraceptives. The working group was established in 2004 to explore the potential of over-the-counter access to oral contraceptives to reduce disparities in reproductive health care access and outcomes, and to increase opportunities for women to access a safe, effective method of contraception, free of unnecessary control, as part of a healthy sexual and reproductive life.

    The working group is coordinated by Ibis Reproductive Health.

    Ibis Logo- high res



  • January 31, 2018 8:57 AM | Ashley Monson (Administrator)

    Weekly / December 22, 2017 / 66(50);1383–1385

    Loretta Gavin, PhD1; Karen Pazol, PhD2; Katherine Ahrens, PhD1 (View author affiliations)

    View suggested citation

    In April 2014, CDC published “Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs” (QFP), which describes the scope of services that should be offered in a family planning visit and how to provide those services (e.g., periodicity of screening, which persons are in need of services, etc.) (1). The sections in QFP include the following: Determining the Client’s Need for Services; Contraceptive Services; Pregnancy Testing and Counseling; Clients Who Want to Become Pregnant; Basic Infertility Services; Preconception Health Services; Sexually Transmitted Disease Services; and Related Preventive Health Services. In addition, the QFP includes an appendix entitled Screening Services for Which Evidence Does Not Support Screening.

    CDC and the Office of Population Affairs developed QFP recommendations by conducting an extensive review of published evidence, seeking expert opinion, and synthesizing existing clinical recommendations from CDC, agencies such as the U.S. Preventive Services Task Force (USPSTF), and professional medical associations such as the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.

    The scope of preventive services related to reproductive health is constantly evolving as new scientific findings are published and clinical recommendations are modified accordingly. Being knowledgeable about the most current recommendations is an important step toward providing the highest quality care to patients. To keep QFP current with the latest recommendations, CDC and the Office of Population Affairs publish occasional updates that summarize newly published clinical recommendations. The first of these updates was published in March 2016 (2), and covered guidelines published during April 2014–December 2015. This report summarizes recommendations from guidelines published during January 2016–April 2017. CDC and the Office of Population Affairs prepared these updates by searching for materials from CDC, USPSTF, and other professional medical organizations that had recommendations referenced in the original QFP. When updated recommendations were identified, they were evaluated for changes in implications for providing family planning care. CDC and the Office of Population Affairs determined that none of the newly published recommendations marked a substantial shift in how family planning care should be provided, and therefore did not seek additional review to consider the implications for the QFP for this update. Technical reviews from clinical experts representing a broad range of family planning providers might be appropriate for future updates.

    Updated recommendations that have implications for clinical practice for family planning providers are highlighted ( Box). In addition, an updated reference list for each section in the QFP is provided for all recommendations published during January 2016–April 2017, including those that did not result in any change in recommended clinical practices for family planning providers.

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    Updated Reference List, by QFP Section

    Determining the Client’s Need for Services

    1. American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women. Committee opinion no. 654: reproductive life planning to reduce unintended pregnancy. Obstet Gynecol 2016;127:e66–9. CrossRef  PubMed

    Contraceptive Services

    1. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016;65(No. RR-3). CrossRef  PubMed
    2. Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. selected practice recommendations for contraceptive use, 2016. MMWR Recomm Rep 2016;65(No. RR-4). CrossRef  PubMed
    3. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice. Committee opinion no. 670: immediate postpartum long-acting reversible contraception. Obstet Gynecol 2016;128:e32–7. CrossRef  PubMed
    4. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice Long-Acting Reversible Contraceptive Expert Work Group. Committee opinion no. 672: clinical challenges of long-acting reversible contraceptive methods. Obstet Gynecol 2016;128:e69–77. CrossRef  PubMed

    Clients Who Want to Become Pregnant

    1. Pfeifer S, Butts S, Fossum G, et al. ; Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Reproductive Endocrinology and Infertility. Optimizing natural fertility: a committee opinion. Fertil Steril 2017;107:52–8. CrossRef  PubMed

    Preconception Health Services

    1. American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women. Committee opinion no. 654: reproductive life planning to reduce unintended pregnancy. Obstet Gynecol 2016;127:e66–9. CrossRef  PubMed
    2. Kim DK, Riley LE, Harriman KH, Hunter P, Bridges CB. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older—United States, 2017. MMWR Morb Mortal Wkly Rep 2017;66:136–8. CrossRef  PubMed
    3. Robinson CL, Romero JR, Kempe A, Pellegrini C; Advisory Committee on Immunization Practices (ACIP) Child/Adolescent Immunization Work Group. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger—United States, 2017. MMWR Morb Mortal Wkly Rep 2017;66:134–5. CrossRef PubMed
    4. US Preventive Services Task Force. Folic acid supplementation for the prevention of neural tube defects: preventive medication. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2017. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication
    5. US Preventive Services Task Force. Depression in adults: screening. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/depression-in-adults-screening1
    6. US Preventive Services Task Force. Depression in children and adolescents: screening. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/depression-in-children-and-adolescents-screening1

    Sexually Transmitted Disease Services

    1. US Preventive Services Task Force. Syphilis infection in nonpregnant adults and adolescents: screening. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-nonpregnant-adults-and-adolescents

    Related Preventive Health Services

    1. US Preventive Services Task Force. Breast cancer: screening. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening1
    2. US Preventive Services Task Force. Gynecological conditions: periodic screening with the pelvic examination. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2017. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/gynecological-conditions-screening-with-the-pelvic-examination

    Screening Services for Which Evidence Does Not Support Screening

    1. US Preventive Services Task Force. Genital herpes infection: serologic screening. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/genital-herpes-screening1

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    Conflict of Interest

    No conflicts of interest were reported.

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    Corresponding author: Katherine Ahrens, kate.ahrens@hhs.gov, 240-453-2831.

     Top

    1Office of Population Affairs, U.S. Department of Health and Human Services, Rockville, Maryland; 2Division of Reproductive Health, CDC.

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    References

    1. Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014;63(No. RR-04). PubMed
    2. Gavin L, Pazol K. Update: providing quality family planning services—recommendations from CDC and the U.S. Office of Population Affairs, 2015. MMWR Morb Mortal Wkly Rep 2016;65:231–4. CrossRef  PubMed


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