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  • December 04, 2017 8:09 AM | Ashley Monson (Administrator)

    By Joshua Miller GLOBE STAFF  NOVEMBER 20, 2017

    Governor Charlie Baker signed into law Monday a bill that will mandate many Massachusetts women receive free access to contraceptives — a direct response to President Trump’s efforts to roll back coverage.

    The bill, which the state House and Senate passed overwhelmingly, will require health insurance in Massachusetts to cover most contraceptive drugs, devices, and products without a copay — that is, at no direct cost to the women getting them.

    “This is a great day in the Commonwealth of Mass.,” Baker said after signing the bill into law, surrounded by top Democratic leaders in the state including Attorney General Maura T. Healey, Senate President Stanley C. Rosenberg, and House Speaker Robert A. DeLeo.

    The mandate will cover a 12-month supply of prescription contraception after a 3-month trial, emergency contraception, and voluntary female sterilization procedures. It will not cover condoms.

    The legal language includes an exemption for insurance policies purchased by a church or church-controlled organization.

    The legislation’s passage followed an executive order by President Trump that tweaks the Obamacare rules. It allows more employers to opt out of providing coverage for birth control to women by claiming religious or moral objections.

    Under Obamacare, also known as the Affordable Care Act, many women no longer pay for contraceptives. The Massachusetts law, which will go into effect in six months, goes further than the national law in some respects. For example, it mandates coverage of over-the-counter emergency contraception at pharmacies without a copayment. The federal mandate only required copay-free emergency contraception with a prescription.

    “This is about the fact that every woman should have access to affordable and reliable basic health preventative services, including birth control. And this bill takes an important step toward insuring that,” Healey said at the signing ceremony at the State House.

    The bill has garnered praise from groups such as the advocacy arm of the state’s Planned Parenthood organization. But it has drawn opprobrium from a Catholic group, the Catholic Action League of Massachusetts.

    “This coercive and gratuitous measure is about ideology, not health care,” the league’s executive director, C. J. Doyle, said in an email.

    It means that those have moral objections to contraceptives and sterilization procedures “will be compelled, in violation of their consciences, to subsidize, at an expanded level, procedures and practices which they find abhorrent,” Doyle said.

    The law is supported by insurance providers in the state. The Massachusetts Association of Health Plans has called it “a sensible bill.”

    An analysis of the legislation released by the state’s Center for Health Information and Analysis found the law would likely increase premiums by a very small amount, about four-one-hundredths of one percent over the next five years.

    Almost all Massachusetts residents are covered by health insurance.

    But the new law will not apply to all insurance coverage in the state. It covers traditional health plans offered by employers who pay a premium to an insurance carrier, and the state Group Insurance Commission, an agency that administers health benefits to public employees and their families. It also covers MassHealth, the state’s Medicaid program for the poor and disabled.

    But the new law will not apply to self-insured employers, usually larger companies, that assume the financial risk of providing health care benefits to their employees. Many in Massachusetts are insured that way, limiting the scope of the law.

    Still, said Dr. Jennifer Childs-Roshak, who leads the Planned Parenthood League of Massachusetts, she anticipates self-insured employers to follow the same policies, which she said are broadly supported by Massachusetts residents.

    Not covering contraceptives, “I would expect, in the state of Massachusetts, it would be not a great business move to choose to do that,” Childs-Roshak told the Globe.

    Baker — a Republican who supports abortion rights, gay marriage, and signed a law to allow people to use the restrooms and locker rooms that match their gender identity — is expected to run for re-election next year.

    Material from the he Associated Press was used in this report. Joshua Miller can be reached at joshua.miller@globe.com.


  • November 27, 2017 9:13 AM | Ashley Monson (Administrator)
    • by Greg Von PortzNovember 21, 2017
    • This article is a collaboration between MedPage Today® and:

       Medpage TodayThe American College of Cardiology and American Heart Association's new blood pressure guidelines came in a comprehensive, and thus ponderous, 192-page document. So here at MedPage Today we've pulled together an abridged version for visual learners.

    Below you'll find key changes to thresholds for diagnosis and treatment, the algorithm for treatment, how prevalence is projected to change, and more.

    1. 130/80 mm Hg is the new 140/90 mm Hg, but there’s more to the new guideline with two stages of hypertension and a new name for prehypertension.

    image



    2. The guideline replaces JNC7, seen here side by side for comparison.

    image



    3. The update emphasizes lifestyle changes in each blood pressure category and leaves antihypertensive medications for higher-risk stage 1 patients and stage 2 hypertension.

    image



    4. The lowered threshold for hypertension increases its prevalence compared with the JNC7 thresholds.

    imagePrevalence of Hypertension, By ACC/AHA 2017 Versus JNC7



    5. The impact will vary by group. Hover over the chart below to see details for each.



    6. The change won’t have as large an impact on prevalence of antihypertensive treatment due to risk-based recommendations in stage 1 hypertension.

    imageACC/AHA 2017 Recommendations for Nonpharmacological Intervention



    7. The pharmacologic treatment thresholds are largely similar across comorbidities.

    imageBlood Pressure Thresholds, By Condition

    The full guideline may be found in Hypertension. Images are reprinted with permission. Copyright American College of Cardiology Foundation and the American Heart Association, Inc.


  • November 27, 2017 9:12 AM | Ashley Monson (Administrator)

    Kronenberg A, et al. BMJ. 2017;doi:10.1136/bmj.j4784.

    November 22, 2017

    Although the NSAID diclofenac decreased antibiotic use among women with uncomplicated lower UTI, it increased the median duration of symptoms and may elevate the risk for pyelonephritis, compared with the antibiotic norfloxacin, according to findings published in the BMJ.

    UTI is one of the most common bacterial infections in adults, affecting considerably more women than men... Antibiotic prescriptions for UTI account for 10% to 20% of all antibiotic prescriptions in ambulatory care and are second only to antibiotic prescriptions for respiratory tract infections,” Andreas Kronenberg, MD, from the Institute for Infectious Diseases, University of Bern, Switzerland, and colleagues wrote. “Reducing antibiotic prescriptions for UTI could potentially decrease the risk of antibiotic resistance.”

    Kronenberg and colleagues conducted a randomized, double-blind trial to determine if NSAIDs are noninferior to antibiotics for resolution of symptoms in cases of uncomplicated lower UTI in women. The researchers enrolled 253 women uncomplicated lower UTI from 17 general practices in Switzerland and randomly assigned them to receive treatment for symptoms of UTI with either the NSAID diclofenac (n = 133) or the antibiotic norfloxacin (n = 120).

    Symptom resolution at day 3, 72 hours after randomization and 12 hours after receiving the last study drug, was experienced by more women in the norfloxacin group than the diclofenac group (80% vs. 54%; risk difference = 27%; 95% CI, 15-38; P < .001 for superiority). Women receiving diclofenac had a median time until symptom resolution of 4 days, while those receiving norfloxacin had a median time of 2 days.

    Use of antibiotics up to day 30 was observed in 62% of women in the diclofenac group and 98% of those in the norfloxacin group (risk difference = 37%; 95% CI, 28-46). Five percent of women receiving diclofenac and no women receiving norfloxacin were diagnosed with pyelonephritis.

    “The observed clinically relevant reduction in antibiotic use, which would likely contribute directly to decreasing resistance rates in the affected population, suggests that alternative approaches of combining symptomatic treatment with deferred, selective antibiotic use should be developed and tested in future trials,” Kronenberg and colleagues concluded. – by Alaina Tedesco

    Disclosure:  Kronenberg reports receiving travel grant and meeting expenses from Gilead, Viofor and the WHO. He also reports that he is an advisor of the Swiss Federal Office of Public Health. Please see study for all other authors’ relevant financial disclosures.

    PERSPECTIVE

    James E. Bryant

    Concern for increasing antimicrobial resistance has led to efforts to decrease antibiotic usage. 

    There are confounding aspects to the trial by Kronenberg and colleagues. Twenty-five percent of each group actually had negative cultures. Of the women in the NSAID arm who decided to take antibiotics, 71% took them in the first 3 days. On subanalysis, resolution and complete absence of symptoms at day 3 were more common in women who never received antibiotics. Finally, 34 women with positive cultures were not treated with antibiotics and 16 of these converted to negative at day 10.

    These results highlight the challenge in diagnosis and treatment of UTIs. Some women do quite well treated only symptomatically, but it is difficult to define those women with this study because of crossover. Symptomatic treatment could be offered while awaiting the results of the culture. Point of care culture technology allows results in 24 hours. Initiation of antibiotic therapy could then be determined by urine culture and also response to symptomatic treatment alone. The challenge is the diverse presentation and treatment response of patient with this diagnosis.

    • James E. Bryant, MD
    • Assistant Professor
      VP of Clinical Affairs
      Department of Urology, University of Alabama at Birmingham

    Disclosures: Bryant reports no relevant financial disclosures.


  • November 27, 2017 9:09 AM | Ashley Monson (Administrator)

    AAPA
    Register today and you can still get the lowest rate for the only national PA conference, Saturday, May 19-Wednesday, May 23, 2018, in New Orleans. Why wait and pay more? And find out how you can get $200 off your registration. You'll get five days of CME, social and networking events, culture and nightlife, the company of thousands of PAs and PA students — and your chance to create connections to your community.

  • November 20, 2017 9:00 AM | Ashley Monson (Administrator)
    Women replete in vitamin D more likely to have live birth, positive pregnancy test, clinical pregnancy

    THURSDAY, Nov. 16, 2017 (HealthDay News) -- For women undergoing assisted reproductive treatment (ART), those who are replete in vitamin D have better outcomes, including live birth, a positive pregnancy test, and clinical pregnancy, according to a review published online Nov. 14 in Human Reproduction.

    Justin Chu, M.B.Ch.B., from the University of Birmingham in the United Kingdom, and colleagues conducted a systematic review and meta-analysis of 11 published cohort studies that included 2,700 women and examined the correlation between vitamin D and ART outcomes.

    Based on data from seven studies that reported live birth (including 2,026 patients), the researchers found that live birth was more likely in women replete with vitamin D versus those with vitamin D deficiency or insufficiency (odds ratio, 1.33). In five studies with 1,700 women, the likelihood of achieving a positive pregnancy test was higher for women replete in vitamin D versus those who were deficient or insufficient in vitamin D (odds ratio, 1.34). Based on data from all 11 studies, the likelihood of clinical pregnancy was higher in women replete with vitamin D (odds ratio, 1.46). There was no correlation for miscarriage with vitamin D concentration based on data from six studies that included 1,635 patients.

    "The findings of this systematic review show that there is an association between vitamin D status and reproductive treatment outcomes achieved in women undergoing ART," the authors write. "Our results show that vitamin D deficiency and insufficiency could be important conditions to treat in women considering ARTs."

    Abstract/Full Text



    Copyright © 2017 HealthDay. All rights reserved.


  • November 17, 2017 8:21 AM | Ashley Monson (Administrator)

    Physical Therapy in Women's Health Webinar Recording Now Available!

    Click here to access all APAOG webinar recordings. 

  • November 16, 2017 8:25 AM | Ashley Monson (Administrator)

    AAPA
    Share your original research with the PA community — submit a proposal today for the ePoster Sessions at AAPA 2018, May 19-23, in New Orleans. Open to both PAs and PA student researchers, research must be about the PA profession or PA education, or conducted by PAs and/or PA students. Deadline is Dec. 31.

    Learn more

  • November 10, 2017 8:12 AM | Ashley Monson (Administrator)

    Prevention - Original Article

    Yeast infections happen. They’re itchy, icky, and uncomfortable. At least they're usually easy to treat, either with a course of over-the-counter cream or prescription medication (or these highly effective yeast infection solutions). But what if they keep coming back?

    “Yeast infections, or candidiasis, are incredibly common: More than half of women will have at least one in their lifetime,” says Katharine O'Connell White, MD, director of fellowship in family planning at Boston Medical Center. But there's a big difference between getting that gross cottage cheese-like discharge occasionally and having to run to the drugstore (or your doctor's office) several times a year.

    If you're in the chronic camp, there's a chance that your yeast infections could be a sign of something more serious. One possibility: diabetes. Candida albicans, the fungus responsible for a yeast infection, normally lives in the vagina in small amounts. It typically won't hurt you, but it flourishes when there's excess sugar available, says Anita Somani, MD, an ob-gyn at Comprehensive Women’s Care in Columbus, Ohio.

    If you have undiagnosed (and untreated) diabetes—or if you know you have diabetes but it's poorly-controlled—your vaginal secretions are likely to contain excess sugar. And when yeast in your vagina has access to that sugar, the yeast begins to take over and cause an infection, Somani explains.

    Chances are frequent yeast infections won't be your only sign of diabetes; you might also feel extra thirsty, more tired than usual, or have blurry vision. But when in doubt, ask your doctor for a blood test to check your glucose levels—especially if other vaginal infections like bacterial vaginosis (bv) and STDs have already been ruled out.

    If a patient comes to White with a recurrent yeast infection, her first step is to consider what she calls “yeast look-alikes," which include bv, trichomonas, chlamydia, and gonorrhea. (Here are 5 common reasons for vaginal itching other than a yeast infection—and 5 products that help.) Yeast infections can also sometimes be a sign of HIV: The body is weakened by the virus, which in turn allows yeast to increase and infect the vaginal membranes, Somani says.

    Bottom line: If the itchy infection doesn't go away or keeps coming back, call your doctor and get it sorted out.


  • November 10, 2017 8:03 AM | Ashley Monson (Administrator)


    11/09/2017

    November 9, 2017 – The U.S. Preventive Services Task Force posted today a final research plan on screening for hepatitis B virus infection in pregnant women. The draft research plan for this topic was posted for public comment from July 13, 2017 to August 9, 2017. The Task Force reviewed all of the comments that were submitted and took them into consideration as it finalized the research plan. To view the final research plan, please go to https://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan/hepatitis-b-virus-infection-in-pregnant-women-screening.

     

     


  • November 09, 2017 1:46 PM | Ashley Monson (Administrator)

    by Molly Walker, Staff Writer, MedPage, November 06, 2017


    BALTIMORE -- More than 21 million pregnant women, or an average of 18% of women worldwide, are colonized with group B Streptococcus bacteria, or GBS, which contributes to stillbirth, preterm birth, and in some cases, death in their infants, researchers here estimated.

    While India had the largest number of pregnant women with group B Streptococcus (over 2 million), the United States was fourth after China and Nigeria, with almost 1 million women colonized with the bacteria, reported Anna Seale, BMBCh, and Joy Lawn, BMedSci, both of the London School of Hygiene & Tropical Medicine, and colleagues.

    In an 11-paper supplement published in Clinical Infectious Diseases, researchers detailed global estimates of the burden of group B Streptococcusbacteria among pregnant women, as well as the impact on infants and stillbirths, with the goal of moving closer to developing a vaccine.

    The data were presented simultaneously at the American Society of Tropical Medicine & Hygieneannual meeting here.

    While incidence of GBS previously focused mostly on infant cases in high-income countries, researchers described worldwide burden of the bacteria as "one of the great 'black holes' for public health worldwide." They added that this is the first comprehensive study of the burden of group B Streptococcus including outcomes for both pregnant women and their babies.

    Researchers also performed a series of systematic reviews and meta-analyses. To estimate colonization data for pregnant women, they analyzed 390 articles from 84 countries, for a total of almost 300,000 pregnant women. In the 188 studies that met CDC-recommended criteria, researchers found the average adjusted estimate for maternal group B Streptococcus global colonization was 18% (95% CI 17%-19%), with substantial regional variation, ranging from 11% in Eastern Asia to 35% in the Caribbean.

    Seale & Lawn and colleagues also found that out of 15 examined studies, a single study estimated the incidence of "invasive maternal GBS disease" at 0.38% per 1,000 pregnancies. Pooled estimates found that two-thirds of cases were detected during labor and delivery or post-partum. The overall case fatality risk of pregnant or postpartum women experiencing invasive GBS was 0.20% (11 studies, 2 deaths, 890 cases), researchers said.

    They then estimated the cases of group B Streptococcus colonization worldwide using a compartmental model, and found that of 140 million live births in 2015, 21.3 million infants were exposed to maternal GBS colonization at delivery. Moreover, they estimated there were 319,000 cases of infant invasive GBS disease worldwide, with 205,000 early-onset GBS disease and 114,000 late-onset GBS cases.

    Researchers estimated 90,000 infant deaths due to group B Strep disease worldwide. Notably, they estimated 51,000 infant deaths due to early-onset GBS without access to healthcare. Stillbirth attributable to GBS disease was estimated at 57,000 cases, and the range of cases of preterm birth caused by GBS disease was 0 to 3.5 million.

    Researchers noted that the treatment for pregnant women with group B Streptococcus is antibiotics prior to delivery, with 60 countries having an antibiotic policy for use in pregnancy that aims to prevent newborn GBS disease.

    While intrapartum antibiotic prophylaxis prevented an estimated 29,000 infant deaths attributable to early-onset GBS and 3,000 deaths attributable to late-onset GBS, gaps in research remain.

    "Existing recommendations should be implemented, but these are insufficient, and the number of affected families remain unacceptable," co-author Johan Vekemans, MD, of the World Health Organization, said in a statement. "It is now essential to accelerate the GBS vaccine development activities."

    Indeed, researchers estimate that with worldwide maternal vaccination, a vaccine with 80% efficacy and 50% coverage would prevent an estimated 127,000 infant and maternal cases of GBS, 23,000 stillbirths, and 37,000 infant deaths.

    Vekemans added that a "comprehensive evaluation" is needed on the cost-effectiveness of a vaccine against group B Streptococcus, and work is needed to strengthen existing maternal immunization programs worldwide.

    This supplement was supported by the Bill & Melinda Gates Foundation.

    Authors disclosed support from the Bill & Melinda Gates Foundation, Wellcome Trust, Medical Research Council UK, the Thrasher Foundation, the Meningitis Research Foundation, the NIH, Sequirus Inc, CureVac Inc, Pfizer Inc., Novartis, Belpharma Eumedica, GlaxoSmithKline and Minervax.

    Members of the Expert Advisory Group received reimbursement for travel expenses to attend working meetings related to this series.

    LAST UPDATED 11.07.2017

    • Reviewed by F. Perry Wilson, MD, MSCEAssistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
    Primary Source
    American Society of Tropical Medicine & Hygiene Secondary Source
    Clinical Infectious Diseases


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