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  • 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.

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    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


  • January 24, 2018 8:15 AM | Ashley Monson (Administrator)

    AAPA
    How can hospitals and health systems create an inclusive workplace culture for PAs? In a new article, the AAPA Center for Healthcare Leadership and Management (CHLM) spoke with one PA leader who shares what her hospital did to positively impact the work environment for its PA employees. Creating an inclusive culture is one criteria for CHLM’s new Employer of Excellence Awards, which recognize hospitals and health systems focused on providing a supportive work environment for PAs. Nominate your employer or encourage them to apply today!


  • January 23, 2018 10:04 AM | Ashley Monson (Administrator)

    JAAPA
    Inhaled nitrous oxide (N 2 O) has been used worldwide for more than 100 years as labor analgesia but has not gained widespread use in the United States. Nitrous oxide provides a noninvasive option for laboring women. This article outlines its efficacy and safety as an analgesic compared with epidural and IV pain medications.

    Learn more.

  • January 22, 2018 9:37 AM | Ashley Monson (Administrator)

    An examination appearing in PLOS One of an unpublished study from 2009 suggested that information the FDA used to approve doxylamine-pyridoxine for treatment of nausea and vomiting in pregnant women showed the drug was not effective.

    The drug is included in the American College of Obstetricians and Gynecologists’ (ACOG) guidelines as the first-line pharmacological therapies for nausea and vomiting for women who are pregnant.

    “Pregnant women should be given accurate information about this and other treatments,” Navindra Persaud, MD, department of family and community medicine, St. Michael’s Hospital in Toronto, told Healio Family Medicine. “Unfortunately, this information [regarding doxylamine-pyridoxine] has not been available to women taking the medication.”

    In the DIC-301 trial from 2009, the efficacy of both doxylamine 10 mg and pyridoxine 10 mg taken from two to four times per day vs. placebo in the treatment of nausea and vomiting was assessed in 280 pregnant women matched in a 1:1 ratio. Information from 131 active treatment participants and 125 control participants were analyzed. By study’s end, 101 active treatment participants and 86 control participants provided primary outcome measures. Symptoms were scored by utilizing the 13-point pregnancy unique quantification of emesis scale between baseline and 14 days using an ANCOVA.

    Using previously unpublished data obtained from public trial registration information, FDA review documents and study report documents from Health Canada, Persaud and colleagues re-analyzed the data from this study to address differences in prior reports of the trial. They found that there was a 0.73 point improvement (95% CI, 0.21-1.25) in symptoms scores with doxylamine-pyridoxine vs. placebo “when last observation carried forward imputation was used for missing data.” However, they added that this difference was not statistically significant when using different approaches to address the missing data (eg, 0.38; 95% CI, –0.08 to 0.84 using complete data).

    Persaud and colleagues also reported that symptom scores plateau after day 10 and “improved substantially” during the 2-week trial in both groups; however, the difference between groups also decreased after the 10th day.

    “Both of these findings could be explained by the natural history of the condition, that is, by the resolution of symptoms irrespective of treatment. This natural resolution could account for the lack of clinical important difference between groups,” Persaud and colleagues wrote.

    According to Persaud, doxylamine-pyridoxine is still a popular option for pregnant women and approved for use in the U.S. and Canada. He told Healio Family Medicine that four prescriptions for the medication were filled for every five live births in Canada in 2014.

    View more

  • January 18, 2018 12:08 PM | Ashley Monson (Administrator)

    Hormones play a major role in how the body works, and when they get off track, it can cause a variety of problems. CLICK HERE to learn more about these symptoms you may see in your patients

  • January 12, 2018 8:51 AM | Ashley Monson (Administrator)

    Tips for how to take a sexual history
    Medscape
    The recent Centers for Disease Control and Prevention (CDC) report on sexually transmitted diseases (STDs) for 2016 showed increased incidence for the third consecutive year. National totals included 1.59 million cases of chlamydia (4.7 percent increase), 468,514 cases of gonorrhea (18.5 percent increase), and 27,814 cases of primary and secondary syphilis (17.6 percent increase), with an alarming 27.6 percent rate increase in congenital syphilis cases. The dramatic rise of these diseases is a cue for clinicians to better understand patient sexual practices and preferences

  • January 12, 2018 7:58 AM | Ashley Monson (Administrator)

    By KYLI RODRIGUEZ-CAYRO

    2 days ago 


    Most of us winced our way through sex education classes some time in middle school, or early high school. Sure, most teachers gave us the bare basics on how to use condoms or identify STI symptoms, but do you remember learning anything about dental dams? Or about safe sex between people of the same gender? According to a new study, sex education for lesbian and bisexual girlsisn't giving them the information they need to have safe sex, and it shows how much more inclusive sex ed needs to be.

    The research, originally published in the Journal of Adolescent Health, was conducted by researchers at the Center for Innovative Public Health Research(CiPHR) in collaboration with professors from the University of British Columbia, and the City University of New York. Through an online focus group, 160 bisexual girls and lesbians in the United States were polled on sex education. Unfortunately, the study revealed these queer teens did not have the proper knowledge to practice safe sex, or protect themselves from STIs.

    One of the study’s authors and Managing Director of the Stigma and Resilience Among Vulnerable Youth Centre, Dr. Jennifer Wolowic, said in a press releasethat the researchers were taken aback by the study participants “overall lack of knowledge when it came to safe sex practices with female partners.” The study revealed a large barrier in receiving proper sex education for bisexual girls and lesbians was the heteronormative language and lesson plans. Meaning, most of the information taught was geared towards the study participants’ straight peers. Dr. Wolowic also said even when the bisexual girls and lesbians asked questions, they reported to the researchers they felt “uncomfortable” about the major focus on heterosexual intercourse.

    "Young people need accurate sexual health information, but sex education has traditionally focused on heterosexual sex," Dr. Elizabeth Saewyc, Director of the University of British Columbia School of Nursing and one of the study’s authors, explained in the press release. “Our findings suggest we need to create more inclusive curriculum to help lesbian and bisexual girls have the knowledge they need to make healthy sexual decisions.”

    The focus on heteronormative sex has dangerous consequences for bisexual girls and lesbians: The study found that these girls had an increased risk of contracting a sexually transmitted infection (STI) than straight peers. Majority of the 160 girls polled reported they would not use regularly use a dental dam — aka, a vaginal and sometime anal condom — due to a lack of education, or fear it would dampen the mood (and their pleasure) during sexual activities.

    "Participants told us, they 'literally had never heard of dental dams,' or thought STIs weren't a concern when having sex with girls. Of those who knew about protective barriers, many said using protection made sex awkward or less pleasurable, and so they left them out during sex,” Dr. Wolowic told EurekAlert.

    Moreover, the bisexual girls and lesbians who participated in the study largely agreed that getting tested for STIs was important, but trusted female partners more implicitly about being “clean,” or free of STIs. In fact, previous studiesrevealed bisexual girls and lesbians were more likely to contract certain STIs such as herpes simplex virus type 2 (aka, HSV-2, or genital herpes).

    Conclusively, the study highlights the need to improve sex education for bisexual girls and lesbians across the U.S. — especially the need to equip queer people with the information they need to have sex safely. “[Bisexual girls and lesbians] need to know that there are sexy ways to use barriers, that they can make dental dams out of condoms if needed, and that they can get STIs having sex with other girls," Dr. Michele Ybarra, the Research Director at CiPHR and the lead author of the study, said in the press release.

    With a 2016 survey estimating only 48 percent of teenagers from ages 13 to 20 identify as straight, making sex education less heteronormative and more inclusive of LGBTQ teens is more important than ever before. Teenagers, both straight and queer, should be equipped with the knowledge to prevent them from getting STIs, and unwanted pregnancies. Inclusive and comprehensive sex education should not be a privilege, but a necessary part of helping teenagers make healthier and happier decisions.  


  • January 11, 2018 8:37 AM | Ashley Monson (Administrator)

    In the first study of its kind, researchers from the Icahn School of Medicine at Mount Sinai found an elevated rate of language delay in girls at 30 months old born to mothers who used acetaminophen during pregnancy, but not in boys.

    The study will be published online January 10 at 3:28 am EST in European Psychiatry.This is the first study to examine  in relation to  levels in urine.

    The Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy study (SELMA) provided data for the research. Information was gathered from 754 women who were enrolled into the study in weeks 8-13 of their pregnancy. Researchers asked participants to report the number of acetaminophen tablets they had taken between conception and enrollment, and tested the acetaminophen concentration in their urine at enrollment. The frequency of , defined as the use of fewer than 50 words, was measured by both a nurse's assessment and a follow-up questionnaire filled out by participants about their child's  milestones at 30 months.

    Acetaminophen was used by 59 percent of the women in early pregnancy. Acetaminophen use was quantified in two ways: High use vs. no use analysis used women who did not report any use as the comparison group. For the , the top quartile of exposure was compared to the lowest quartile.

    Language delay was seen in 10 percent of all the children in the study, with greater delays in boys than girls overall. However, girls born to mothers with higher exposure—those who took acetaminophen more than six times in early pregnancy—were nearly six times more likely to have language delay than girls born to mothers who did not take acetaminophen. These results are consistent with studies reporting decreased IQ and increased communication problems in children born to mothers who used more acetaminophen during pregnancy.

    Both the number of tablets and concentration in urine were associated with a significant increase in language  in girls, and a slight but not significant decrease in boys. Overall, the results suggest that acetaminophen use in pregnancy results in a loss of the well-recognized female advantage in language development in early childhood.

    The SELMA study will follow the children and re-examine language development at seven years.

    Acetaminophen, also known as paracetamol, is the active ingredient in Tylenol and hundreds of over-the-counter and prescription medicines. It is commonly prescribed during pregnancy to relieve pain and fever. An estimated 65 percent of  in the United States use the drug, according to the U.S. Centers for Disease Control and Prevention.?

    "Given the prevalence of prenatal acetaminophen use and the importance of language development, our findings, if replicated, suggest that pregnant women should limit their use of this analgesic during ," said the study's senior author, Shanna Swan, PhD, Professor of Environmental and Public Health at the Icahn School of Medicine at Mount Sinai. "It's important for us to look at language development because it has shown to be predictive of other neurodevelopmental problems in children."

    Explore further: Is acetaminophen use when pregnant associated with kids' behavioral problems?



  • January 10, 2018 8:55 AM | Ashley Monson (Administrator)

    By Dennis Thompson

    HealthDay Reporter

    TUESDAY, Jan. 9, 2018 (HealthDay News) -- Breakthroughs in breast cancer screening and treatment have slashed the percentage of women dying from the disease, a new analysis reveals.

    "Advances in screening and treatment are saving lives," said lead researcher Sylvia Plevritis, a professor of radiology and biomedical data science at the Stanford University School of Medicine. "Here's an example that all this investment in research and discovery has had a real benefit. This has translated into making a difference."

    Screening and treatment reduced breast cancer deaths by 49 percent in 2012, compared with a 37 percent reduction in 2000, according to the study.

    Treatments that target specific types of breast cancer have generated the most scientific advancement and, as such, have taken a larger role in saving lives, the researchers found.

    Better cancer treatments accounted for 63 percent of the reduction in breast cancer deaths in 2012, compared with 37 percent due to early detection of cancer through screening, the study findings showed.

    Back in 2000, treatment and screening were of equal importance, splitting 50-50 the lives saved from breast cancer, the researchers said.

    Hormone therapy now is available to counter breast cancers spurred by estrogen, while the targeted drug Herceptin (trastuzumab) has been a wonder in treating breast cancers caused by genetic abnormalities, explained Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society.

    These new treatments, combined with improvements in traditional chemotherapy, are helping more women beat breast cancer, Lichtenfeld said.

    The greatest advance in breast cancer screening during the same period was the move to digital mammography, which produces cleaner and better images, he added.

    "For the period between 2000 and 2012, there were some advances made in the technology for screening for breast cancer, but there was greater impact made by treatment," Lichtenfeld said.

    For the study, Plevritis and her colleagues fed breast cancer monitoring data into a series of six different computer simulations.

    Each simulation estimated what the death rate would have been in a given year between 2000 and 2012 without the availability of state-of-the-art screening and treatment, and how much each contributed to the reduction in deaths, Plevritis said.

    The computer analysis also looked at how much reduction had taken place within different subtypes of breast cancer.

    For example, treatment accounts for about 69 percent of the lives saved in women with cancers driven by both estrogen and genetic abnormalities, while screening is associated with only 31 percent of the mortality decline, the investigators said.

    On the other hand, screening still plays a large role in saving the lives of women with so-called "triple-negative" breast cancer, which is not driven by either hormones or genetics. Triple-negative cancers account for about 12 percent of all breast cancer cases, but are nearly twice as common in black women than white women, according to the American Cancer Society.

    About 48 percent of the decline in deaths due to triple-negative breast cancer can be chalked up to screening and 52 percent to treatment, similar to the split found in 2000, the researchers said.

    "Mammography is an important contributor to the reduction in breast cancer mortality," Plevritis said. "But the overall benefit is greater largely because of the advances in treatment."

    Screening remains important because breast cancers detected early are easier to treat, said Dr. Daniel Hayes, clinical director of the University of Michigan breast oncology program.

    "Early detection makes the systemic treatment better as well," said Hayes, who's also immediate past president of the American Society of Clinical Oncology. "Most of us who take care of patients still believe rational screening programs are good public health policy. No matter what kind of cancer you have, detecting it early with screening and then treating it substantially reduces your risk of dying from it," he added.

    According to Lichtenfeld, "These computer models clearly show that mammography reduces mortality from breast cancer and has made a significant contribution over time. We should not take the message that everything's about treatment. That's not the right message."

    The study findings were published Jan. 9 in the Journal of the American Medical Association.

    More information

    For more on breast cancer, visit the American Cancer Society.

    SOURCES: Sylvia Plevritis, Ph.D., professor, radiology and biomedical data science, Stanford University School of Medicine, Stanford, Calif.; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society; Daniel Hayes, M.D., clinical director, breast oncology program, University of Michigan, and immediate past president, American Society of Clinical Oncology; Jan. 9, 2018, Journal of the American Medical Association

    Last Updated: Jan 9, 2018

    Copyright © 2018 HealthDay. All rights reserved.


  • January 03, 2018 8:41 AM | Ashley Monson (Administrator)

    January is National Cervical Cancer Awareness Month. Complete this six-module curriculum to learn more about cervical and other gynecologic cancers. Learn the risk factors, symptoms, and prevention strategies as well as screening guidelines and HPV vaccination recommendations. Earn free CE.

    Learn more

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