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  • December 13, 2017 7:22 AM | Ashley Monson (Administrator)

    12/12/2017

    December 12, 2017 The U.S. Preventive Services Task Force released today a final recommendation statement on hormone therapy for the primary prevention of chronic conditions in postmenopausal women. The Task Force recommends against hormone therapy for preventing chronic conditions in women who have gone through menopause, as the benefits do not outweigh the harms. To view the recommendation and the evidence on which it is based, please go to https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/menopausal-hormone-therapy-preventive-medication1. The final recommendation statement can also be found in the December 12, 2017 online issue of JAMA.

     

     


  • December 12, 2017 3:43 PM | Ashley Monson (Administrator)

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  • December 12, 2017 9:04 AM | Ashley Monson (Administrator)

    JAAPA
    Bacterial vaginosis is a common vaginal infection that causes discharge, odor, and irritation. It can predispose women to sexually transmitted infections (STIs) including HIV. Recurrent bacterial vaginosis may require prolonged treatment to return the vaginal flora to a normal predominately lactobacilli-dominated environment. 

    LINK

  • December 07, 2017 9:49 AM | Ashley Monson (Administrator)
    • by Kristen Monaco, Staff Writer, MedPage TodayDecember 06, 2017

    Menopause-related vasomotor symptoms (VMS) may heighten diabetes risk, researchers reported.

    VMS, such as hot flashes and night sweats, were tied to an 18% increased risk for type 2 diabetes (95% CI 1.14-1.22), according to Kristen E. Gray, PhD, of the VA Puget Sound Health Care System in Seattle and colleagues. Independent of obesity status, VMS persisting for a longer duration were tied to a continually increasing risk for diabetes (4% per 5 years, 95% CI 1.03-1.05), they wrote in Menopause: The Journal of The North American Menopause Society.

    Diabetes risk also increased with the severity of symptoms:

    • Mild symptoms: hazard ratio 1.13 (95% CI 1.08-1.17)
    • Moderate: HR 1.29 (95% CI 1.22-1.36)
    • Severe: HR 1.48 (95% CI 1.34-1.62)

    The prospective study, previously at the 2016 American Diabetes Association annual meeting, included 150,007 postmenopausal women who participated in the Women's Health Imitative, conducted at 40 centers across the U.S. All women had data regarding VMS and no history of diabetes at baseline. Menopause-related VMS were self-reported via a questionnaire, while diabetes was defined as the initial report of insulin or oral treatment.

    During an average 13.1-year follow-up, there were 18,316 cases of type 2 diabetes reported among the cohort. Women who did not report experiencing VMS at baseline had a lower incidence of diabetes than women who did (8.4 per 1,000 person-years versus 11.3 per 1,000).

    With regard to specific VMS, night sweats had a slightly stronger association with diabetes risk than hot flashes alone:

    • Night sweats only: HR 1.20 (95% CI 1.13-1.26)
    • Hot flashes only: HR 1.08 (95% CI 1.02-1.15)
    • Both: HR 1.22 (95% CI 1.17-1.27)

    Women who only reported experiencing VMS early on did not have an increased associated risk for type 2 diabetes (HR 0.99, 95% CI 0.95-1.04). However, those who only reported late-onset symptoms, or who experienced early and late symptoms, did have significantly associated risks (HR 1.12, 95% CI 1.07-1.18; HR 1.16, 1.11-1.22, respectively).

    "There are several potential explanations for our pattern of findings," the authors noted. "The most plausible and consistent explanation may be through associations with sleep disturbance. VMS overall are associated with objective and subjective sleep disturbance, 28 and individuals with disruptions in both the quantity and quality of sleep have a higher risk of diabetes."

    Gray's group found sleep disturbances were commonly reported among the cohort, with 36% of women having experienced short sleep durations. Similarly, 24% of women were considered to be at high risk of sleep-disordered breathing, while 31% were at high risk of insomnia. Those who experienced more severe VMS, as well as experiencing both hot flashes and night sweats, were more likely to report sleep disturbances.

    Study limitations included the fact that much of the cohort were clinical trial participants, which "were likely healthier than the general population," they stated.

    While the results do not support different clinical care for women who experience VMS, "they suggest that leveraging the immediate repercussions of VMS may be a particularly effective strategy for eliciting behavior change among affected women as compared with counseling about the more distant and abstract future risk of diabetes and CVD," the authors said.

    "Menopause is a perfect time to encourage behavior changes that reduce menopause symptoms, as well as the risk of diabetes and heart disease," noted JoAnn Pinkerton, MD, executive director of the North American Menopause Society, in a press release. "Suggestions include getting regular exercise and adequate sleep, avoiding excess alcohol, stopping smoking, and eating a heart-healthy diet. For symptomatic women, hormone therapy started near menopause improves menopause symptoms and reduces the risk of diabetes."

    Click here for the American Association of Clinical Endocrinologists' comprehensive type 2 diabetes management algorithm and guidelines for the treatment of menopause.

    The study was supported by the US Department of Veterans Affairs Health Services Research & Development Program.

    Gray and co-authors disclosed no relevant relationships with industry.

    • Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner


  • December 07, 2017 9:48 AM | Ashley Monson (Administrator)

    During menopause a woman’s ovaries stop working—leading to hot flashes, sleep problems, weight gain, and worse, bone deterioration.

    Now scientists are exploring whether transplanting lab-made ovaries might stop those symptoms. In one of the first efforts to explore the potential of such a technique, researchers say they used tissue engineering to construct artificial rat ovaries able to supply female hormones like estrogen and progesterone.

    The work, carried out at Wake Forest Baptist Medical Center, suggests a potential alternative to the synthetic hormones millions of women take after reaching middle age. A paper describing the findings was published Tuesday in Nature Communications.

    When tested in rats, the pieces of tissue, known as organoids, were better than traditional hormone replacement drugs at improving bone health and preventing weight gain. The treatment was also as good as hormone drugs at maintaining healthy tissue in the uterus.

    Clinical trials of artificial ovaries are not likely to happen soon. For one thing, it is uncertain where the cells needed to build the organoids would come from. Emmanuel Opara, a professor at Wake Forest who led the research, says younger women might need to donate the tissue.

    Women going through menopause, as well as those who have undergone cancer treatment or had their ovaries removed for medical purposes, lose the ability to produce important hormones, including estrogen and progesterone. Lower levels of these hormones can affect a number of different body functions.

    To counteract unpleasant symptoms, many women turn to combinations of hormone replacement medications—synthetic estrogen and progestin. But hormone replacement carries an increased risk of heart disease and breast cancer, so it’s not recommended for long-term use. Opara thinks artificial ovaries could be safer and more effective.

    To engineer the organoids, Opara and his colleagues combined two cell types—granulosa and theca cells. They collected samples of these cells from female rats that had their ovaries removed and grew them in the lab so they eventually formed three-dimensional tissue.  

    Within a week of implantation, the artificial ovaries started secreting estrogen, progesterone, and two other natural hormones not found in current hormone replacement drugs.  

    Cynthia Stuenkel, a clinical professor of medicine at the University of California, San Diego, and a spokeswoman for the Endocrine Society, says the report  is “fascinating” but sees a downside if such treatments really reverse menopause. She wonders if the hormones would be enough to bring back a woman’s period and the symptoms that often come along with it.

    IMAGE CREDIT: 

    • WAKE FOREST INSTITUTE FOR REGENERATIVE MEDICINE


  • December 07, 2017 9:42 AM | Ashley Monson (Administrator)

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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
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