Monday, August 25, 2014

'Sex superbug': Concerns over spread of highly resistant gonorrhoea strain found in Australia

The Independent
http://www.independent.co.uk/life-style/health-and-families/health-news/sex-superbug-concerns-over-spread-of-highly-resistant-gonorrhoea-strain-found-in-australia-9689173.html
LIZZIE DEARDEN

A “sex superbug” has put doctors in Australia and New Zealand on high alert amid mounting evidence that antibiotics used to treat the infection are no longer working.

The most highly resistant strain of gonorrhoea ever detected in Australia was recently found in a tourist from central Europe who contracted the STI in Sydney.

Australia’s Health Department said a new multidrug resistant type of gonococcal bacteria, dubbed A8806, was identified with similarities to an untreatable strain of gonorrhoea known as H041.

It was first discovered in Japan in 2009, when a 31-year-old sex worker who had no symptoms of the disease tested positive in a routine check-up in Kyoto and could not be treated with the commonly-used ceftriaxone.

There have also been reports of a resilient strain in Hawaii in May 2011, as well as in California and Norway.

The Australian Health Department has urged GPs to refer all cases of gonorrhoea, known as “the clap”, for culture testing and New Zealand health clinics are on a high state of alert.

Electron micrograph of Neisseria gonorrhoeae, the aerobic Gram-negative bacterium responsible for the Sexually transmitted infection
Electron micrograph of Neisseria gonorrhoeae, the bacterium responsible for the sexually transmitted infection

The capacity of the gonorrhoea bacterium to develop antibiotic resistance is well known, the New Zealand Sexual Health Society said, and many of the antibiotics used in the past 70 years no longer provide effective treatment.

“Gonorrhoea infection can result in severe complications,” the president, Dr Edward Coughlan, said.

“This is a major public health concern.”

The latest figures from Public Health England showed new diagnoses in England jumped by 21 per cent to 25,525 cases in 2012, following another huge rise in 2011.

The agency said a switch in prescribing guidelines had been effective targeting more resilient strains but urged continued vigilance.

Gonorrhoea is easily transmitted by unprotected oral or penetrative sex and the bacteria can infect the throat and eyes as well as sexual organs.

Typical symptoms of gonorrhoea include a thick green or yellow discharge from the vagina or penis, pain when urinating and bleeding in women but many infected people have no symptoms, according to the NHS.

If left untreated, it can lead to infertility, ectopic pregnancy, fever, rashes and arthritis-like symptoms and complications can cause joint and heart infections, as well as meningitis.

Saturday, August 23, 2014

The Historic Drop In Teen Births Illustrated In One Chart

ThinkProgress Logo
http://thinkprogress.org/health/2014/08/21/3473959/historic-drop-teen-births/
BY TARA CULP-RESSLER

pregnancy

Teen births have been steadily declining for half a century and have dramatically dropped over the past two decades, according to a new report from the Centers for Disease Control and Prevention (CDC) examining the trend. Overall, the birth rate among young women between the ages of 15 and 19 fell by a staggering 57 percent between 1991 and 2013:

cdc
credit: CDC

According to the government researchers, about four million fewer babies were born to teenagers as a result of that decline. Since low-income young mothers often need government programs like Medicaid and food stamps to help support their families, the CDC projects that the drop in births helped save billions of dollars. The new report estimates that $12 billion was saved in 2010 alone thanks to the 45 percent drop in the teen birth rate between 1991 and 2010.
The steepest declines in the teen birth rate appear to be occurring in the areas where it’s historically been the highest. Southern states — where the teen pregnancy rate has been significantly higher for years — have seen the largest drops, although there’s still a noticeable disparity between states in the South and states in the Northeast. Similarly, while teen births have declined across all racial groups, they’ve recently fallen the fastest among Hispanic women, who currently have the highest rate.
The CDC has been observing this positive trend over the past several years; the pregnancy, abortion, and birth rates among U.S. teenagers continue to hit new historic lows, and public health experts have credited that success story largely to teens who are making responsible choices about their sexual health.
However, it’s not entirely clear what exactly caused the behavior change contributing to the steep drop in births between 2007 and 2013. Experts have suggested it might come down to a “perfect storm” of several factors: the economic downturn that may have led to more cautious decisions; the increase in teens using more reliable forms of birth control; the proliferation of effectivecomprehensive sex ed programs; and the rise of TV shows like 16 & Pregnant that depict the difficulty of raising a child as a young adult.

There is one factor that researchers are comfortable ruling out: abortion. It’s true that teen pregnancy rates don’t necessarily match up with teen birth rates because not every young women will carry the pregnancy to term. But the sharp drop in births is because teens aren’t getting pregnant in the first place, not because they’re increasingly choosing to end their pregnancies. “Abortion hasn’t played a role because abortion rates have been falling faster than the birth rate, and the declines in abortion go back to the late 1980s,” Stephanie Ventura, a senior demographer for the CDC’s National Center for Health Statistics and the author of the report, told HealthDay News.

Tuesday, August 19, 2014

DOCTOR: Practicing on Patients

http://mobile.nytimes.com/blogs/well/2014/08/14/practicing-on-patients-2/
By SANDEEP JAUHAR, M.D



“Who should do this case?” That was the question a senior surgeon posed to me outside a patient’s room in the cardiac care unit. Judging by his expression, he already knew the answer.

The patient had a serious infection that had eroded her heart valve, rendering it “incompetent.” Fluid was filling up in her lungs, making it difficult for her to breathe. A helium-filled balloon pump had been inserted into her aorta, the main artery coming out of the heart, to support her low blood pressure, but her condition was deteriorating.

The senior surgeon explained that the patient had been referred to a young surgeon in his practice who had just graduated a year before. “Ethically, I’m not comfortable with him doing the case,” the senior surgeon said. “This lady’s mortality is already high, probably close to 40 percent. In his hands, it’s even higher.”

The young surgeon was obviously going to have to learn to do such cases, but he wasn’t going to start that day. The patient’s condition was too unstable, and even a small mistake could have had devastating consequences. The senior surgeon obviously appreciated his young colleague’s eagerness in seeking out referrals to build up his practice, but he and I knew that a junior surgeon wasn’t the best man for the job.

Every doctor’s expertise is earned on patients, but unfortunately, there is a learning curve.

How to protect patients while doctors learn is a conundrum faced in all areas of medicine. For example, studies have shown that surgeons’ outcomes improve up to four years after their first hospital appointment. Some have argued that neophyte surgeons during this period should take on only the most straightforward cases. Yet every doctor eventually has to perform a procedure for the first time.

A few weeks ago, a second-year cardiology fellow told me that he had taught a first-year how to pull out a balloon pump. “When we went in the room, the patient said, ‘You’re not learning on me, are you?’ And I had to lie and say: ‘No! He’s done this many times. We’re going to do it together. You get two for the price of one.’ That calmed him down. Then I had to talk the first-year through the entire procedure, pretending like I was explaining it to the patient.”

It isn’t only doctors who face this quandary. Hospitals too have their own learning curves. Medical teams work better together with practice. The first few cases of a new procedure frequently have subpar results.

In the early 1990s, a hospital in England introduced an innovative operation to correct transposition of the great arteries, a congenital heart abnormality in babies. Before this, newborns with this condition were treated with a palliative procedure that had poor long-term outcomes. Children at the hospital ultimately benefited from the innovation, but a heavy price was paid. The death rate for babies in the first few years was several-fold higher than with the palliative procedure. Commenting on the poor outcomes, a pediatric surgeon wrote that it was understood that “there would initially be a period of disappointing results.”

The question of how to innovate without hurting patients comes up in my practice. For example, as a heart-failure specialist, I have long wanted to provide left ventricular assist devices (LVADs) to my terminally ill patients. LVADs, such as the one former Vice President Dick Cheney had, are tiny rotor pumps made of plastic and titanium that piggyback onto the heart, pumping blood directly out of it and into the aorta, which transports it to the rest of the body. Most of my patients who require an LVAD say they would prefer to have it implanted close to home on Long Island rather than at the more established centers in Manhattan.

So a couple of years ago, we started an LVAD program for patients with acute cardiac shock. As the cardiologist on the team, I received two days of classroom instruction. My surgical colleagues additionally received animal training (they implanted the device into a calf).

We have now successfully performed the procedure on several patients. A few months ago, I treated a young man who had had a heart attack. His blood pressure was so low that his kidneys had stopped working. I called one of my surgical colleagues to put in an LVAD. He agreed to do it, but he asked me whether my patient wouldn’t be better off being transferred to a hospital that had more experience. “Do we have the best team in place to manage potential complications?” he asked. If it were your father, he said, what would you want?

And he was right. We have had good results with the few implants we’ve done. However, some centers in Manhattan do more than a hundred a year. Though our surgical teams are excellent, theirs are undoubtedly on a flatter portion of the learning curve.

I often wonder whether certain procedures should be “regionalized.” There is a positive correlation between a hospital’s surgical volume and its surgical mortality. For example, hospitals that do 200 or more coronary bypass operations annually have death rates nearly a third lower than hospitals with lower volumes.

But in American medicine, we believe in democracy. Any hospital can apply to be credentialed in a new procedure as long as it can demonstrate a need in the population it serves.

In the current economic climate, with ever-decreasing profit margins, many hospitals are trying to move into profitable surgical ventures. But we need to be careful. Hospitals have the right to innovate, but adequate protections such as expert supervision need to be put in place so patients are not harmed while doctors and institutions learn on them.

Sandeep Jauhar is a cardiologist and the author of “Intern: A Doctor’s Initiation”and the soon-to-be-published memoir “Doctored: The Disillusionment of an American Physician.”