DiversityNursing Blog

Nurse Practitioners More In Demand Than Most Physicians

Posted by Erica Bettencourt

Fri, Jul 17, 2015 @ 10:44 AM

Bruce Japsen

Contributor: Marissa Garey

www.forbes.com 

It comes as no surprise that primary care doctors are, and have always been, highest in demand. All hospitals and health systems require family physicians, as well as other internists, to service their patients. However, recent data shows that this paradigm is shifting.

To fill the necessary vacancies in medical staff, an increasing number of health systems are looking to Nurse Practitioners and Physician Assistants. According to the Merrit Hawkins’ review, neither of these positions had been among the top 20 in-demand health professionals in 2011. While primary care doctors still rank the highest, NP’s and PA’s have progressed over the past 4 years to be placed among the top 10. Both professional areas have grown to fill critical positions in the healthcare industry.

When it comes to what a hospital or health system needs to fill the vacancies in a medical staff, primary care doctors like family physicians and internists have long been the top need.

But climbing the ranks and jumping past many doctor specialties on the demand scale aren’t physicians at all. They’re nurse practitioners and physician assistants who are filling a critical role for the health care industry, according to national doctor recruiting firm Merritt Hawkins.

The snapshot into the U.S. health care workforce from Merritt Hawkins, a subsidiary of AMN Healthcare (AHS) comes as trends in insurance payment from private health plans, employers and the government under the Affordable Care Act emphasize keeping people well. The value-based care push away from fee-for-service medicine also emphasizes the outpatient care provided by nurse practitioners (NPs) and physician assistants (PAs) working with primary care doctors.

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“In the team-based, population health model, primary care physicians remain recruiting target number one, but PAs and NPs are target 1A,” Travis Singleton, senior vice president at Merritt Hawkins said in a statement to Forbes. “You really can’t build patient access or patient satisfaction without them.”

To be sure, patient satisfaction and quality of care are being built into contracts insurers have with medical care providers as health plans like Aetna AET -0.78% (AET), Anthem (ANTM), UnitedHealth Group UNH -0.67% (UNH) and the nation’s Blue Cross and Blue Shield plans consolidate into larger payers and shift payments to value-based care.

For the ninth consecutive year, the family doctor was the most highly recruited doctor. Internists were second on the Merritt list followed by psychiatrists amid a nationwide shortage of behavioral health specialists.

“Combined, physician assistants and nurse practitioners were fourth on the list,” Merritt Hawkins said in its report. “Four years ago, neither NPs or PAs were among (the firm’s) top 20 assignments either collectively or individually.”

On their own, nurse practitioners ranked fifth behind hospitalists who were fourth and physician assistants were in 10th place, tied on the “in demand” scale with general surgeons. Advanced practitioners are more in demand than several specialties including general surgery, cardiology, urology and neurology.

Merritt Hawkins’ review comes from a database of more than 3,100 recruiting assignments conducted by the firm from April of last year through March of this year.

Topics: nurse practitioners, physicians, medical staff

23 Things People Always Get Completely Wrong About Nurses

Posted by Erica Bettencourt

Fri, Feb 13, 2015 @ 12:11 PM

Alana Massey

 

We asked the BuzzFeed Community to tell us what the most common misconceptions about nurses are. They had a lot to say.

We asked the BuzzFeed Community to tell us what the most common misconceptions about nurses are. They had a lot to say.
Getty Images/iStockphoto

1. First of all, “Why didn’t you just become a doctor? You’re too smart to be a nurse” is a rude thing to say.

23 Things People Always Get Completely Wrong About Nurses
Wall Street Journal Live

Submitted by SadiaK.

2. And no, people can’t just apply for nursing licenses before being educated and rigorously trained.

23 Things People Always Get Completely Wrong About Nurses
20th Century Fox

Submitted by jennah4377addc7.

3. Because nursing is not about wiping butts all day.

Because nursing is not about wiping butts all day.
Shironosov / Getty Images/iStockphoto

Submitted by MariliseB

4. And nurses are not just there for their ability to “nurture” and “mother” patients; they’re there to use science and critical thinking to save lives.

23 Things People Always Get Completely Wrong About Nurses
PBS

Submitted by hellokitty914 and edwyer94.

5. Which is why it’s annoying when people think you’re always just following a doctor’s orders.

Which is why it's annoying when people think you're always just following a doctor's orders.
Getty Images/iStockphoto Dana Bartekoske

Submitted by oneloveyogi.

6. But you’d never know that from TV and movies, which almost never portray nurses accurately.

But you'd never know that from TV and movies, which almost never portray nurses accurately.
NBC / Getty Images

Submitted by angry penguin.

7. The reality is that doctors rely heavily on the knowledge and observations of nurses to make decisions about patient care.

23 Things People Always Get Completely Wrong About Nurses
NBC

Submitted by lexia49c9c42e3.

8. And it is often the nurses who make life and death decisions.

23 Things People Always Get Completely Wrong About Nurses

Submitted by andreae41060b2b6.

9. Nurses are actually more like a doctor-social worker-respiratory therapist-pharmacist-phlebotomist-physiotherapist-receptionist-X-ray technician-transporter-housekeeper-caregiver hybrid.

Nurses are actually more like a doctor-social worker-respiratory therapist-pharmacist-phlebotomist-physiotherapist-receptionist-X-ray technician-transporter-housekeeper-caregiver hybrid.
ThinkStock

Submitted by oneloveyogi.

10. Which is probably why they’re not actually wearing sexy nurse outfits over lingerie with stilettos on their feet.

Which is probably why they're not actually wearing sexy nurse outfits over lingerie with stilettos on their feet.

Submitted by sandrafromparis.

11. That might also be because a huge number of nurses are men.

That might also be because a huge number of nurses are men.

Submitted by preciouskittenn.

12. Who, by the way, are not all gay.

23 Things People Always Get Completely Wrong About Nurses
ABC

Submitted by richardd31.

So now that all that’s cleared up, there are a few more things that nurses don’t want or need to hear.

13. When nurses are “just taking blood pressure” they are simultaneously assessing a dozen things about a patient’s condition.

23 Things People Always Get Completely Wrong About Nurses

Submitted by shannooney.

14. It doesn’t help anyone to say that all nurses do is put on Band-Aids when they’re actually catching potentially fatal mistakes made by doctors who don’t know the patient as well.

It doesn't help anyone to say that all nurses do is put on Band-Aids when they're actually catching potentially fatal mistakes made by doctors who don't know the patient as well.
Fox

Submitted by betty.swiecka.

15. And when people assume a home health care nurse is there to give sponge baths and clean the house, it makes it harder for them to provide care.

And when people assume a home health care nurse is there to give sponge baths and clean the house, it makes it harder for them to provide care.
ThinkStock

Submitted by kimberly.riggs.18.

16. Saying nurses are so lucky to work three days a week ignores how much recovery time and rest is needed after long shifts and demanding work.

23 Things People Always Get Completely Wrong About Nurses
1492 Pictures

Submitted by lydia.maria.94.

17. Patients with the “I write your check” mentality that feel justified using nurses as servants make it harder for nurses to do their jobs.

23 Things People Always Get Completely Wrong About Nurses
Columbia Records / Via tumblr.com

Submitted by kelly.hilker.

18. That job is not being a personal drug dealer who is totally OK with going to jail just so a patient can get some OxyContin.

23 Things People Always Get Completely Wrong About Nurses
United Artists

Submitted by nic0lie0lie and cheries4218b4a82.

19. So if you come in and say you’re allergic to every drug except Dilaudid and that you needs lots and lotsof Dilaudid, the nurse is onto you, buddy.

So if you come in and say you're allergic to every drug except Dilaudid and that you needs lots and lots of Dilaudid, the nurse is onto you, buddy.
Warner Bros.

Submitted by cheries4218b4a82.

20. And when a nurse clearly knows the answer to your question and you say, “Can you ask the doctor?” you’re undermining their expertise and their profession.

23 Things People Always Get Completely Wrong About Nurses
United Artists

Submitted by lalroma.

21. But the great thing about nurses is that they don’t actually care all that much about all these misconceptions.

But the great thing about nurses is that they don't actually care all that much about all these misconceptions.
ThinkStock

Submitted by jonathanr49e5c50fe.

22. Because the thing they care more about than anything is saving your life.

Because the thing they care more about than anything is saving your life.
ThinkStock

Submitted by jonathanr49e5c50fe.

23. But for those of us who are annoyed on their behalves, we are just going to leave this here.

But for those of us who are annoyed on their behalves, we are just going to leave this here.
BuzzFeed

Submitted by ashleym45a8b720b.

Source: www.buzzfeed.com

Topics: nursing, health, nurse, nurses, doctors, medical, patients, physicians, hospitals

Coma Patients Show Improved Recovery From Hearing Family Voices

Posted by Erica Bettencourt

Mon, Jan 26, 2015 @ 12:12 PM

By David McNamee

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It has been a dramatic plot device within countless movies and soap operas, but now a new study from Northwestern Medicine and Hines VA Hospital, both in Illinois, has attempted to answer the question: can the voices of family members and loved ones really wake coma patients from unconsciousness?

A coma is defined as an unconscious condition in which the patient is unable to open their eyes. When a patient begins to recover from a coma, they progress first to a minimally conscious or "vegetative state," though these states can last anywhere from a few weeks to several years.

Lead author Theresa Pape was inspired to conduct the new study - the results of which are published in the journal Neurorehabilitation and Neural Repair - while working as a speech therapist for coma patients with traumatic brain injuries. Pape observed that patients appeared to respond better to family members than to strangers.

From this, Pape began to wonder if patients' ability to recover might be increased if therapists were able to stimulate and exercise people's brains while they were unconscious.

As part of the randomized, placebo-controlled study, 15 patients with traumatic closed head injuries who were in a minimally conscious state were enrolled to Familiar Auditory Sensory Training (FAST). The 12 men and three women had an average age of 35 and had been in a vegetative state for an average of 70 days before the FAST treatment began.

At the start of the study, Pape and her colleagues used bells and whistles to test how responsive the patients were to sensory information. They also assessed whether the patients were able to follow directions to open their eyes or if they could visually track someone walking across the room.

Magnetic resonance imaging (MRI) was also used to get a baseline impression of how blood oxygen levels in the patients' brains changed while listening to both familiar and unfamiliar voices tell different stories.

The therapists then asked the patients' families to look at photo albums to identify and piece together at least eight important stories concerning events that the patient and their family took part in together.

"It could be a family wedding or a special road trip together, such as going to visit colleges," Pape explains. "It had to be something they'd remember, and we needed to bring the stories to life with sensations, temperature and movement. Families would describe the air rushing past the patient as he rode in the Corvette with the top down or the cold air on his face as he skied down a mountain slope."

Patients were more responsive to unfamiliar voices after 6 weeks of therapy

The stories were rehearsed and recorded by the families and then played to the coma patients for 6 weeks. Following this listening period, the MRI tests were repeated, with blood oxygen levels being taken while the patients listened to their stories being told by familiar and unfamiliar voices.

The MRI recorded a change in oxygen levels when the unfamiliar voice was telling the story, but there was no change from baseline levels for the familiar voice.

Pape says that these findings demonstrate a greater ability to process and understand speech among the patients, as they are more responsive to the unfamiliar voice telling the story: "At baseline they didn't pay attention to that non-familiar voice. But now they are processing what that person is saying.''

At this point in the treatment, the researchers also found that the patients were less responsive to the sound of a small bell ringing than they had been at the start of the study. The team believes that this indicates the patients were now better able to discriminate between different types of audio information and decide what is most important to listen to.

"Mom's voice telling them familiar stories over and over helped their brains pay attention to important information rather than the bell," Pape says. "They were able to filter out what was relevant and what wasn't."

The first 2 weeks were found to be the most important period for treatment and demonstrated the biggest gains. The remaining 4 weeks of treatment saw smaller, more incremental gains.

"This gives families hope and something they can control," Pape says of the treatment, recommending that families work with a therapist to help construct stories that augment the other therapies the patient may be undergoing.

Now, the team is analyzing the study data to investigate whether the FAST treatment strengthened axons - the fibers that make up the brain's "wiring" and transmit signals between neurons.

Source: www.medicalnewstoday.com

Topics: recovery, coma, voices, family, nurse, research, medical, hospital, patient, treatment, physicians

Gotta Dance

Posted by Erica Bettencourt

Wed, Jan 21, 2015 @ 10:50 AM

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Moments after Jacob "Jake" Boddie woke from surgery to remove a tumor in his pelvis, his father, Kyle Boddie, said to his 2-year old son, "Hey, Jake, bust a move!" Although he was still groggy, the toddler smiled. One tiny shoulder, then the other, wiggled in time to a beat. 

Kyle and Jake's mother, Ashley McIntyre, say Jake started dancing long before he could walk. "And now that's all he does," Kyle said. "He loves it. You can't stop him."

During his yearlong treatment for a rare cancer, Jake danced with his nurses, child life specialists and doctors at the University of Chicago Medicine Comer Children's Hospital. He boogied in his hospital room, in the hallways, and even on the way to the operating room. His parents say dance helped Jake recover from his treatments and surgery. It helped them cope with their son's illness. 

"Even though Jake went through so much, he uplifted us," Ashley said. "We thought, if he can have fun through all of this, why can't we?"

Kyle and Ashley knew something was wrong when Jake wasn't acting like himself at a Fourth of July picnic in 2013. Agitated and restless, the toddler wasn't his "silly self" and refused to dance or play with the other children. A few days later he began limping. An ultrasound performed in the emergency room at Comer Children's Hospital showed a large mass resting in the lower part of his abdomen and reaching into his pelvis.

A biopsy revealed the mass to be a sarcoma, a fast-growing cancer. "The tumor was 4 inches in diameter, about the size of a small grapefruit," said pediatric oncologist Navin Pinto, MD, an expert on sarcoma treatment. In addition to his clinical work, Pinto leads a personalized medicine initiative at Comer Children's Hospital that is sequencing the genetic makeup of pediatric tumors from every patient to help guide treatment.

For Jake, several rounds of chemotherapy were needed to shrink the tumor to half its original size. It was then small enough to be removed, but Jake's surgery would be complicated. The tumor was wrapped around critical blood vessels as well as the right ureter, a tube that brings urine from the kidney to the bladder. 

On the morning of the surgery in January 2014, Ashley and Kyle danced with Jake to the song "Happy" as they headed toward the operating room doors; there they turned him over to the surgical team. "Jake knew something was going on," Ashley recalled, "but I think it made him feel better to see us laughing and dancing."

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Pediatric urologist Mohan Gundeti, MD, and pediatric surgeon Grace Mak, MD, worked together in the surgical suite. First, Gundeti used an endoscopic approach, placing a stent in the ureter to mark its location and keep the fragile tube open. Mak then surgically removed as much of the tumor as possible, meticulously separating it from the vessels and ureter while avoiding nearby nerves. 

"Jacob recovered beautifully and bounced back quickly after the operation," Mak said, adding, "he was eating -- and doing his moves -- a few days later."

Completing Jake's treatment required both chemotherapy and radiation to eliminate any lingering cancer cells. In addition, the lower section of the right ureter had narrowed, leading to pressure on the right kidney, and needed attention before it became completely obstructed. 

Gundeti performed reconstructive surgery, moving the right kidney down a few centimeters and making a new tube for the ureter using a flap from the bladder. Again, Jake recovered quickly from an extensive surgery.

Today, the 3-year-old visits Comer Children's Hospital regularly for follow-up care with the nurses and doctors who cared for him. 

"He feels comfortable at the hospital; he's always laughing and having a good time," Kyle said. "Everyone knows him now. And everyone dances with him."

Source: www.uchicagokidshospital.org

Topics: surgery, toddler, biopsy, health, healthcare, nurse, nurses, doctors, health care, medical, cancer, hospital, medicine, treatment, physicians, tumor

Freakishly High Definition Future of Body Scanning

Posted by Erica Bettencourt

Wed, Jan 21, 2015 @ 10:44 AM

By Dan Kedmey

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General Electric released images on Wednesday from its first clinical trial of a next generation body scanner that captures bones, blood vessels and organs in high-definition.

The patients ride into the chamber of the scanner, dubbed “Revolution CT,” where a fan-shaped beam of x rays passes down their bodies and a computer reconstructs a digital model of the body, slice-by-slice. The scanner can build an image of a heart in the time it takes for a single heartbeat, according to GE.

The snapshots below, provided by GE, may look like an artist’s rendering from an anatomy textbook. In fact, they were taken from living patients at West Kendall Baptist Hospital in south Florida, the first hospital to test the new scanner in the field.

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Source: http://time.com

Topics: digital, tests, anatomy, organs, bones, GE, General Electric, trial, body scanner, blood vessels, high-definition, x rays, health, healthcare, nurse, nurses, doctors, health care, hospital, treatment, physicians, clinical

Gates Foundation Uses Art to Encourage Vaccination

Posted by Erica Bettencourt

Wed, Jan 07, 2015 @ 01:33 PM

By MELENA RYZIK

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Artists, it’s fair to say, usually don’t know much about bacteria. Vik Muniz is an exception. Mr. Muniz, the Brazilian-born photographer known for his unorthodox materials, has been working with the M.I.T. bioengineer and designer Tal Danino on a series of trompe l’oeil images of microscopic organisms: cancer cells, healthy cells and bacteria.

At first glance, they look like ornate and colorful patterns. In reality, they represent teeming, living things. Among his latest: a pink print that could pass for floral wallpaper. But it’s made up of liver cells infected with the Vaccinia virus, which is used to make the smallpox vaccine.

“Normally, patterns are soothing structures,” Mr. Muniz said, “and all of a sudden, there’s a lot of drama.”

The work now has another meaning. It will be used in a new online campaign, The Art of Saving a Life, sponsored by the Bill & Melinda Gates Foundation. The intent is to promote vaccination just in time for an international effort to raise funds to inoculate millions, especially in poor nations.

The campaign, to be released online on Wednesday, is the first time that the foundation has commissioned artists in the service of a cause. The global roster includes photographers (Annie Leibovitz, Sebastião Salgado, Mary Ellen Mark); writers (Chimamanda Ngozi Adichie); filmmakers (Luc Jacquet, director of the documentary “March of the Penguins”); and bands (Playing for Change).

The intent is that their work will spread virally — in the digital sense — and be shared on social media with the hashtag #VaccinesWork to inspire a dialogue and donations.

“We want to get the buzz and the conversation going, because it’s easy to take these important lifesaving tools for granted,” said Dr. Christopher Elias, president of the global development program at the Gates Foundation. Art, the foundation hopes, will serve as a reminder to people “who aren’t going to read the editorial in Science,” Dr. Elias said. If the program is successful, he said, it could serve as a model for other Gates Foundation projects.

The idea came from Christine McNab, a consultant to the foundation. In brainstorming new ways to promote vaccines, she considered “what makes me cry, what makes me think,” she said. “It’s films, it’s books, it’s galleries.”

Ms. McNab and her team invited the artists in and suggested which diseases or issues to address. But they had no control over what was created. Some artists were paid a small fee to cover expenses; some retained their copyright, and others donated their work.

Ms. Leibovitz snapped a black-and-white portrait of people involved in vaccine development. Fatoumata Diabaté, a photographer from Mali, captured the last phase of trials for an Ebola vaccine. The German painter Thomas Ganter paid tribute to the little-sung medical aides who administer the shots, with his oil on canvas of “The Unknown Health Worker.”

The project is timed to lead up to a Jan. 27 meeting of Gavi, the Vaccine Alliance, an international public-private partnership in Berlin. Some images will be displayed at the conference, which aims to raise $ 7.5 billion from donors for Gavi’s next phase of development. Separately, the Gates Foundation has funded many immunization-related grants, at a cost of millions — far greater, a spokeswoman said, than the budget for the art initiative, which she would not disclose.

As the project developed in the last year, the anti-vaccination movement, in the United States and other Western countries, only gained steam. Though the programs that the Art of Saving a Life supports are targeted elsewhere, “in some ways what we’re hoping for is not just a broader debate about vaccination and immunization, but a more informed debate,” Dr. Elias said.

Countering the anti-vaccination rhetoric was part of the reason that Alexia Sinclair, a photographer from Australia, participated, she said. “I have a young daughter, and it’s quite a hot topic here,” she said, adding that she thought that producing a work of art “allows the conversation to happen in a clearer way.”

After learning that the Chinese characters for smallpox mean “heavenly flowers” — because the pustules bloom on the body, and the sufferers eventually die — Ms. Sinclair, who makes historically-inspired tableaus, created a scene of an 18th-century doctor administering a vaccination, surrounded by grass and blossoms. It brings a fashion-y aesthetic to an ugly disease. “I wanted to create something that looked at smallpox, but did it in a way that didn’t repulse people,” she said.

In an era when viewers are image-saturated, the campaign’s success, and how to measure it, are an open question. “We’ll look at the metrics,” Dr. Elias said. But, he added, the project has already proved valuable inside the Gates Foundation, as a new perspective on old problems.

“The phenomenal response” from artists, he said, “suggests that we have tapped a set of interests and voices that we perhaps should’ve been paying attention to sooner.”

Source: www.nytimes.com

Topics: health, healthcare, nurses, population, children, medical, medicine, diseases, physicians, art, vaccinations, vaccines, shots, prevent

Can Fast Food Hinder Learning in Kids?

Posted by Erica Bettencourt

Mon, Dec 29, 2014 @ 10:28 AM

FSF050 resized 600A steady diet of fast food might hurt your child in the classroom, a new study finds.

Kids who frequently ate fast food in fifth grade lagged behind by eighth grade, said researchers who reviewed questionnaires and test scores of more than 8,500 U.S. students.

"The largest effects were found for the kids who reported daily consumption of fast food," said study leader Kelly Purtell, assistant professor of human sciences at Ohio State University. "On average they were scoring three or four points lower than the kids who did not report eating fast food at all in the past week." 

The researchers compared academic test scores in reading, math and science for fifth and eighth grade and looked at the students' responses to food questions on a national survey. 

On average, test scores increased 16 to 19 points, depending on the subject, Purtell said.

But kids who ate fast food the most had test-score gains of up to 20 percent less than those who never ate fast food, she found.

The study was published online this month in Clinical Pediatrics

More than two-thirds of the students surveyed reported some fast-food intake. And one in five had eaten at least four fast-food meals in the previous week, the survey found.

The amount of fast food consumed corresponded with eighth-grade scores, even after researchers took into account for physical activity, TV watching, income levels and school characteristics, Purtell said.

The proliferation of fast food is already a concern because of America's obesity epidemic.

However, the study can't prove the fast food caused the lower scores, only that the two were linked, Purtell noted. Still, other research has linked high-sugar and high-fat diets with an adverse effect on learning processes requiring attention, she said.

Although researchers can't explain the tie-in for sure, it's also possible that those with a fast-food habit may not get the nutrients needed for good learning, she suggested.

Experts aren't recommending you ban all fast foods on the basis of this one report, but they do advise moderation.

"It is premature to presume that frequent fast-food consumption will compromise one's later academic functioning," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven & Alexandra Cohen Children's Medical Center of New York, who wasn't involved in the study.

"Although this study found an association between frequently eating fast food and weaker academic performance a year later, we cannot be certain that the observed differences were due to nutritional factors and not other variables," he said.

Still, it's advisable to "encourage kids to go slow when it comes to fast food" to preserve health and good nutrition, Adesman added.

More research is needed, he said, to determine what impact fast food has on students' learning potential.

In the meantime, Purtell said, "I don't think the occasional fast meal is anything to worry about." Once a week or less might be a good goal, she suggested.

Source: www.nlm.nih.gov

Topics: learning, kids, fast food, harmful, healthy lifestyle, lifestyle choices, classroom, youth, pediatrics, nursing, health, healthcare, children, diet, medical, food, physicians

Why more adults are getting "kids' diseases"

Posted by Erica Bettencourt

Wed, Dec 17, 2014 @ 11:50 AM

By DENNIS THOMPSON

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Chickenpox befell Angelina Jolie this week, preventing the actress-turned-director from attending the premiere of her new film.

Meanwhile, an outbreak of mumps has hit the National Hockey League, sidelining more than a dozen players and two referees.

These are considered kids' diseases. Most adults have vivid, fretful childhood memories of standing in line to get vaccinations that they expected to provide lifetime protection.

Why, then, are these prominent adults -- and scores of others -- coming down with these infections?

Mainly, it comes down to two factors, experts say.

Vaccination rates have declined among children in some parts of the United States, increasing everyone's risk of exposure to virulent diseases like chickenpox, measles, mumps and whooping cough, said Dr. Aaron Glatt, a spokesman for the Infectious Diseases Society of America.

"These vaccines are not perfect," said Glatt, who's also executive vice president of Mercy Medical Center in Rockville Centre, N.Y. "If you don't have a perfect vaccine and you couple that with a less-than-ideal number of people getting it, then if one person gets it then it's more likely to spread to others."

On top of that, even adults who got their shots as kids are at risk of contracting these diseases once exposed to them, because the protection provided by childhood vaccinations can fade over time.

"You can be vaccinated for something and have antibodies that wane over time or disappear entirely," said Dr. Len Horovitz, an internist and lung specialist at Lenox Hill Hospital in New York City. "You can have intermittent immunity, or no immunity."

America's public health defense against infectious diseases is built on a concept called "herd immunity," Glatt explained. If enough people are vaccinated against diseases like chickenpox, influenza, mumps and whooping cough, then even those who aren't vaccinated benefit because those who are immune can't spread the disease.

Skepticism over the effectiveness and safety of vaccines has caused vaccine rates to decline in some parts of the country, Horovitz and Glatt said. In those locations, adults with waning or imperfect immunity could fall prey to childhood infectious diseases, particularly if there's an outbreak.

"There is less vaccination going on than there was previously," Glatt said. "These childhood diseases have not gone away, and there is a strong anti-vaccine lobby that plays a role in people's decision to have their children vaccinated."

Since the early 1980s, there has been an overall increasing trend of whooping cough in the United States, said Angela Jiles, a spokeswoman for the federal Centers for Disease Control and Prevention.

Between Jan. 1 and Aug. 16 of this year, the CDC received reports of 17,325 cases of whooping cough, a 30 percent increase from the same time period in 2013 and the most cases seen in six decades, Jiles said.

California is experiencing its worst outbreak of whooping cough in seven decades.

There also have been more reported mumps cases in the United States this year, due to some larger outbreaks, according to the CDC. A reported 1,078 people have contracted mumps in 2014, compared with 438 the year before. In 2006 -- the worst year in recent history -- there were 6,584 cases of mumps, largely due to outbreaks on college campuses, according to the CDC.

No one has said how Jolie might have contracted chickenpox, but many of the NHL players appear to have gotten mumps from each other, despite efforts by the hockey league to get players vaccinated.

A single dose of mumps vaccine is about 80 percent effective, and two doses is about 90 percent effective, Amy Parker Fiebelkorn, an epidemiologist with the CDC's measles, mumps, rubella and polio team, told The New York Times.

"There is no vaccine that's 100 percent effective," Fiebelkorn said. "There is some margin for fully vaccinated individuals to still be infected with mumps if they're exposed to the virus."

Unfortunately, adults who contract these diseases are in for a rougher ride than children. They are more likely to develop serious complications, and are at higher risk of death, Glatt and Horovitz said.

These viruses also can increase a person's risk of future illness. For example, chickenpox patients like Jolie have a lifetime risk of shingles, a disease that can cause terrible rashes and intense nerve pain. The chickenpox virus hides in deep reservoirs inside the human body, and then emerges later in life to cause shingles.

Concerned adults can ask their doctor for a blood test that will check their antibodies and see if they remain immune to these infectious diseases, Horovitz said.

"It's something that could be done in the course of your annual exam. It takes no more than an extra tube or two of blood," the same as regular checks for blood sugar and cholesterol, he said. "It would be particularly important for people with chronic medical conditions or who do a lot of foreign travel where these diseases are running rampant."

People also can talk with their doctor about vaccinations that are recommended for adults. For example, the CDC recommends that adults get a booster shot every 10 years for tetanus, diphtheria and whooping cough, as well as an annual flu shot.

Source: www.cbsnews.com

Topics: measles, adults, mumps, shingles, chickenpox, whooping cough, infections, immunity, nurses, CDC, children, medical, vaccine, diseases, treatment, physicians, vaccinations, hospitals

Delayed cord clamping results in better immediate newborn outcomes

Posted by Erica Bettencourt

Wed, Dec 17, 2014 @ 11:35 AM

mother and newborn resized 600

At birth, a newborn baby is still attached to its mother through the umbilical cord, which is either cut very early - within the first 60 seconds - or later, with some women opting to wait until after the cord has stopped pulsating. Though the right timing for cutting the cord - also referred to as clamping - is widely debated, a new study suggests delaying cord clamping by 2 minutes results in better development for the newborn during the first days of life.

What do you think about it? Do you think the 2 minutes makes a difference? Perhaps you can share a personal and/or professional experience about this.

The research, carried out by scientists from the University of Granada and the San Cecilio Clinical Hospital in Spain, is published in the journal Pediatrics, the official journal of the American Academy of Pediatrics (AAP).

According to the American Congress of Obstetricians and Gynecologists (ACOG), the reason that cord clamping timing is so controversial is that a previous series of studies into blood volume changes after birth concluded that in healthy term infants, more than 90% of blood volume was attained within the first few breaths he or she took after birth.

As a result of these findings, as well as a lack of other recommendations regarding optimal timing, the amount of time between birth and umbilical cord clamping was widely shortened; in most cases, cord clamping occurs within 15-20 seconds after birth.

However, before these studies, in the mid-1950s, cord clamping within 1 minute of birth was defined as "early clamping," and "late clamping" was defined as more than 5 minutes after birth. And the ACOG have stated that "the ideal timing for umbilical cord clamping has yet to be established."

Meanwhile, the World Health Organization (WHO) advocate for late cord clamping (between 1-3 minutes after birth), as it "allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to 6 months after birth."

Waiting 2 minutes increased antioxidant capacity

To provide further evidence in the debate of early versus late cord clamping, the researchers from this latest study, led by Prof. Julio José Ochoa Herrera of the University of Granada, assessed newborn outcomes for infants born to 64 healthy pregnant women to determine the impact of clamping timing on oxidative stress and the inflammatory signal produced during delivery.

All of these women had a normal pregnancy and spontaneous vaginal delivery. However, half of the women's newborns had their umbilical cord cut 10 seconds after delivery and half had it cut after 2 minutes.

Results revealed beneficial effects of late cord clamping; there was an increase in antioxidant capacity and moderation of inflammatory effects in the newborns.

Commenting further, Prof. Ochoa says:


"Our study demonstrates that late clamping of the umbilical cord has a beneficial effect upon the antioxidant capacity and reduces the inflammatory signal induced during labor, which could improve the development of the newborn during his or her first days of life."

He adds that umbilical cord clamping is one of the most frequent surgical interventions practiced in humans, with proof of the practice dating back centuries. 

Early clamping 'not advised unless newborn needs resuscitation'

With evidence of benefits for delayed cord clamping, however, why are most newborns separated from the placenta within 15-20 seconds after birth? According to the ACOG, there are concerns over universally adopting delayed clamping because it could "jeopardize timely resuscitation efforts, if needed, especially in preterm infants."

"However," the organization states, "because the placenta continues to perform gas exchange after delivery, sick and preterm infants are likely to benefit most from additional blood volume derived from a delay in umbilical cord clamping."

There are also other concerns regarding delayed cord clamping, including an increased potential for "excessive placental transfusion, which can lead to neonatal polycythemia" - an abnormally high level of red blood cells. This is especially of concern in the presence of risk factors including maternal diabetes, intrauterine grown restriction and high altitude.

Another concern stated by the ACOG is that delayed umbilical cord clamping "may be technically difficult in some circumstances."

Still, the WHO say late cord clamping is recommended for all births, and the improved iron status associated with it "may be particularly relevant for infants living in low-resource settings with reduced access to iron-rich foods."

The organization clearly states that early cord clamping - less than 1 minute after birth - is not advised unless the newborn is asphyxiated and needs to be moved for resuscitation.

Source: www.medicalnewstoday.com

Topics: studies, WHO, birth, health, healthcare, nurses, medicine, physicians, hospitals, newborns, babies, cord clamping, umbilical cord, AAP

The debilitating outbreak sweeping the Americas

Posted by Erica Bettencourt

Wed, Dec 17, 2014 @ 11:04 AM

By Meera Senthilingam

141212185044 chikungunya mosquito vector horizontal gallery

Its name means "bending over in pain." It has no treatment or vaccine. Its symptoms resemble Dengue fever. And it has infected more than 1 million people -- 155 of them fatally -- since spreading to the Americas one year ago.

The mosquito-borne Chikungunya virus has long been diagnosed in travelers returning from countries in Asia and Africa, where the disease is widespread. But in December 2013, the first people infected by mosquitoes local to the region were reported on the Caribbean island of Saint Martin.

This was the first outbreak of the debilitating disease in the Western hemisphere, health officials said.

All countries in Central America have now reported local transmission of Chikungunya [pronounced chik-un-GOON-ya], and the United States had 11 confirmed cases of local infection this year as of December 12, all in the state of Florida. There also have been 1,900 imported cases across the U.S. in returning travelers.

"It wasn't until 2013 that unfortunately a traveler resulted in local transmission of Chikungunya," said Erin Staples of the U.S. Centers for Disease Control (CDC), referring to the people infected in Saint Martin.

Those infected carry the virus in their bloodstream; it can then be picked up by mosquitoes as they bite, making them carriers. The virus has since spread rapidly and shows no signs of leaving, as ecological conditions are perfect for the disease to flourish.

"We knew it would spread," said Staples, a medical epidemiologist.

The big question perplexing officials: Why now?

Two mosquito species primed to the temperatures of Central and South America carry Chikungunya. The species -- Aedes aegypti and Aedes albopictus -- also carry the virus behind Dengue fever.

"Given the level of Dengue in the region, we knew there could be the same levels of Chikungunya," Staples said. Both diseases can cause joint pain and inflammation, headaches, rashes and fever, and can lead to death in rare cases.

But this tropical disease with an exotic name (which originates from the African Makonde dialect) causes more intense joint pain and inflammation. For some people the pain can last for months or years, resulting in additional psychological strain.

The lack of immunity among people living in the Americas provided a blank canvas for Chikungunya to spread throughout the population this year. As of December 12, more than 1.03 million people have been infected, in addition to the 155 who died, according to the Pan-American Health Organisation (PAHO). Almost all of the fatalities occurred in the Caribbean island countries of Guadaloupe and Martinique.

"Where we saw the biggest jump was after it reached the Spanish-speaking countries in the region," said Staples, referring to the weakened infrastructures and health systems of countries such as the Dominican Republic, which has reported more than 520,000 cases -- more than half of the overall outbreak and 5% of the island country's population.

As South American countries approach their summer, numbers are expected to rise there as the mosquitoes flourish in the heat.

"Brazil, Peru, Paraguay are coming into their summer months and reporting their first local transmission," Staples said. Already, more than 2,000 people have been infected in Brazil.

Is there cause for concern?

Because infection with Chikungunya is rarely fatal, the issue of most concern to officials is the burden on health services and the impact of the debilitating symptoms on the economy.

"The high number of cases can overload health services," says Dr. Pilar Ramon-Pardo, regional adviser for PAHO, the regional office of the World Health Organization. Until recently, monitoring for Chikungunya was not part of routine surveillance in the region.

"Clinicians have to be ready to diagnose," she said

About 20% to 30% of cases are expected to become chronic, with symptoms such as arthritis and other rheumatic manifestations leading to physical disabilities, Ramon-Pardo said. Further long-term effects are psychological as people become more depressed and tired.

All of this can result in missed work and lower school attendance, she said, hurting local economies.

Is it here to stay?

The warm climate of the region offers potential for Chikungunya levels to be maintained for years to come, just like Dengue fever. But areas of most concern are the tropics.

"The areas which have year-round favorable climate for the mosquito are at the greatest risk," says Dr. Laith Yakob of the London School of Hygiene and Tropical Medicine, which is monitoring the spread of the outbreak.

While the climate and mosquitos have long been present, Ramon-Pardo said, "we don't know why this is happening now." She said globalization is likely to blame, with increased population movement from one country to another. This offers more opportunities for local mosquitos to bite infected humans.

The CDC's Staples said she is temporarily at ease regarding numbers in the U.S. "We're moving into fall and winter periods, which should see activity decrease," she said. Cold temperatures reduce mosquito survival rates.

The rapid spread of Chikungunya this year also could help minimize future infections. "Chikungunya will go through a region quite rapidly and create a level of population immunity which helps mitigate large outbreaks of the disease," Staples said. Unlike Dengue, infection with Chikungunya results in lifelong immunity.

Like many other infections, Chikungunya could, however, remain in the background through animals capable of carrying the virus in their bloodstream and acting as so-called reservoirs of the disease.

"In Asia and Africa there is a transmission cycle in small mammals and monkeys," Ramon-Pardo said, meaning these animals keep the virus present within the population. "In the Americas ... we don't know yet."

Those words -- "we don't know" -- resonate throughout the community of scientists and government officials trying to control the outbreak.

The future risk of spread, levels of future immunity, risk from animal reservoirs, why this is only happening now, and the total economic impact are all unknown.

"Mathematical models are under construction by numerous research groups around the world to improve confidence over projections of future spread," said Yakob, whose team is modeling the disease. As they work, control efforts continue.

Getting it under control

When it comes to controlling Chikungunya, there are two main strategies -- reduce the likelihood of bites and remove the ever-biting mosquito. Prevention is the priority.

Unlike the mosquitoes behind malaria, which bite at night, the species behind Chikungunya bite any time, day or night. Those living in affected areas are asked to use repellent, sleep under bed nets and wear long clothing to avoid getting bitten. The air conditioned and indoor environments of people living in the U.S. mean numbers are likely to stay low there.

But mosquito control is at the heart of it all. Mass spraying of insecticides and removal of any sources of shallow water in which mosquitoes can breed are taking place across the continents. According to the CDC's Staples, Florida has been highly aggressive with its approach to control. "We're only at 11 (cases) due to such proactive measures," Staples said. For now, prevention is all they have as officials wait and see how the outbreak pans out.

"There is no vaccine currently and no good antivirals, so we are trying to control the spread of the disease," Staples said. "There are a lot of questions and only time will tell what we'll see for Chikungunya in the future."

Source: www.cnn.com

Topics: symptoms, Chikungunya, DCD, mosquitos, WHO, health, healthcare, nurses, disease, medical, vaccine, medicine, treatment, physicians, hospitals, infection

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