DiversityNursing Blog

By Val Willingham and Miriam Falco

 (CNN) -- Chikungunya -- a tropical disease with a funny name that packs a wallop like having your bones crushed -- has finally taken up residence in the United States.

Ever since the first local transmission of chikungunya was reported in the Americas late last year, health officials have been bracing for the arrival of the debilitating, mosquito-borne virus in the United States. Just seven months after the first cases were found in the Caribbean, the Centers for Disease Control and Preventionreported the first locally acquired case of chikungunya in Florida.

Even though chikungunya is not on the National Notifiable Diseases Surveillance System list, 31 states and two U.S. territories have reported cases of the disease since the beginning of the year. But only Puerto Rico and the U.S. Virgin Islands reported locally acquired cases. All the other cases were travelers who were infected in countries where the virus was endemic and were diagnosed upon returning to the United States.

That ended Thursday, when the CDC reported a man in Florida, who had not recently traveled outside the country, came down with the illness.

As of right now, the Florida Department of Health confirmed there are at least two cases. One case is in Miami Dade County and the other is in Palm Beach County.

Its arrival did not surprise the chair of the Florida Keys Mosquito Control Board.

"It was just a matter of when. We are prepared in the Keys and have been prepared for some time to deal with chikungunya," Steve Smith said. "From what I am seeing, I'm sure there are more cases out there that we don't know about. It's really a matter of time."

The CDC is working closely with the Florida Department of Health to investigate how the patient came down with the virus. The CDC will also monitor for additional locally acquired U.S. cases in the coming weeks and months.

The virus, which can cause joint pain and arthritis-like symptoms, has been on the U.S. public health radar for some time.

Usually about 25 to 28 infected travelers bring it to the United States each year. But this new case represents the first time that mosquitoes themselves are thought to have transferred the disease within the continental United States

"The arrival of chikungunya virus, first in the tropical Americas and now in the United States, underscores the risks posed by this and other exotic pathogens," said Roger Nasci, chief of CDC's Arboviral Diseases Branch. "This emphasizes the importance of CDC's health security initiatives designed to maintain effective surveillance networks, diagnostic laboratories and mosquito control programs both in the United States and around the world."

The virus is not deadly, but it can be extremely painful, with symptoms lasting for weeks. Those with weak immune systems, such as the elderly, are more likely to suffer from the virus' side effects than those who are healthier. About 60% to 90% of those infected will have symptoms, says Nasci. People infected with chikungunya will often have severe joint pain, particularly in their hands and feet, and can also quickly get very high fevers.

The good news, said Dr. William Schaffner, an infectious diseases expert with Vanderbilt University in Nashville, is that the United States is more sophisticated when it comes to controlling mosquitoes than many other nations and should be able to keep the problem under control.

"We live in a largely air-conditioned environment, and we have a lot of screening (window screens, porch screens)," Shaffner said. "So we can separate the humans from the mosquito population, but we cannot be completely be isolated."

Mosquito-borne virus worries CDC

Chikungunya was originally identified in East Africa in the 1950s. Then about 10 years ago, chikungunya spread to the Indian Ocean and India, and a few years later an outbreak in northern Italy sickened about 200 people. Now at least 74 countries plus the United States are reporting local transmission of the virus.

The ecological makeup of the United States supports the spread of an illness such as this, especially in the tropical areas of Florida and other Southern states, according to the CDC.

The other concern is the type of mosquito that carries the illness.

Unlike most mosquitoes that breed and prosper outside from dusk to dawn, the chikungunya virus is most often spread to people byAedes aegypti and Aedes albopictus mosquitoes, which are most active during the day, which makes it difficult to use the same chemical mosquito control measures.

These are the same mosquitoes that transmit the virus that causes dengue fever. The disease is transmitted from mosquito to human, human to mosquito and so forth. A female mosquito of this type lives three to four weeks and can bite someone every three to four days.

Shaffner and other health experts recommend people remember the mosquito-control basics:

-- Use bug spray if you are going out, especially in tropical or wooded areas near water.

-- Get rid of standing water in empty plastic pools, flower pots, pet dishes and gutters to eliminate mosquito breeding grounds.

-- Wear long sleeves and pants.

Source: www.cnn.com

By Reuters

Three more people in Colorado have been diagnosed with the plague after coming in contact with an infected dog whose owner contracted a life-threatening form of the disease, state health officials said on Friday.

In all, four people were infected with the disease from the same source, the Colorado Department of Public Health and Environment said in a statement.

Last week the department said a man in an eastern Colorado county whose dog died of the plague had been diagnosed with pneumonic plague, a rare and serious form of the disease.

The man remains hospitalized, but authorities have not released his condition.

The three people in the latest reported cases had "mild symptoms" and have fully recovered after being treated with antibiotics, the department said, adding that they are no longer contagious.

Two of the patients in the new cases contracted pneumonic plague, the department said.

Pneumonic plague is the only form of the disease that can be transmitted person-to-person, usually through infectious droplets from coughing.

The bacteria that causes plague occurs naturally in the western United States, primarily in California, New Mexico, Arizona and Colorado, according to the U.S. Centers for Disease Control and Prevention.

The infected canine in Colorado likely contracted the disease from prairie dogs or rabbits, which are the primary hosts for fleas that carry the bacteria.

When an infected animal dies, the fleas spread the disease when they find another host.

Colorado has seen a total of 12 cases of humans infected with the plague over the last decade, said Jennifer House, the department's public health veterinarian.

"We usually don't see an outbreak like this related to the same source," House said.

Colorado had not had a confirmed human case of pneumonic plague since 2004, she said.

Source: http://www.foxnews.com/health

Source: University of San Francisco Online

Source: http://onlinenursingdegrees.maryville.edu

By KATIE MOISSE

It’s been nine months since the government shutdown, and some D.C. area hospitals are reporting a surprising development: Babies. Lots of them.

Sibley Memorial Hospital in Washington, D.C., has seen an additional three births per day in July, according to spokesman Gary Stephenson.

“We’re at near-capacity right now,” said Stephenson, joking that some furloughed workers “apparently found ways to amuse themselves.”

Virginia Hospital Center in Arlington delivered 99 more babies in April, May and June than they did in the same stretch last year, according to spokeswoman Maryanne Boster.

Both hospitals stopped short of crediting the two-week shutdown in October 2013 for the spike in births, stressing that the apparent link was purely anecdotal. But it’s not the first time a local baby boom has been blamed –- albeit anecdotally –- on an event nine months prior.

“It’s just so appealing to think, ‘Oh, it’s a full moon,’ or ‘it’s nine months after a blackout or Hurricane Sandy,’” said Dr. Marjorie Greenfield, chief of obstetrics and gynecology at University Hospitals Case Medical Center in Cleveland. “But there’s a lot of natural fluctuation.”

Some days Greenfield has 20 women in labor, she said. Other days, there are four.

“There are so many things that play into whether someone gets pregnant,” she said, explaining that a small proportion of furloughed couples would be fertile –- not to mention eager to conceive -– during the two-week shutdown.

“It’s such a sexy topic,” she said of the big event-baby boom link. “It just doesn’t appear to be real.”

But other OBs say they not only see an uptick in births nine months after unusual events like blizzards and blackouts, their patients say those events are why they got pregnant.

“I can say that I've definitely seen spikes after things like hurricanes, blackouts and blizzards,” said Dr. Jennifer Ashton, ABC News’ senior medical contributor and a practicing OB/GYN. “I’m not aware of any hard data on this, but anecdotally, many obstetricians will ask their patients about the events nine months prior, and many women will say 'Yes, we conceived during the blackout.'"

Ashton said it’s definitely possible that the link is coincidental, and said there tend to be seasonal fluctuations in birth rates as well.

Boster of Virginia Hospital Center said they expect to see the baby boom continue through the summer months “after the long, snowy winter.”

Source: http://abcnews.go.com

By CNN Staff

(CNN) -- In the future, a test of your sense of smell may help doctors predict your risk of developing Alzheimer's disease, according to new research presented at the Alzheimer's Association International Conference in Copenhagen, Denmark, this week.

In two separate studies, scientists found that people who were unable to identify certain odors were more likely to experience cognitive impairment. The researchers believe that brain cells crucial to a person's sense of smell are killed in the early stages of dementia.

Researchers say this information could help doctors create a smell test to detect Alzheimer's earlier. Early detection means early intervention and treatment to slow the progression of the disease. Doctors today can only diagnose Alzheimer's disease once it has caused significant brain damage.

"In the face of the growing worldwide Alzheimer's disease epidemic, there is a pressing need for simple, less invasive diagnostic tests that will identify the risk of Alzheimer's much earlier in the disease process," Heather Snyder, director of medical and scientific operations for the Alzheimer's Association, said in a statement.

More than 35 million people worldwide live with dementia today, according to a new report. By 2050, that number is expected tomore than triple to 115 million.

Source: cnn.com

By Foxnews.com

On Thursday, 3-year-old cancer patient Wyatt Schmaltz was sworn in as the nation’s youngest special sheriff deputy from his hospital room in Indianapolis.

In April, Wyatt was diagnosed with aggressive, stage 4 neuroblastoma and has undergone several rounds of chemotherapy.  Soon, he’ll undergo surgery to remove a tumor from his abdomen and he will also undergo a stem cell transplant.

As a tribute to his courage throughout his treatments, an Indiana sheriff and a state trooper visited Wyatt at his room in Riley Hospital for Children at Indiana University Health, giving him the powers of a sheriff deputy – as well as a badge and uniform.  Terry Stoffel, a sheriff for Huntington County, noted that the title is an official designation.

"We have given Wyatt all the powers of a real sheriff deputy, which are to carry out the orders of the sheriff. Right now, his only orders are to get better,” Stoffel said.

According to doctors at Riley Hospital, such acts of kindness can really help to make children well again.

"Gestures like this really aid the healing process for our patients," said Dr. Michele Saysana, a pediatrician with Riley Hospital for Children at IU Health. "It brought tears to our team members’ eyes to see officers, who are sworn to protect and serve, travel to pay tribute to one of our patients."

After being sworn in, Wyatt asked: “What else do you have?”

Source: foxnews.com

By GILLIAN MOHNEY

A girl believed to be “cured” of HIV at birth now has detectable levels of the virus, health officials said today.

The unnamed girl, dubbed the “Mississippi baby” after being born to an HIV-positive mother in 2010 and quickly treated with an intense dose of antiretroviral medication, showed no signs of the virus for roughly four years, according to the National Institute for Allergy and Infectious Disease. But a recent round of tests revealed detectable levels of HIV in her blood as well as antibodies to the virus and a decreased T-cell count -- all signs of the infection.

“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care, and the HIV/AIDS research community,” NIAID director Dr. Anthony Fauci said in a statement. “Scientifically, this development reminds us that we still have much more to learn about the intricacies of HIV infection and where the virus hides in the body.”

The case of the Mississippi baby made headlines across the globe after being published in the New England Journal of Medicine. Dr. Hannah Gay, the University of Mississippi Medical Center pediatrician who treated the infant at birth, was listed as one of Time magazine’s most influential people of 2013.

Gay's decision to give the newborn antiretroviral medication in the days before it was confirmed that she was in fact HIV-positive was controversial, since there was only a 25 percent chance that the girl would contract the virus from her mother.

The girl continued treatment for 18 months before her mother stopped taking her to her clinic appointments. Five months later, when she went back for a check-up, she surprised doctors with undetectable levels of the virus.

At first, Gay and her colleagues said the baby had been “functionally cured” of the virus, but later revised their language to “remission” to better convey that there was a chance the virus could rebound, they said at the time.

Although the girl's positive test results have been described as a disappointment, experts say her case still shows tremendous progress in treating the virus that causes AIDS.

“The fact that this child was able to remain off antiretroviral treatment for two years and maintain quiescent virus for that length of time is unprecedented,” Dr. Deborah Persaud, professor of infectious diseases at the John Hopkins Children’s Center in Baltimore, said in a statement released by NIAID. “Typically, when treatment is stopped, HIV levels rebound within weeks, not years.”

Persaud is one of the two pediatric HIV experts involved in the ongoing analysis of the case.

“This virus is amazingly recalcitrant,” said Fauci. “It’s in reservoirs, except we don’t know every place in the body where the reservoir is going to be.”

NIAID and the National Institute of Child Health and Human Development announced today that they would provide funding to analyze the unique case and will take the new findings into account during a new clinical trial.

Source: abcnews.go.com

By NPR Staff

As hearing aid technology has improved, so has health reporter Kathleen Raven's confidence.

When she was 5 years old, she found out she had a hearing problem. Complications during her birth led to damage in her inner ear.

"I couldn't hear water dripping from a faucet. I couldn't hear crickets on a summer night," she tells NPR's Kelly McEvers. "I couldn't hear sirens, couldn't hear fire alarms in our school fire drills, so I did a lot of watching other people."

The diagnosis was moderate to severe loss of high- and low-frequency hearing. When it comes to speech, certain sounds are out of range for her. Sounds like "ch," "sh" and "th" blend together.

Raven says she reads lips "religiously," but when she can't see a person's lips, she can understand maybe every third word — that is, without a hearing aid.

She got her first hearing aids — a large, clunky set — back when she was 5 in 1993.

"They were about 2 inches long and very thick, and they connected to a very large ear mold inside my ear," she says. "They call them flesh-colored, but they're not the color of anyone's flesh." Her young classmates teased her.

But the technology kept changing. Every few years, her parents would shell out $4,000 to $5,000 on each new device. By the time she got to high school, she had her first completely inside-the-ear hearing aid. That changed everything.

"I just became more confident walking into crowds. I didn't try to hide, I didn't arrange my hair to cover my ears. I started being more talkative, going out with my friends more," says Raven. "I didn't realize how much that fear had impacted me until I got completely in-the-ear hearing aids."

She went on to college and started pursuing her dream of reporting.

"I encountered a few raised eyebrows along the way," she says. "Why do you want to make a living of hearing people when that's a challenge for you?"

She pushed past the skeptics and became a reporter. Today she writes about oncology forBioPharm Insight.

As years passed and the technology progressed, Raven thought her hearing had maxed out. But with each upgrade, she discovered more sounds. Two years ago, she received her latest pair, which cost $7,000.

When her audiologist put them in her ears, she heard an unfamiliar noise. "I just happened to smack my lips together, like you're tasting something," she recalls. "It's just such a simple sound, but it was earth-shattering."

Her audiologist put on Beethoven, and she heard new instruments and trills. "It was like seeing the world in 3-D, or hearing the world in 3-D for the first time," Raven says.

These latest hearing aids are basically invisible. Even still, now she tells people about her hearing loss.

"Five years ago, I still was not ever telling people unless it was absolutely necessary. And now I do work it into conversation in the first five minutes or so," she says. If she needs to ask someone to repeat something, she'll just add, "I have a hearing problem."

"That phrase was impossible for me to say for the first 20 years of my life," Raven says. "Now I think it's very important for hearing loss to be accepted for younger people, of course, and also for older people."

Source: npr.org

By Julie Scharper

Every working breastfeeding mother has had it happen at least once: You're on a break, ready to pump, when you discover you forgot a crucial piece of equipment. 

Maybe it's a valve, a piece of tubing or a storage bag. You find yourself wondering if you can store milk in a water bottle or use butter as a nipple cream because there's no time to run home.  What can you do?

Workers at Johns Hopkins Hospital can now purchase breastfeeding equipment from a vending machine -- believed to be the first of its kind.

The machine, which was installed last month, stocks pump accessories, storage bottles, breast pads and nipple cream, among other supplies for nursing mothers.

It's the brain child of Meg Stoltzfus, Lifespan Services Manager for the Office of Work, Life and Engagement at Hopkins.

"I worked and pumped as well, so I've made it sort of a mission to help other moms," she said.

Stoltzfus was walking through an airport last year when she noticed what a large variety of items are sold in vending machines.  It occurred to her that a vending machine would be the perfect way to provide pumping equipment for mothers at the hospital, who often work unusual hours and may need equipment when the hospital gift shops are closed.

Stoltzfus worked directly with a manufacturer to design a machine that specializes in pumping gear.  It was installed last month in a nursing mother's room in the hospital's Nelson building.

As an added bonus, the equipment is sold at a discount because it is an employee benefit. Customers swipe a credit or debit card to purchase items.

"I tried to brainstorm the kinds of things people forget," or don't have time to purchase after work, Stoltzfus said.  

Stoltzfus believes that the vending machine is the first of its kind. Representatives from the two major breast-pump companies --  Medela and Ameda -- said they had not seen one before. Nor had other work life professionals who attended a recent conference hosted by Hopkins.

Hopkins -- the hospital, university and other affiliates -- has 14 dedicated nursing-mothers' rooms equipped with hospital grade pumps, so women don't have to lug a pump to work.  The rooms also have microwaves and refrigerators to sterilize equipment and store milk.

"It ties into our mission of retaining wonderful employees," Stoltzfus said.

She said she might add another machine at an additional Hopkins location if this one catches on, and she said other institutions have expressed interest in following suit.

Should more places have these vending machines available to the public? Comment below!

Source: baltimoresun.com