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tag:reuters.com,2020:newsml_L1N2DM0RR:2108519098
0
By Will Boggs MD NEW YORK (Reuters Health) - Obstructive sleep apnea syndrome (OSAS) is associated with nocturia in adults under age 65 years, researchers in Japan report. In cases where "relatively young adults complain of nocturnal urine frequency but lack any urological disorders, we need to suspect OSAS and to refer them to the appropriate department," Dr. Yasuyuki Miyauchi of Kagawa University Faculty of Medicine, in Kagawa, told Reuters Health by email. Dr. Miyauchi and colleagues previously reported that OSAS is associated with nocturia and deterioration of lower-urinary-tract symptom (LUTS)-related quality of life and that both were improved by continuous positive airway pressure (CPAP) treatment. In the current secondary analysis of the earlier study, the team evaluated the impact of OSAS on nocturia, with a focus on differences between young (<65 years) and older (65 years and older) adults. The study included 65 young adults (median age, 51.0 years) and 25 older adults (median age, 70.0 years). In multiple linear regression analyses, nocturnal urine volume and total International Prostate Symptom Score (IPSS) were significant predictors of nocturnal urinary frequency. In young patients, nocturnal frequency was significantly associated with apnea-hypopnea index (AHI), nocturnal volume and total IPSS, the researchers report in Urology. Nocturnal frequency and urinary sodium content increased significantly with OSAS severity in younger people. By contrast, among older patients, nocturnal frequency was not associated with demographic or polysomnographic characteristics, and there was no significant association between OSAS severity and nocturnal frequency or urinary sodium content. This does not necessarily mean that nocturia is insignificant as a symptom of OSAS in older people, the authors note. Instead, nocturia in this group has multiple other causes, including overactive bladder, benign prostatic hyperplasia and other age-related structural changes in urinary organs. "When a younger patient complains of nocturia, urologists should keep in mind OSAS as a potential cause of nocturia, rather than treating them as pathological LUTS indiscriminately," Dr. Miyauchi said. "Thereby, it will be beneficial in avoiding severe events caused by unrecognized OSAS." SOURCE: https://bit.ly/2MuPMXd Urology, online May 28, 2020.
340
L1N2DM0RR
2108519098
NOCTURIA-SLEEP APNEA/
OSA syndrome linked to nocturia in adults
3
[]
[]
['Clinical Medicine', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Otolaryngology', 'Psychology', 'Sleep Disorders', 'Urological Disorders']
['CLIMED', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'OTOL', 'PSYCHO', 'SLEDIS', 'UROLOG']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DN2WJ:1613307094
0
By Saumya Joseph (Reuters) - Ventilators can be safely shared by two COVID-19 patients for up to two days, a small U.S. study found, validating an experimental method followed by hospitals struggling to handle the onslaught of lung failure cases with limited medical resources. At the peak of the coronavirus outbreak, the New York-Presbyterian/Columbia University Medical Center in Manhattan began using a single ventilator in pairs of selected surgery patients with healthy lungs, to free up the machines for COVID-19 patients. The approach has been criticized by some medical experts who argue that it could worsen outcomes. The few existing studies of ventilator sharing did not test so-called ventilator-splitting in patients with the type of lung injuries seen with COVID-19. However, a new study involving six critically-ill COVID-19 patients at the Manhattan hospital who were paired up on the basis of similarities in breathing needs, found ventilator sharing was a viable option for up to two days. During acute shortages, ventilator sharing is a reasonable stopgap to support patients for short periods in centers with appropriate expertise, the researchers wrote in the American Journal of Respiratory and Critical Care Medicine on Tuesday. "Ventilator sharing does not obviate the need for more ventilators," Dr. Jeremy Beitler of the New York-Presbyterian Hospital and his team wrote. At most, it could buy some time while relocating ventilators to hospitals or transferring patients to hospitals with the life-saving machines. They recommend restricting ventilator sharing to expert centers that could properly identify suitable patients and manage their care. "Safely supporting two patients with one ventilator entails far more than 'splitting' the ventilator, which itself is simple plumbing," Dr. Beitler told Reuters by email. "Careful patient selection and management are essential to ensure safety. Ventilator sharing had never before been attempted in patients with severe lung injury, and we were committed to proceeding only if we believed it could be done safely and responsibly. Before attempting ventilator sharing, we wrote a step-by-step clinical protocol that explicitly addresses how to identify compatible patients, transition them to/from the shared ventilator, prevent changes in one patient from affecting the other, and ensure full support and monitoring during ventilator sharing. Ventilators are designed to monitor a single patient, he noted. "We overcame this issue by using freestanding respiratory monitors with their own alarms for each patient, ensuring we knew precisely how each patient was supported with breath-to-breath measures, just as normally would happen with single-patient ventilation," Dr. Beitler said. "Another hurdle is that different patients require different levels of ventilator support," he continued. "Our protocol addressed this issue by identifying compatible patient pairs with similar respiratory mechanics, gas exchange, and type of infection. Before transitioning patients to the shared ventilator, we placed them on identical ventilator settings to prove they could be safely and fully supported with the same settings." "Finally," he said, "we addressed infection control challenges by requiring both patients have the same respiratory pathogen(s) and placing redundant antimicrobial filters in the split ventilator circuit. "We decided ahead of time that we would limit time on the shared ventilator to two days unless our ventilator supply was completely exhausted," he said. "Fortunately, it never came to that. During acute ventilator shortages, we believe the clearest role for ventilator sharing is when sufficient ventilators exist elsewhere and time is required to relocate ventilators or transfer patients." "Thankfully, to date at no point during the COVID-19 pandemic was the entire United States about to run out of ventilators," Dr. Beitler concluded. "The sudden mass ventilator shortage was isolated to one region, New York. The problem was that enough ventilators were not located where the surge in patients occurred. Supply is scattered across the country, while unprecedented demand in March and April was hyper-localized. Ventilator sharing offers a stopgap. It buys time to relocate ventilators to where they are needed." SOURCE: https://bit.ly/3hc6Pv7 American Journal of Respiratory and Critical Care Medicine, online June 9, 2020.
653
L1N2DN2WJ
1613307094
COVID19-VENTILATORS/SHARING
Short-term ventilator sharing may be viable for COVID-19 patients
3
[]
[]
['Clinical Medicine', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Internal Medicine', 'Respiratory Conditions']
['CLIMED', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'INTMED', 'RESPIR']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DP0NF:645717344
0
By Will Boggs MD NEW YORK (Reuters Health) - The use of first-line immune-checkpoint inhibitor (ICI) treatment in patients with advanced non-small-cell lung cancer (NSCLC) increased following publication of clinical trials that demonstrated their clinical efficacy at lower PD-L1 expression levels, according to new research. "This study highlights the rapid adoption of biomarker-driven treatment strategies and the important dynamic between clinical evidence, regulatory guidance, and the clinicians who integrate these factors in decision-making for patients," Dr. Michael S. Leapman of Yale University School of Medicine, in New Haven, Connecticut, told Reuters Health by email. The U.S. Food and Drug Administration (FDA) first approved the ICI pembrolizumab as first-line treatment for advanced NSCLC in 2016, initially restricting its use to patients with PD-L1 expression of 50% or greater. Subsequent studies showed evidence of clinical efficacy at lower PD-L1 expression levels, ultimately leading to broadened approval without restriction to PD-L1 status (2017 for nonsquamous NSCLC and 2018 for squamous NSCLC). Dr. Leapman and colleagues evaluated trends in PD-L1 testing and changes in ICI treatment among patients diagnosed with advanced NSCLC from 2011 through 2018. In 2015, before regulatory approval of pembrolizumab, 7.2% of patients underwent PD-L1 testing within 30 days of diagnosis; this increased to 73.2% in 2018. Overall, patients who received PD-L1 testing were more frequently treated with an ICI (54.3% vs. 32.8% of untested patients). A similar fraction of patients with negative PD-L1 expression (0% staining) received first-line ICI treatment (32.3%). The proportion of patients with low or untested PD-L1 expression who received ICI treatment rose from 13.2% in the last quarter of 2016 to 53.4% in 2018. The use of ICIs remained high in all study periods among patients with PD-L1 expression of 50% or greater (67.4% in the last quarter of 2016 and 82.3% in 2018), however, the researchers report in JAMA Network Open. The FDA restriction of first-line ICI treatment for patients with advanced squamous NSCLC was loosened in the fourth quarter of 2018, but there was increasing use of first-line ICI treatment that predated this broadened approval. "We found that use of first-line immune-checkpoint-inhibitor therapy largely tracked with recommended thresholds for PD-L1 expression," Dr. Leapman said. "However, as approvals for these agents broadened in the face of new evidence, clinical practice also responded rapidly - sometimes preceding formal changes to regulatory guidance." "New cancer therapies are increasingly approved in conjunction with biomarker tests to help identify those most likely to benefit from treatment," he said. "Our findings appear to highlight some of the practical complexities associated with implementing a biomarker-based strategy, particularly one that emerges in the setting of rapidly changing lines of evidence." Dr. Hossein Borghaei of Fox Chase Cancer Center, in Philadelphia, who co-authored a linked editorial, told Reuters Health by email, "It is surprising to see the use of drugs without the proper biomarker testing or use in patients in which studies have not established efficacy and safety yet. So in this case, the use of ICI in patients with low PD-L1 expression when trials were not completed yet." He pointed out that "besides cost, (there is) possible toxicity where patient benefit has not been established." "Extrapolating from one set of data and applying toxic treatments to another group still not investigated is risky and can compromise outcomes," Dr. Borghaei concluded. "There is a lot of data that is being generated now. Peer review and proper patient selection are keys in avoiding harm." SOURCE: https://bit.ly/2MRn173 and https://bit.ly/30zwjgi JAMA Network Open, online June 8, 2020.
581
L1N2DP0NF
645717344
LUNG CANCER-ICI/
Trial findings prompt greater use of immune-checkpoint inhibitors for lung cancer
3
[]
[]
['Clinical Medicine', 'Cancer', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Immunology', 'Lung Cancer', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research']
['CLIMED', 'CNCER', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'IMMOGY', 'LUNGCA', 'MRCH', 'PHMR']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DP0NL:2136583168
0
By Reuters Staff NEW YORK (Reuters Health) - Patients with Hodgkin lymphoma (HL) and secondary hemophagocytic lymphohistiocytosis (HLH) have worse prognosis and higher mortality than other HL patients, researchers in China report. HLH, a life-threatening disorder characterized by high inflammatory-cytokine production, can occur as a primary condition or secondary to malignant tumors, infection, autoimmune diseases and other causes. HL accounts for about 6% of HLH cases. Dr. Zhao Wang and colleagues from Beijing Friendship Hospital, Capital Medical University, compared the clinical characteristics and outcomes of eight patients with HLH-associated HL and 20 with non-HLH-HL. Two of the HLH-HL patients were classified as "HLH during chemotherapy," and the other six were classified as "malignancy-triggered HLH." The median age of the HLH-HL patients was 52.5 years (range, 26-75 years), compared with 31 years (range, 16-66 years) among non-HLH-HL patients. All of the HLH-HL patients were Ann Arbor stage III or IV, whereas only 65% of the non-HLH-HL patients were stage III or IV. Before treatment, all HLH-HL patients tested positive for plasma Epstein-Barr virus DNA, while only one patient with non-HLH-HL did. Among the HLH-HL patients, three died (two from disease progression and one from septic toxic shock); maximum survival for the rest as of the data cutoff was 31 months. All 20 non-HLH-HL patients survived. For all 28 HL patients, overall survival rates were 96.4% at one month, 92.6% at three months, and 86.4% at 12 months. In the subset of patients with HLH-HL, overall survival rates were 87.5% at one month, 75% at three months and 56.3% at 12 months. "It may be beneficial to give priority to targeting HLH during the acute phase of HLH, followed by treating the primary disease (HL) once the HLH condition has stabilized," the authors conclude. "HL patients found positive for EBV may be more likely to develop HLH-HL." Dr. Wang did not respond to a request for comments. SOURCE: https://bit.ly/30KA16U Annals of Hematology, online June 4, 2020.
324
L1N2DP0NL
2136583168
HODGKIN-LYMPHOMA/HLH-PROGNOSIS
Hemophagocytic lymphohistiocytosis worsens Hodgkin lymphoma prognosis
3
[]
[]
['Blood Cancer', 'Clinical Medicine', 'Cancer', 'General News', 'General Health', 'Haematology / Blood Disorders', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Immunology', 'Pharmaceuticals & Medical Research']
['BLOOCA', 'CLIMED', 'CNCER', 'GEN', 'GENHLT', 'HAEMAT', 'HEA', 'HECA', 'HUMDIS', 'IMMOGY', 'PHMR']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DS0O3:1555175499
0
By Reuters Staff ABUJA (Reuters) - Resident doctors in Nigerian public hospitals went on strike on Monday to demand better benefits as they battle the coronavirus pandemic in Africa's most populous country, the union said. Those treating COVID-19 patients will stay on the job but their union, the National Association of Resident Doctors (NARD), gave the government two weeks to meet the demands or else they would also walk out. Resident doctors are pivotal to frontline healthcare in Nigeria as they dominate the emergency wards in its hospitals. Strikes are common in Nigeria's public health system, with clinicians frequently seeking pay rises and improvements to under-funded infrastructure to meet the rising burden of healthcare in the West African nation of 200 million people. "If the government fails to meet our minimum demands within two weeks, the resident doctors working in (COVID-19) isolation centres will automatically join the strike," Aliyu Sokomba, the head of the union, said in a statement. The resident doctors are seeking a COVID-19 pay supplement in addition to life insurance for doctors and more funds in the federal budget for their training, among other demands. NARD has complained about inadequate protective equipment to treat COVID-19 patients and has said that 10 doctors have died so far from the highly infectious respiratory disease. Nigeria has had more than 16,000 confirmed cases of the virus and 420 deaths. Most of the cases have been in Lagos, sub-Saharan Africa's biggest city with some 20 million inhabitants. Last month, doctors in Lagos staged a one-day strike over what they described as police harassment of health workers trying to move through the city to treat patients during a coronavirus curfew.
278
L1N2DS0O3
1555175499
HEALTH-CORONAVIRUS/NIGERIA-HEALTHCARE (PIX, TV)
Nigerian doctors strike for better benefits during coronavirus crisis
3
[]
[]
['Disasters / Accidents', 'Economic Indicator Published', 'Epidemics', 'Financials (Legacy)', 'Financials', 'Financials', 'General News', 'General Health', 'Healthcare Policy', 'Healthcare Professional Development', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Insurance', 'Life & Health Insurance', 'Economic Events']
['DIS', 'ECI', 'EPMICS', 'FIN', 'FINS', 'FINS08', 'GEN', 'GENHLT', 'HCPOL', 'HCPROF', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'INSR', 'LINS', 'MCE']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DS0OF:773826963
0
By Ludwig Burger and Rene Wagner FRANKFURT/BERLIN (Reuters) - Germany will take a stake in unlisted biotech firm CureVac, which is working on a COVID-19 vaccine, Economy Minister Peter Altmaier said on Monday, confirming an earlier Reuters report. The Berlin government will acquire a 23% stake for 300 million euros ($337.4 million), according to Altmaier, in a deal that values the company at 1.3 billion euros. The move followed reported attempts by the U.S. government to acquire CureVac or its assets in March, which stirred a backlash in Berlin, with Altmaier and the interior minister voicing support for keeping CureVac German. Altmaier said that the government wanted to strengthen the life sciences and biotech sectors in Germany and that Berlin would not have any influence over CureVac's business strategy. "The German federal government has decided to invest in this promising company because it expects that this will accelerate development programmes and provide the means for CureVac to harness the full potential of its technology," said the minister, adding the transaction would not require EU approval. "With this investment we aim to give CureVac financial security so that it can continue to work on vaccine production with the same commitment," he told a news conference. Reuters reported about the German plan to take a stake in CureVac earlier on Monday. A government source said the move reflected German concerns about relying too much on overseas suppliers for healthcare products and equipment. Reflecting the sensitivity about ownership of the country's two coronavirus vaccine developers - CureVac and BioNTech - Berlin gave itself new powers in May to veto hostile foreign takeover bids for healthcare companies. Dietmar Hopp - co-founder of software firm SAP and owner of a stake of more than 80% in CureVac – said none of the existing CureVac investors would sell shares to the government, and their stakes would be diluted by the deal on a pro-rata basis. ($1 = 0.8891 euros)
323
L1N2DS0OF
773826963
HEALTH-CORONAVIRUS/GERMANY-CUREVAC
Germany to buy stake in CureVac as world races for COVID-19 vaccine
3
['Europe']
['EUROP']
['Corporate Events', 'Drug & Device Development', 'Economic Indicator Published', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Economic Events', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health', 'Regulation / Compliance', 'Vaccines']
['BACT', 'DRUDEV', 'ECI', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MCE', 'MRCH', 'PHMR', 'PUBHEA', 'REGS', 'VACCIN']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DS13R:1096990993
0
By Ryan Woo and Colin Qian BEIJING (Reuters) - Several districts of the Chinese capital put up security checkpoints, closed schools and ordered people to be tested for the coronavirus on Monday after an unexpected spike of cases linked to the biggest wholesale food market in Asia. After nearly two months with no new infections, Beijing officials have reported 79 cases over the past four days, the city's biggest cluster of infections since February. The return of the coronavirus has shrouded Beijing, home to the headquarters of many big corporations, in uncertainty at a time when China is trying to shake off the economic torpor caused by the disease. "The containment efforts have rapidly entered into a war-time mode," senior city government official Xu Ying told a news conference. Xu said 7,200 neighbourhoods and nearly 100,000 epidemic-control workers had entered the "battlefield". The outbreak has been traced to the sprawling Xinfadi market where thousands of tonnes of vegetables, fruits and meat change hands each day. A complex of warehouses and trading halls spanning an area the size of nearly 160 soccer pitches, Xinfadi is more than 20 times larger than the seafood market in the city of Wuhan where the outbreak was first identified. The new cases have led to many parts of Beijing to reimpose tough measures to stifle the spread of the virus, including round-the-clock security checkpoints, closing schools and sports venues and reinstating temperature checks at malls, supermarkets and offices. Residents were also advised to avoid crowds and gathering in groups for meals. Some districts even sent officials to residential compounds in what they described as a "knock, knock" operation to identify people who had visited Xinfadi. None of Beijing's 16 districts has been hit by a blanket lockdown. But access to the neighbourhoods of the people who were infected has been blocked as tests are being administered to residents. The 11 neighbourhoods around Xinfadi and 10 others near another market have also been sealed as 90,000 residents undergo tests. FROM EUROPE? The World Health Organization said on Sunday it was informed of the outbreak and an investigation by Chinese officials. "WHO understands that genetic sequences will be released as soon as possible once further laboratory analyses are completed," it said in a statement. China has completed genome sequencing for the coronavirus found in the samples collected in the latest outbreak and arrived at a preliminary conclusion, state media reported on Monday, citing Gao Fu, director of the Chinese Center for Disease Control and Prevention. Gao did not elaborate, however. Efforts to trace the origins of the virus are still underway, Gao added. An epidemiologist with the Beijing government said on Sunday a DNA sequencing of the virus showed the Xinfadi outbreak could have come from Europe. Governments in many parts of China warned residents against non-essential travel to the capital and imposed quarantine requirements on visitors from Beijing. Some provinces asked people arriving from Beijing's designated high and medium-risk areas to be quarantined for seven days. One city in Heilongjiang province is demanding three weeks. The municipality of Shanghai and nine other provinces including Hubei, Guangdong and Hainan have yet to impose quarantine rules on Beijing visitors and returnees, though local conditions vary. Wang Xiaoyang, who works in public relations in the southern boomtown of Shenzhen in Guangdong, said she got a text message from authorities telling her to stay at home for 14 days after returning from Beijing on Friday. Baoding, an industrialised city near Beijing, was closely monitoring arrivals. "Every gate to Baoding should be strictly guarded to prevent the contagion from spreading," state media quoted officials as saying.
605
L1N2DS13R
1096990993
HEALTH-CORONAVIRUS/CHINA (PIX)
Beijing imposes curbs as coronavirus returns to Chinese capital
3
[]
[]
['Communicable Diseases', 'Economic Indicator Published', 'Epidemiology', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Economic Events', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health']
['COMDIS', 'ECI', 'EPMEOL', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MCE', 'MRCH', 'PHMR', 'PUBHEA']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DS1HZ:555627046
0
By Linda Carroll (Reuters Health) - Many U.S. parents are skipping or delaying routine vaccinations for their children because of safety concerns and a lack of confidence in their efficacy, a new study suggests. In a survey of more than 2,000 parents, researchers found that 1 in 15 participants was hesitant about routine vaccines and 1 in 4 was hesitant about the influenza vaccine. Moreover, while 70% of parents strongly agreed that routine childhood vaccinations are effective, just 26% had the same level of confidence in the influenza vaccine, according to the report in Pediatrics. It was a surprise to see that one in four parents were hesitant about the flu vaccine, said Dr. Allison Kempe, a professor of pediatrics and director of Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, in Aurora. Kempe and her colleagues suspect hesitancy about the influenza vaccine is due to the perception among many parents that flu shots don't work and may come with scary side effects. "Although 70% of parents strongly agreed that routine vaccines were effective, only one quarter think that the influenza vaccine is," she said. Kempe believes media coverage of vaccine mismatches may play a role in parents' lack of confidence in the flu vaccine. "What we see is concerns that the vaccine isn't well matched," she said. The message that isn't getting through is that while the flu shot may not be a perfect match in a given year, it will still reduce hospitalizations and deaths, Kempe said. Coupled with that concern about effectiveness is a fear of side effects, Kempe said. "There are very rare side effects of vaccines that are serious," she added. It's not clear what the best strategy is to encourage more parents to vaccinate their children, Kempe said. "Some naively think we just need to educate people," she added. "But that tends to be ineffective. Changing people's behavior is easier than changing their attitudes." That's why Kempe supports stronger recommendations, state school and preschool vaccination requirements and elimination of most exemptions. For their study, Kempe and her colleagues surveyed families with children aged 6 months to 17 years who were participating in the Ipsos "KnowledgePanel," a nationally-representative sample of the U.S. population. Of the 4,445 parents Kempe's team invited to participate in their survey in February 2019, 2,176 completed it. Along with the 70% of parents who strongly believed routine vaccinations are effective, another 24% somewhat agreed that routine vaccinations are effective. Among hesitant responders, 67.5% had deferred or refused routine vaccination for their child because of concerns about that vaccine compared with 8.7% of the non-hesitant parents. Regarding the flu vaccine, among hesitant respondents, 70.1% had ever deferred or refused vaccination for their child because of concerns about the vaccine as compared with only 10% of non-hesitant parents. Among vaccine hesitant responders, only 10.1% reported that their child had received the vaccine or that they planned to have the child vaccinated during the current season as compared to 84.1% of the non-hesitant respondents. The survey item most associated with hesitancy about childhood vaccines was concerns about side effects, with 12% strongly and 27% somewhat endorsing this concern. A full 13% either strongly or somewhat disagreed that "all childhood vaccines . . . are beneficial." And just 26% strongly agreed that the influenza vaccine is effective, as compared to 70% for routine childhood vaccines. Factors associated with hesitancy included a lower educational level and a household income less than 400% of the poverty level. Parents from the western U.S. and those with a preschool child were also more hesitant about childhood vaccines. The new study is "important," said Dr. Albert Wu, an internist and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. The good news, Wu said is that a large proportion of parents have confidence in the majority of childhood vaccinations. "The frightening news is that one quarter are hesitant about the influenza vaccine," he added. "We are now facing the greatest pandemic of the last century in the coronavirus and I am worried that the skepticism or fear about the influenza vaccine could have dangerous implications for our hoped for COVID vaccines. If similar numbers of people resist the COVID vaccine it could sabotage any chances of us controlling the virus." Dr. Peter Hotez blames vaccine hesitancy on "the massive misinformation campaign out there." "It's a real struggle to get the message out there," said Dr. Hotez, a professor of pediatrics and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. "Over the past couple of years, a significant number of children have died because they weren't vaccinated against the flu." Dr. Hotez and colleagues have been searching for ways to counteract the anti-vax messaging on social media outlets. "One component that no one is willing to do, is to dismantle some of the social media," Hotez said. "Right now, getting correct information out there is like putting a message in a bottle in the Atlantic Ocean. It's just not getting out there." SOURCE: https://bit.ly/37u4Iyv Pediatrics, online June 15, 2020.
861
L1N2DS1HZ
555627046
PEDIATRIC-VACCINES/PARENTAL-HESITANCY
High proportion of U.S. parents hesitant about childhood vaccines, especially for flu
3
['Americas', 'United States', 'North America']
['AMERS', 'US', 'NAMER']
['Clinical Medicine', 'Communicable Diseases', 'Drug & Device Development', 'Drug Safety', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Influenza', 'Biotechnology & Medical Research', 'Paediatric Medicine', 'Pharmaceuticals & Medical Research', 'Vaccines']
['CLIMED', 'COMDIS', 'DRUDEV', 'DRUSAF', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'INFLUE', 'MRCH', 'PEDMED', 'PHMR', 'VACCIN']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DS1I8:1727195197
0
By Linda Carroll (Reuters Health) - While just 12% of patients with confirmed SARS-Cov-2 infection experience gastrointestinal symptoms, 40.5% have viral RNA in their stool, a new study suggests. In a meta-analysis of 29 studies that included more than 4,800 patients, researchers found that gastrointestinal symptoms are common and fecal shedding may present an important transmission risk, according to the report published in JAMA Network Open. "First, this shows that diarrhea, nausea and vomiting can be symptoms of COVID-19," said the study coauthor, Dr. Sravanthi Parasa, a gastroenterologist at Swedish Medical Center in Seattle. "Second, and this is a more significant public health concern, among those who were tested positive for the virus in their stool by PCR, 40% had viral shedding." At present it's not known if the virus detected in patients' stool samples is infectious, Parasa said. But if it is, Parasa said, "a lot of exposure could happen through a fecal oral route through food handling or in public restrooms - if you were to use a restroom after someone who was pre-symptomatic or asymptomatic, you could potentially contract the virus (if it becomes aerosolized)." To look at how common GI symptoms such as nausea, vomiting, diarrhea were, as well as liver enzyme changes and and fecal shedding, Parasa and her colleagues scoured the recent literature. Ultimately the researchers included 23 published studies and six preprint articles, which contained data on a total of 4,805 patients with a mean age of 52.2 years. Based on pooled data, the researchers found that 12% of patients showed any GI symptoms, with 7.4% reporting diarrhea and 4.6% reporting nausea or vomiting. Eight of the studies reported on fecal testing for the virus in a total of 407 patients. Viral RNA was detected in feces in 40.5% of the patients. Under electron microscopy, two stool samples (1.3%) showed live virus. Overall, viral loads in stool samples were lower than in respiratory samples (range, 550 copies per mL to 1.21 × 105 copies per mL versus 641 copies per mL to 1.34 × 1011 copies per mL). While it's clear that people can test positive for virus in their stool, it's not known whether the virus particles found in feces can infect anyone, said Dr. Saurabh Mehandru, an associate professor of gastroenterology at the Icahn School of Medicine at Mount Sinai in New York City. The concern, clearly, is that there could be fecal-oral transmission, Mehandru said. But it's not clear that that is possible, he added. "And this paper does not address that," Mehandru. "It's a basic science question: is the virus coming out infectious? Will it survive the acidity of the stomach and infect the intestines?" Unlike the norovirus, say, SARS-CoV-2 has an envelope of lipid covering it, Mehandru said. That lipid layer makes the virus more susceptible to stomach acid, he explained. "It's a pretty hostile environment," he said. SOURCE: https://bit.ly/3hp8UDZ JAMA Network Open, online June 11, 2020.
489
L1N2DS1I8
1727195197
COVID19-FECAL SHEDDING/
Four in 10 patients with coronvirus infection shed virus in stool
3
[]
[]
['Cyclical Consumer Services', 'Communicable Diseases', 'Consumer Cyclicals', 'Cyclical Consumer Goods & Services', 'Epidemiology', 'Epidemics', 'Gastric Disorders', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Internal Medicine', 'Media & Publishing', 'Media & Publishing', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Media / Publishing (Legacy)', 'Public Health', 'Technology / Media / Telecoms']
['CCOS', 'COMDIS', 'CYCS', 'CYCS08', 'EPMEOL', 'EPMICS', 'GASTRI', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'INTMED', 'MDIA', 'MDIA08', 'MRCH', 'PHMR', 'PUB', 'PUBHEA', 'TMT']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DS23L:1997941329
0
By Diego Oré MEXICO CITY (Reuters) - Hundreds of Cuban doctors and nurses who were sent to Mexico City to help respond to the coronavirus pandemic could stay longer if cases keep rising, a senior government official said. In May, 585 healthcare workers from the island nation arrived in Mexico City, epicenter of the pandemic in Mexico. It marked one of the largest medical crews that Cuba, which dispatches doctors around the world, has sent to tackle the pandemic. Mexico City Health Minister Oliva Lopez said the Health Institute for Wellbeing (Insabi) is paying the Cuban health ministry 135 million pesos ($6.03 million). The agreement was designed to end July 31, "but with the possibility of extension," Lopez said in an interview on Friday. "We must deeply consider the dynamics of the epidemic." Biomedical engineers and epidemiologists have also been deployed, she said. Mexico City has almost 37,000 confirmed cases of coronavirus, about 25% of the national total. Mexican health officials have said the country is short about 6,600 doctors and 23,000 nurses to properly respond to the pandemic. Despite having hired more than 2,000 doctors and nurses, Mexico City still does not have enough health personnel, Lopez said. Cuba has agreements with almost 70 countries to send doctors and other medical professionals. Few details about the deals are known, but under an agreement with Brazil that was in place through 2018, the Cuban government kept 80% of what it charged for each doctor, according to Brazilian health officials. United Nations officials said in November that the conditions under which Cuban doctors work could be considered "forced labor". But Lopez defended the use of Cuban health care workers. "I have seen the criticism (of the Cuban program), but the role they play in the city is fundamental," she said. ($1 = 22.3768 Mexican pesos)
304
L1N2DS23L
1997941329
HEALTH-CORONAVIRUS/MEXICO-CUBA
Cuban doctors may stay longer in Mexico if coronavirus cases keep rising
3
[]
[]
['Economic Indicator Published', 'Epidemiology', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Economic Events', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health']
['ECI', 'EPMEOL', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MCE', 'MRCH', 'PHMR', 'PUBHEA']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DS248:1970135122
0
By Lawrence Hurley WASHINGTON (Reuters) - The U.S. Supreme Court on Monday delivered a watershed victory for LGBT rights and a defeat for President Donald Trump's administration by ruling that a longstanding federal law barring workplace discrimination protects gay and transgender employees. The landmark 6-3 ruling represented the biggest moment for LGBT rights in the United States since the Supreme Court legalized same-sex marriage nationwide in 2015. Two conservative justices joined the court's four liberals in the decision: Neil Gorsuch, a 2017 Trump appointee who wrote the ruling, and Chief Justice John Roberts. The justices decided that gay and transgender people are protected under Title VII of the Civil Rights Act of 1964, which bars employers from discriminating against employees on the basis of sex as well as race, color, national origin and religion. Workplace bias against gay and transgender employees had remained legal in much of the country, with 28 U.S. states lacking comprehensive measures against employment discrimination. The ruling - in two gay rights cases from Georgia and New York and a transgender rights case from Michigan - recognizes new worker protections in federal law. "The Supreme Court's historic decision affirms what shouldn't have even been a debate: LGBTQ Americans should be able to work without fear of losing jobs because of who they are," said Sarah Kate Ellis, president of the gay rights group GLAAD. The legal fight focused on the definition of "sex" in Title VII. The plaintiffs, along with civil rights groups and many large companies, had argued that discriminating against gay and transgender workers was inherently based on their sex and consequently was illegal. Trump's administration had backed the employers who were sued for discrimination. The administration and the employers argued that Congress did not intend for Title VII to protect gay and transgender people when it passed the law. Gorsuch conceded that point in his opinion but said what mattered was the text of the law. "An employer who fires an individual for being homosexual or transgender fires that person for traits or actions it would not have questioned in members of a different sex," Gorsuch wrote. "Sex plays a necessary and undisguisable role in the decision, exactly what Title VII forbids." Strongly supported by evangelical Christian voters, Trump has taken actions that have undermined gay and transgender rights since taking office in 2017. Conservative Justices Samuel Alito, Clarence Thomas and Brett Kavanaugh dissented from the ruling. Writing in dissent, Alito said the court had basically re-written the law. "There is only one word for what the court has done today: legislation," Alito wrote. 'TREATED FAIRLY' The court ruled in two consolidated cases about gay people who have said they were fired due to their sexual orientation. One involved a former county child welfare services coordinator from Georgia named Gerald Bostock. The other involved a New York skydiving instructor named Donald Zarda who died after the litigation began, with the matter then pursued by his estate. The court also ruled in a case that involved a transgender funeral director named Aimee Stephens fired by a Detroit funeral home after revealing plans to transition from male to female. Stephens died in May. Stephens' wife Donna is now representing the estate. "I am grateful for this victory to honor the legacy of Aimee, and to ensure people are treated fairly regardless of their sexual orientation or gender identity," Donna Stephens said in a statement. Gorsuch wrote that "there is no way an employer can discriminate against those who check the homosexual or transgender box without discriminating in part because of an applicant's sex." "By discriminating against homosexuals, the employer intentionally penalizes men for being attracted to men and women for being attracted to women. By discriminating against transgender persons, the employer unavoidably discriminates against persons with one sex identified at birth and another today," Gorsuch wrote. The Human Rights Campaign gay rights group called the decision "a landmark victory for LGBTQ equality." Alphonso David, the group's president, said, "No one should be denied a job or fired simply because of who they are or whom they love." The White House had no immediate comment. Trump's Justice Department reversed the government's position taken under Democratic former President Barack Obama that Title VII covered sexual orientation and gender identity. Trump's administration last week issued a rule that would lift anti-discrimination protections for transgender people in healthcare. His administration also has backed the right of certain businesses to refuse to serve gay people on the basis of religious objections to gay marriage, banned most transgender service members from the military and rescinded protections on bathroom access for transgender students in public schools.
774
L1N2DS248
1970135122
USA-COURT/LGBT (PIX)
In landmark ruling, U.S. Supreme Court bars discrimination against LGBT workers
3
['Americas', 'United States', 'North America']
['AMERS', 'US', 'NAMER']
['Economic Indicator Published', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Lesbian / Gay / Bisexual / Transsexual', 'Economic Events', 'Medical Law', 'Public Health', 'Society / Social Issues']
['ECI', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'LGBT', 'MCE', 'MEDLAW', 'PUBHEA', 'SOCI']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DS25W:2060976946
0
By Marilynn Larkin NEW YORK (Reuters Health) - Cesarean delivery was associated with severe maternal outcomes and clinical deterioration compared to vaginal delivery among women infected with COVID-19 in Spain. "We were really surprised by the high rate of cesarean section in (COVID-19 patients) in China," Dr. David Baud of Lausanne University Hospital in Switzerland, told Reuters Health by email. "We were not so surprised to discover (in our own study) that vaginal delivery is safer in (such) patients." Dr. Baud and colleagues studied data on women in Spain with SARS-CoV-2 and singleton pregnancies between March 12 and April 6, 2020, and who delivered within the next 14 days. As reported in JAMA, among the 82 participants, four presented with severe COVID-19 symptoms, including one with concomitant preeclampsia. All four underwent cesarean delivery and required ICU admission. Seventy-eight women presented with no or mild COVID-19, including 11 who required oxygen supplementation. Forty-one (53%) delivered vaginally and 37 (47%) by cesarean delivery - 29 for obstetrical indications and eight for COVID-19 symptoms without other obstetrical indications. Compared to those delivering vaginally, women who underwent cesarean deliveries were more likely to be multiparous, obese, require oxygen at admission, and have abnormal chest x-ray findings. No severe adverse outcomes occurred in women who had a vaginal delivery. However, five (13.5%) who underwent a cesarean required ICU admission. Two (4.9%) with a vaginal delivery experienced clinical deterioration after birth versus eight (21.6%) with cesarean delivery. After adjustment for potential confounders, cesarean birth was significantly associated with clinical deterioration (adjusted odds ratio, 13.4). Eight newborns (19.5%) delivered vaginally and 11 (29.7%) born by cesarean delivery were admitted to the neonatal ICU. After adjustment, cesarean birth was significantly associated with an increased risk of NICU admission (aOR, 6.9). Three newborns delivered vaginally tested within six hours after birth had a positive SARS-CoV-2 RT-PCR result. However, repeat testing at 48 hours was negative. None developed COVID-19 symptoms within 10 days. Two other newborns, both cesarean deliveries at term, developed COVID-19 symptoms within 10 days. In this case, although initial testing at birth was negative, repeat testing was positive. Both newborns were in contact with their parents immediately after birth. Symptoms resolved within 48 hours. Dr. Baud said, "Clinicians should not perform cesarean section just because the patient has COVID-19 or to prevent transmission of the virus to the baby. Cesarean section seems not to prevent infection of the newborn." Dr. Matthew Blitz, maternal fetal medicine specialist at Northwell Health's Southside Hospital in Bayshore New York, commented by email, "Our health system has now cared for more than 500 pregnant women with positive SARS-CoV-2 test results and only about a dozen were admitted to the ICU, as we recently reported in the American Journal of Obstetrics and Gynecology."(https://www.ajog.org/article/S0002-9378(20)30528-7/pdf) "In nearly all of those cases, the patients had severe or critical disease on presentation to the hospital," he told Reuters Health. "In our experience, significant clinical deterioration of patients presenting with mild or absent symptoms, regardless of mode of delivery, is exceedingly rare." Like Dr. Baud, he said, "the decision to perform a cesarean section should be based on standard obstetrical indications. The presence or absence of COVID-19 should not be a factor. There is certainly much debate about mode of delivery and optimal delivery timing in severe COVID-19 cases, but larger studies will be needed to guide management." Dr. Robert Atlas, Chair of the Department of Obstetrics and Gynecology at Mercy Medical Center in Baltimore, commented in an email to Reuters Health, "The patients undergoing cesarean section were in general sicker, heavier and earlier in gestation." "I am a little surprised at the results," he said. "The total number is relatively small, and I would like to see an update to the data. I think this is helpful as we look at how we are dealing with delivery surrounding this disease and should attempt delivery, as we always should, weighing the risks and benefits of cesarean section versus vaginal delivery." "If we can deliver these patients vaginally, in general, it will be better, as with all patients," he said. "However, there may be very ill individuals who just will not tolerate an induction of labor and will require a cesarean section." SOURCE: https://bit.ly/2YBCLRk JAMA, online June 8, 2020.
710
L1N2DS25W
2060976946
COVID19-CHILDBIRTH/
Cesarean delivery tied to worse outcomes in women with COVID-19
3
[]
[]
['Clinical Medicine', 'General News', 'General Health', 'Obstetric / Gynaecological Conditions', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Internal Medicine', 'Paediatric Medicine', 'Pregnancy & Newborn', 'Respiratory Conditions', "Women's Health"]
['CLIMED', 'GEN', 'GENHLT', 'GYNACO', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'INTMED', 'PEDMED', 'PRENEW', 'RESPIR', 'WOMHEA']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DS294:906237021
0
By Lisa Rapaport (Reuters Health) - Women who fill benzodiazepine prescriptions in the 90 days prior to conception have an increased risk of ectopic pregnancy, a U.S. study suggests. Researchers examined U.S. commercial insurance claims data for a cohort of 1.69 million pregnancies between November 2008 and September 2015. Overall, 1.06% of pregnancies involved women who filled two or more benzodiazepine prescriptions totaling at least a 10-day supply in the 90 days prior to conception. Women who did fill benzodiazepine prescriptions had an excess of 80 ectopic pregnancies per 10,000 pregnancies, which translates to an inverse probability of treatment (IPT)-weighted relative risk of 1.47 compared to women without benzodiazepine prescriptions. Greater risk was associated with benzodiazepines prescribed for anxiety than for depression (IPT-weighted RR 1.34 and 1.28, respectively), the authors note. "This matters because ectopic pregnancies can result in serious complications and even death if not treated early, and patients and care providers should understand this risk when starting benzodiazepine treatment," said study coauthor Elizabeth Wall-Wieler of Stanford University in California. Women being treated with benzodiazepine who are trying to conceive should talk to providers about whether a change in treatment is possible, and taper off benzodiazepine if they can prior to conception, Wall-Wieler said by email. When women do become pregnant while taking benzodiazepine, doctors should monitor them more closely, especially in the first two months, so that any ectopic pregnancy can be detected sooner when the most serious complications are easier to prevent, Wall-Wieler added. Overall, there were a total of 30,046 (1.78%) ectopic pregnancies during the study period, including 17,990 involving women who took benzodiazepine prior to conception. Women who were older, had an intrauterine device, a sexually transmitted infection, used assisted reproductive technology to conceive, or who had been treated within the previous nine months for a smoking-related health issue were more likely to use benzodiazepine, the researchers report in Human Reproduction. One limitation of the study is that the authors lacked data on exactly when in the 90 days prior to conception women might have taken benzodiazepine. In addition, it's possible some women filled prescriptions without actually taking the medicine. "Benzodiazepines are mainly used as intermittent treatment, and so it is difficult to ascertain the exact time of drug intake using dispensation data," said Angela Lupattelli, a researcher in the department of pharmacy at the University of Oslo, who wasn't involved in the study. It's also unclear how history of a prior ectopic pregnancy in these women was accounted for, Lupattelli said by email. "A prior ectopic pregnancy is an important risk factor for a subsequent one, and so residual confounding cannot be ruled out," Lupattelli said. Still, benzodiazepines should be used as short-term treatment, and antidepressants are often recommended as first choice for treatment of anxiety disorders, Lupattelli said. "It is important to underline that benzodiazepines, independently of this study, should preferably be used as short-term treatment because of their inherent risk of morbidity and dependency, and also because their effectiveness for treatment of some conditions is questionable," Lupattelli advised. SOURCE: https://bit.ly/3e5HUY5 Human Reproduction, online June 3, 2020.
514
L1N2DS294
906237021
PREGNANCY-ECTOPIC/BENZODIAZEPINE
Benzodiazepine prescription tied to increased ectopic pregnancy risk
3
[]
[]
['Anxiety Disorders', 'Depression', 'Drug Safety', 'Fertility & Reproduction', 'General News', 'General Health', 'Obstetric / Gynaecological Conditions', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Mental Illness', 'Pregnancy & Newborn', 'Psychology', 'Public Health', "Women's Health"]
['ANXIET', 'DEPRES', 'DRUSAF', 'FERREP', 'GEN', 'GENHLT', 'GYNACO', 'HEA', 'HECA', 'HUMDIS', 'MENTIL', 'PRENEW', 'PSYCHO', 'PUBHEA', 'WOMHEA']
[]
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en
English
tag:reuters.com,2020:newsml_L1N2DS2AS:1528337192
0
By Kate Kelland LONDON (Reuters) - Scientists at Imperial College London will start the first clinical trials of a potential COVID-19 vaccine this week with more than 45 million pounds ($56.50 million) in backing from the UK government and philanthropic donors. The trials are the first human tests of a new technology which the researchers say could transform vaccine development by enabling rapid responses to emerging diseases such as the COVID-19 infection caused by the new coronavirus. Robin Shattock, a professor at Imperial's department of infectious disease who is leading this work, said that rather than using a part of the virus, as many vaccines do, this potential vaccine uses synthetic strands of the virus' genetic material - RNA - which are packaged inside tiny fat droplets. When injected, it instructs muscle cells to produce virus proteins to protect against future infection. In animal tests, the vaccine was shown to be safe and showed "encouraging signs of an effective immune response", Shattock's team said in a statement. Around 300 healthy volunteers will receive two doses of the vaccine in the initial human trials to test whether it is safe in people and whether it produces an effective immune response against COVID-19. If it shows promise, larger trials with around 6,000 people would be planned for later this year. More than 100 potential COVID-19 vaccines are in development around the world, including several already in human trials from AstraZeneca, Pfizer, BioNtech, Johnson & Johnson, Merck, Moderna, Sanofi and CanSino Biologics. The Imperial trials come after the team won £41 million pounds in funding from the UK government plus £5 million in philanthropic donations. Business secretary Alok Sharma, said Imperial's was "one of the world's front-runners" and had Britain's full backing. ($1 = 0.7965 pounds)
293
L1N2DS2AS
1528337192
HEALTH-CORONAVIRUS/VACCINE-IMPERIAL (PIX)
UK funds human trials of potential COVID-19 vaccine from Imperial
3
['United Kingdom', 'United Kingdom', 'Western Europe', 'Europe']
['UK', 'GB', 'WEU', 'EUROP']
['Drug & Device Development', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Immunology', 'Industrials', 'Industrials', 'Infectious Diseases', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health', 'Vaccines']
['DRUDEV', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'IMMOGY', 'INDS', 'INDS08', 'INFDIS', 'MRCH', 'PHMR', 'PUBHEA', 'VACCIN']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DT0YH:929877606
0
By Reuters Staff SINGAPORE (Reuters) - Singapore scientists testing a COVID-19 vaccine from U.S. firm Arcturus Therapeutics plan to start human trials in August after promising initial responses in mice. More than 100 vaccines are being developed globally, including several already in human trials from the likes of AstraZeneca and Pfizer, to try to control a disease that has infected more than 8 million people and killed over 430,000 worldwide. The vaccine being evaluated by Singapore's Duke-NUS Medical School works on the relatively-untested Messenger RNA (mRNA) technology, which instructs human cells to make specific coronavirus proteins that produce an immune response. "The fact that it replicates and triggers a very balanced immune response, both in terms of the antibody and killer cells - those are welcome properties," Ooi Eng Eong, deputy director of the school's emerging infectious diseases programme, told Reuters on Tuesday. Antibodies stick to the virus and prevent it from infecting cells, while killer cells, another arm of the immune system, recognise infected cells and destroy them, he said. The mRNA approach has not yet been approved for any medicine so its backers, which also include U.S. biotech firm Moderna, are treading uncharted territory. Because of that, Ooi said longer studies were needed to ensure its safety. "The most optimistic case is that it's about this time next year, that we will have a vaccine," Ooi said. Ooi is also working on a monoclonal antibody treatment for COVID-19 and will begin safety trials on healthy people this week, before testing on COVID-19 patients in the coming months. Ooi said potential deployment of the treatment could be faster than the vaccine, without giving an exact timeline. Antibodies are generated in the body to fight off infection. Monoclonal antibodies mimic natural antibodies and can be isolated and manufactured in large quantities to treat diseases. Tiny city-state Singapore has one of the highest infection tallies in Asia, with more than 40,000 cases, largely due to mass outbreaks in dormitories for its migrant workers.
332
L1N2DT0YH
929877606
HEALTH-CORONAVIRUS/SINGAPORE-VACCINE (TV)
Singapore scientists to start human trials of COVID-19 vaccine in August
3
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['Corporate Events', 'Drug & Device Development', 'Economic Indicator Published', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Immunology', 'Infectious Diseases', 'Economic Events', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health', 'Regulation / Compliance', 'Vaccines']
['BACT', 'DRUDEV', 'ECI', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'IMMOGY', 'INFDIS', 'MCE', 'MRCH', 'PHMR', 'PUBHEA', 'REGS', 'VACCIN']
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[]
en
English
tag:reuters.com,2020:newsml_L1N2DT0YR:1872617597
0
By Reuters Staff BRUSSELS (Reuters) - AstraZeneca's potential coronavirus vaccine is likely to provide protection against contracting COVID-19 for about a year, the company's chief executive told a Belgian radio station on Tuesday. The British drugmaker has already begun human trials of the vaccine developed by the University of Oxford, with a phase I trial in Britain due to end soon and a phase III trial already begun, Pascal Soriot told broadcaster Bel RTL. "We think that it will protect for about a year," Soriot said. AstraZeneca said on Saturday that it had signed contracts with France, Germany, Italy and the Netherlands to supply the European Union with up to 400 million doses of the potential vaccine. It has also agreed deals with Britain and the United States. "If all goes well, we will have the results of the clinical trials in August/September. We are manufacturing in parallel. We will be ready to deliver from October if all goes well," Soriot said.
162
L1N2DT0YR
1872617597
HEALTH-CORONAVIRUS/VACCINE-ASTRAZENECA
AstraZeneca COVID-19 vaccine likely to protect for a year -CEO
3
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[]
['Corporate Events', 'Clinical Medicine', 'Drug & Device Development', 'Economic Indicator Published', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Immunology', 'Infectious Diseases', 'Economic Events', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health', 'Regulation / Compliance', 'Vaccines']
['BACT', 'CLIMED', 'DRUDEV', 'ECI', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'IMMOGY', 'INFDIS', 'MCE', 'MRCH', 'PHMR', 'PUBHEA', 'REGS', 'VACCIN']
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en
English
tag:reuters.com,2020:newsml_L1N2DT178:1049323267
0
By Will Boggs MD NEW YORK (Reuters Health) - Regular cannabis use reduces the frequency of autonomic dysreflexia manifested as blood pressure instability following spinal cord injury (SCI), according to a new case report. "Importantly, not only was the severity and frequency of transient episodes of hypertension (autonomic dysreflexia) drastically reduced over 24-hours, but smoking cannabis was able to treat a refractory episode of autonomic dysreflexia," Dr. Tom E. Nightingale of the University of Birmingham, in the U.K., told Reuters Health by email. In patients with SCI that disrupts autonomic pathways, routine peripheral stimuli can trigger episodes of transient hypertension in a process called autonomic dysreflexia. Dr. Nightingale and colleagues describe the case of a 41-year-old man with a C5 spinal cord injury 21 years earlier that produced a complete loss of sensory and motor function below the injury. He had been smoking cannabis daily for 13 years (about 1 g of cannabis concentrate via a vaporizer) and also consumed several edibles containing tetrahydrocannabinol (THC), the authors report in Annals of Internal Medicine. The man's blood pressure stability - evaluated using a 24-hour ambulatory blood pressure monitor on four separate occasions, twice while following his standard cannabis routine and twice after abstinence from cannabis for three days and four seven days - was worse on days when he did not use cannabis and better on days when he did. Dr. Nightingale said that the patient experienced 56 and 57 episodes of autonomic dysreflexia on the days without cannabis versus five and 17 episodes on the days when he used cannabis. On another occasion, after eight days of cannabis abstinence, cannabis smoking successfully treated a refractory episode of autonomic dysreflexia, but also produced prolonged hypotension. Cannabis also reportedly reduced global pain intensity, spasm frequency, and spasm severity; improved sleep; and improved overall well-being by reducing anxiety, impairment, confusion, and sensation and enhancing motivation and attention, according to the authors. "We believe that our findings document that cannabis use improved blood pressure stability in this patient by reducing the intensity and frequency of the visceral stimuli, such as pain and spasms, that are known to trigger autonomic dysreflexia," the authors note. "While these findings are promising, information is lacking on optimal dosage, method of delivery, composition, and concentration of cannabinoid compounds to manage secondary conditions associated with SCI," Dr. Nightingale said. "To answer these questions, long-term, double-blind, randomized clinical trials assessing a wider range of outcomes should be conducted to further understanding of the effects of cannabinoid use in people with SCI." Dr. Alexander Rabchevsky of the University of Kentucky, in Lexington, said that although the findings were based on just one person, "this report has been done by the best SCI physiatrists and urologists that I know personally, having been a paraplegic neuroscientist for 35 years studying autonomic dysreflexia (AD). The results are compelling and warrant further investigations into alternative medicines to treat/alleviate and perhaps even curtail AD episodes from occurring, especially since the medications available are highly variable in efficacy, at best, and can be very costly." He suggested that physicians "encourage SCI folks to be open with their reports of marijuana use (or other drugs) so that countless others may either support or rebuke myths about marijuana or other potential remedies that are not recognized or regulated by the" U.S. Food and Drug Administration. "Future studies require equal diligence and compliance, but it is far overdue that such studies be funded as nations worldwide are moving to decriminalize and legalize marijuana usage," Dr. Rabchevsky told Reuters Health by email. SOURCE: https://bit.ly/3e6xN5D Annals of Internal Medicine, online June 16, 2020.
600
L1N2DT178
1049323267
CANNABIS-BLOOD PRESSURE/
Cannabis reduces blood pressure instability following spinal cord injury: case report
3
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[]
['Agriculture', 'Cannabis', 'Clinical Medicine', 'Crime / Law / Justice', 'Commodities', 'Crime', 'General News', 'General Health', 'Health / Medicine', 'Heart / Cardiac Disease', 'Healthcare', 'Human Diseases / Conditions', 'Hypertension / High Blood Pressure', 'Internal Medicine', 'Drug Trafficking / Narcotics', 'Nerve Injury', 'Neurological Disorders']
['AGRI', 'CANNAB', 'CLIMED', 'CLJ', 'COM', 'CRIM', 'GEN', 'GENHLT', 'HEA', 'HEARCA', 'HECA', 'HUMDIS', 'HYPERT', 'INTMED', 'NARC', 'NERVIN', 'NEUROL']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DT19U:1168824501
0
By Megan Brooks NEW YORK (Reuters Health) - For preterm infants with significant patent ductus arteriosus (PDA), doing nothing seems to work as well as giving oral ibuprofen, according to a randomized controlled noninferiority trial. The two approaches resulted in similar rates of bronchopulmonary dysplasia (PDA) or death (the primary outcome) and no differences in ductal-closure rates before discharge. "I do hope clinicians take home from the study that nonintervention approach is as good as standard medical therapy for PDA in preterm infants," Dr. Won Soon Park of Samsung Medical Center and Sungkyunkwan University School of Medicine, in Seoul, South Korea, told Reuters Health by email. The findings are based on 142 preterm infants with hemodynamically significant PDA (ductal size >1.5 mm plus respiratory support) diagnosed between postnatal days 6 and 14. Infants were stratified by gestational age (GA 23-26 weeks and 27-30 weeks), and 70 received oral ibuprofen (initial dose of 10 mg/kg followed by a 5-mg/kg dose after 24 hours and a second 5-mg/kg dose after 48 hours) and 72 who received placebo (no intervention). Ibuprofen significantly enhanced the ductal closure rate at one week compared with no intervention in the 27- to 30-week GA subgroup (34% vs. 7%; P=0.007), but not in the 23- to 26-week GA subgroup (8% vs. 2%; P=0.34). There was no significant difference in ductal-closure rates before hospital discharge (89% with ibuprofen vs. 82%, P=0.27), however. In addition, no intervention was noninferior to ibuprofen for the primary composite outcome of BPD incidence or death (44% vs. 50%, respectively; 95% confidence interval, -0.11 to 0.22; noninferiority margin -0.2; P=0.51). One infant in the ibuprofen arm received oral ibuprofen backup rescue treatment due to cardiopulmonary compromise that failed to respond to conservative management, and another infant in the ibuprofen arm underwent surgical ligation. None of the infants in the placebo arm received backup treatment. The researchers note in their JAMA Pediatrics paper that the noninferiority of no intervention over drug treatment might be due to the low efficacy of oral ibuprofen for closing PDA, especially in the infants with GA 23 to 26 weeks. "Although higher odds of PDA closure have been reported with oral ibuprofen than with intravenous ibuprofen or indomethacin, further studies using other NSAIDs are necessary to clarify whether there is a variation in the effectiveness of NSAIDs for closing PDA and thereby improving BPD or death," they write. A limitation of their trial is its single-center design and a relatively large noninferiority margin that limited the power to detect small differences in the efficacy of the treatments according to stratified GA subgroups, they note. Other limitations are the arbitrary definition of hemodynamically significant PDA defined only on the basis of the PDA size and respiratory assistance dependency and the lack of long-term neurodevelopmental outcome data. Despite these limitations, "I think our results might alter the standard practice from medical therapy with non-steroidal anti-inflammatory agents and/or surgical ligation to conservative nonintervention approach for PDA in preterm infants," Dr. Park told Reuters Health. The study had no commercial funding and the authors have declared no relevant conflicts of interest. SOURCE: https://bit.ly/2MZddYO JAMA Pediatrics, online June 15, 2020.
524
L1N2DT19U
1168824501
PRETERM-PATENT DUCTUS ARTERIOSUS/IBUPROFEN
No intervention as good as oral ibuprofen for patent ductus arteriosus in preemies
3
[]
[]
['Cardio', 'Clinical Medicine', 'General News', 'General Health', 'Health / Medicine', 'Heart / Cardiac Disease', 'Healthcare', 'Human Diseases / Conditions', 'Paediatric Medicine', 'Pregnancy & Newborn', 'Respiratory Conditions']
['CARDIO', 'CLIMED', 'GEN', 'GENHLT', 'HEA', 'HEARCA', 'HECA', 'HUMDIS', 'PEDMED', 'PRENEW', 'RESPIR']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DT1BB:199310002
0
By Will Boggs MD NEW YORK (Reuters Health) - Two new reports in JAMA strengthen the link between SARS-CoV-2 infection and pediatric inflammatory multisystem syndrome (PIMS). Pediatricians from several communities have reported children who developed fever and multisystem inflammation during the COVID-19 pandemic. Some children were critically ill and some had characteristics similar to Kawasaki disease (KD) or KD shock syndrome. Dr. Michael Levin from Imperial College London and colleagues describe the clinical and laboratory characteristics of 58 children admitted to eight hospitals in England who satisfied published criteria for PIMS temporally associated with SARS-CoV-2 infection (PIMS-TS). The median age of these children was 9 years, 57% were girls, and 69% were of black or Asian race. Only seven had comorbidities (three with asthma and one each with neurodisability, epilepsy, sickle cell trait, and alopecia). All children had persistent fever for three to 19 days, and some had abdominal pain (53%), erythematous rash (52%), conjunctival injection (45%), headache (26%) and sore throat (10%). Half of the patients required admission to the pediatric critical-care unit, 47% had shock requiring inotropic support and 43% received mechanical ventilation for respiratory support. Overall, 45 patients (78%) had evidence of current or prior SARS-CoV-2 infection. All children had evidence of a marked inflammatory state, with significant elevations in C-reactive protein, ferritin, troponin and N-terminal pro-B-type natriuretic peptide (NT-proBNP), along with neutrophilia. The authors identified three provisional clinical patterns: 23 children had persistent fever and elevated inflammatory markers, but no features of organ failure or mucocutaneous features suggestive of KD or toxic shock syndrome; 29 children developed shock, with evidence of left ventricular dysfunction or with elevation of cardiac enzymes; and seven fulfilled the American Heart Association diagnostic criteria for KD (13 children met the criteria when coronary artery aneurysms were included). One child died from PIMS-TS. Patients with PIMS-TS tended to be older than reported cases of KD or KD shock syndrome or toxic shock syndrome and had higher white blood cell count, neutrophil count, and C-reactive protein, as well as more profound lymphopenia and anemia, compared with KD or KD shock syndrome patients. "This suggests that PIMS-TS differs from these other pediatric inflammatory entities," the authors note. "As these cases have emerged in temporal association with the pandemic, a link with SARS-CoV-2 is likely." Dr. Stanford T. Shulman of Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, who recently reviewed early reports of PIMS in association with COVID-19, told Reuters Health by email, "Categorizing patients has been a problem, including in this paper in which 3 distinct groups of patients are described." "My main message is that this is quite complicated and clearly not all of these patients have the same condition," he said. "Definitions of disease entities need to be more precise." In the second report, Dr. Eva W. Cheung of Columbia University Irving Medical Center, in New York City, describe 17 previously healthy patients (median age, 8 years; range, 1.8-16 years) who presented with a clinical syndrome characterized by prolonged fever, systemic inflammation, shock, end-organ dysfunction, or symptoms reminiscent of KD or toxic shock syndrome and who also had evidence of recent SARS-CoV-2 infection. Inflammatory markers were elevated in all patients, and most had lymphopenia, bandemia, elevated troponin T, and elevated NT-proBNP. All but one patient had elevated serum interleukin 6. Fifteen patients required admission to the pediatric intensive-care unit and 10 required vasoactive support, but none of the nine patients with hypoxia required mechanical ventilation. Eight children met criteria for KD and five met criteria for incomplete KD, but all children had normal coronary arteries by measurement. One child had a medium-sized aneurysm of the left anterior descending coronary artery. Echocardiograms revealed moderate or more ventricular dysfunction in six patients, and electrocardiograms showed nonspecific ST/T-wave abnormalities in 10 patients, attenuated QRS voltage in one patient, and dysrhythmias in three patients. By May 20, all patients had been discharged home with no fatalities after a mean length of hospital stay of 7.1 days (range, 3-18 days). Dr. Cheung told Reuters Health by email, "The most interesting finding of our study was the breakdown of the presenting characteristics and demographics of this syndrome. It really highlighted how different this syndrome is from acute COVID-19 infections, which in the previous months was primarily affecting children with comorbidities and presented with severe respiratory failure, while this multisystem inflammatory syndrome was affecting mostly healthy children with very different clinical features." "Children who present with this syndrome have primarily been treated in our institution with supportive therapies, anti-inflammatory medications such as methylprednisolone (especially in moderate and severe cases with shock), and intravenous immunoglobulin for the concern of the development of coronary artery aneurysms, which we rarely observed," she said. "We are encouraged that children are recovering and, even some of the sickest have been discharged home," Dr. Cheung said. "On-going follow-up of these children is needed to understand any long-term effects of this syndrome. Research is actively happening to better understand this syndrome that will help us move forward with recognition and treatment and how this will impact our view of COVID-19 in children overall." Dr. Brian McCrindle of The Hospital for Sick Children, in Toronto, Canada, who co-authored a linked editorial, told Reuters Health by email, "The PIMS patients had a lot of similar features to the KD patients, but the pattern of different laboratory abnormalities and the higher prevalence and greater severity of cardiac complications are different from KD. These differences will be helpful to clinicians in be alert for PIMS when faced with a patient with KD-like features." "These PIMS patients tend to respond to the same anti-inflammatory medications used to treat KD, together with supportive care, although they may require more medication and a longer course, and take longer to recover," he said. Dr. Levin did not respond to a request for comments. SOURCE: https://bit.ly/2YsD54O, https://bit.ly/37o1Lzm and https://bit.ly/2B6MlDm JAMA, online June 8, 2020.
983
L1N2DT1BB
199310002
COVID19-PEDIATRIC/MULTISYSTEM-INFLAMMATORY SYNDROME
More evidence links pediatric inflammatory multisystem syndrome to SARS-CoV-2
3
['United Kingdom', 'United Kingdom', 'Western Europe', 'Europe']
['UK', 'GB', 'WEU', 'EUROP']
['Cardio', 'General News', 'General Health', 'Haematology / Blood Disorders', 'Health / Medicine', 'Heart / Cardiac Disease', 'Healthcare', 'Human Diseases / Conditions', 'Immunology', 'Infectious Diseases', 'Paediatric Medicine']
['CARDIO', 'GEN', 'GENHLT', 'HAEMAT', 'HEA', 'HEARCA', 'HECA', 'HUMDIS', 'IMMOGY', 'INFDIS', 'PEDMED']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DT1MD:263363225
0
By Reuters Staff PARIS (Reuters) - At the peak of the COVID-19 crisis in France, 29-year-old nurse Justine Debrie volunteered to work in a hospital coronavirus unit. Now she wants to know how the French state is going to recognise her sacrifice. "I don't know if the public really understood us," she said in her studio apartment in Paris, the day after completing a 12-hour shift in the Robert Debre children's hospital. "We give them care, and we'll need care too, sooner or later. We're human beings too," she said. On Tuesday, dressed in her hospital scrubs and carrying a sign she painted at her apartment, Debrie met up with colleagues outside her hospital and together they marched towards the health ministry headquarters to demand better pay and conditions. At one point along the protest route, police used tear gas to disperse a small group of people who overturned a car and threw projectiles. Police said they were a fringe group who tried to hijack the protest. In recognition of health workers' role during the coronavirus outbreak, the government has paid them a 1,500 euro bonus. For weeks, people came onto their balconies every evening at 8 p.m. to applaud carers. But for Debrie, these felt like empty gestures. Her basic pay is around 1,900 euros per month, only 200 euros more than she earned when she first started in nursing eight years ago. She said staffing levels were such that she and colleagues had to rush through their shifts and could not give patients the attention they needed. "The management of the pandemic, of the crisis, within the hospitals was made possible because each hospital worker was devoted," Debrie said. "I'm angry because they're trying to appease us with charity." The French government has promised a reform of the healthcare system which it says will involve massive investment and greater appreciation shown for health workers.
316
L1N2DT1MD
263363225
HEALTH-CORONAVIRUS/FRANCE-HEALTH (TV, PIX)
French nurse: We cared for COVID patients, who will care for us?
3
['Europe']
['EUROP']
['Economic Indicator Published', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Industrials', 'Industrials', 'Infectious Diseases', 'Economic Events', 'Nursing', 'Public Health']
['ECI', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INDS', 'INDS08', 'INFDIS', 'MCE', 'NURSIN', 'PUBHEA']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DT1W6:342959336
0
By Megan Brooks NEW YORK (Reuters Health) - Adults with poorly controlled type 2 diabetes living in rural areas saw their blood sugar levels improve after participating in a comprehensive telehealth program, according to new research. The telehealth intervention - known as Advanced Comprehensive Diabetes Care (ACDC) - leverages existing Veterans Health Administration home telehealth infrastructure, with modifications to support use in rural areas. It has been shown to reduce hemoglobin (Hb)A1c in a previous randomized trial, according to an abstract presented at the American Diabetes Association (ADA) virtual 2020 scientific sessions. "Compared with their urban counterparts with diabetes, rural populations are more likely to experience poor glycemic control, are less likely to receive recommended diabetes healthcare measures and are more likely to lack access to specialty care and intensive self-management programs," Elizabeth Kobe, study investigator and MD candidate at Duke University Medical School in Durham, North Carolina, noted in her presentation. "All of this perpetuates poor diabetes outcomes in rural areas and this is where telehealth may be able to help. Telehealth represents a potential strategy for extending specialized diabetes care to rural areas," said Kobe. The ACDC program consists of telemonitoring, self-management support and clinician-guided medication management. The first two elements, Kobe explained, are delivered by the existing VA network of home telehealth nurses during 30-minute phone calls every two weeks. During these calls, the nurses review blood sugar data (transmitted by participants daily using provided equipment), discuss medications and adherence, and provide eight self-management modules. For the third element, medication managers work with the nurses to review individual patient data and decide on medication changes. Kobe reported that among 125 participants across five sites, HbA1c levels fell by an average of 1.36 percentage points, from a starting point of 9.25% to 7.89% at six months. HbA1c levels remained reduced at 12 and 18 months after the intervention, by an average of 1.22 percentage points and 1.07 percentage points below baseline levels, respectively. "All of these changes from baseline were statistically significant," Kobe said in her presentation. Qualitative interviews with patients and staff suggest that ACDC "enhanced patient engagement and awareness of glycemic control, while moderately increasing workload for providers," Kobe said. "Despite the drastic changes that COVID-19 has forced healthcare systems to make, ACDC delivery has continued unabated. ACDC has truly made a substantial difference for rural patients with diabetes, and it's well positioned for further dissemination," Kobe said. The study had no commercial funding and the authors disclosed no relevant conflicts of interest. SOURCE: https://bit.ly/2UN9Zfd American Diabetes Association (ADA) 2020 Virtual Scientific Sessions.
427
L1N2DT1W6
342959336
DIABETES-TELEHEALTH/
Telehealth helps rural patients with diabetes control their blood sugar
3
[]
[]
['Clinical Medicine', 'Diabetes', 'Endocrinology', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Internal Medicine', 'Medical Conferences']
['CLIMED', 'DIABET', 'ENDOCR', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'INTMED', 'MEDCON']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DT1ZG:513139068
0
By Lisa Rapaport (Reuters Health) - An intervention designed to train both teachers and parents how to foster better behavioral in elementary school children may improve outcomes for not only these students but also for their offspring, a new study suggests. Researchers examined data collected from 1980 to 2011 from the Raising Healthy Children (RHC) intervention, a program at elementary schools in high-crime Seattle neighborhoods that gave teachers classroom management and instruction training and taught parents skills to help support children's active participation in school. The current study followed 72 offspring of 156 students at schools participating in the RHC program and a control group of 110 offspring of 220 students at nonparticipating schools. Offspring of students at participating schools had improved child development functioning at ages 1 to 5 years compared to offspring of students at nonparticipating schools, the study found. And, from ages 6 to 18, offspring of students at participating schools also had lower teacher-rated behavior problems, higher teacher-rated academic skills, and lower child-reported risky behaviors. "It is the first published study, to our knowledge, that reports outcome differences in the next generation, in the children of those who were in a prevention program when they were children," said lead author Karl Hill, director of the Problem Behavior and Positive Youth Development Program and a professor of psychology and neuroscience at the University of Colorado Boulder. In 1980, no prevention program showed strong evidence to suggest it could help curb drug use and violence, Hill said by email. Since then, however, numerous family, school, and community programs have been proven effective at reducing these problems, with effects of childhood outreach lasting well into adulthood. The current study, published in JAMA Pediatrics, suggests the effects can span generations. Early on, offspring of students from participating schools had fewer developmental delays in communications skills, gross motor skills, fine motor skills, and overall by the time they were five years old compared to offspring of students from nonparticipating schools. From ages 6 to 18, offspring of students from participating schools were also less likely to have oppositional defiance, attention deficit hyperactivity disorder, and overall externalizing behavior problems. They also had better cognitive skills, academic skills, and emotional skills. In addition, offspring of students at participating schools were less likely to use any drugs, alcohol, cigarettes, or marijuana (OR 0.27) than offspring of students at nonparticipating schools. "The intervention taught parents and teachers how to provide positive opportunities to their kids in the family and classroom, taught them how to recognize and reward good behavior, and taught the kids how to manage their emotions and impulses, and how to work cooperatively with other kids," Hill said. "This then prepares both the parents and their kids as they enter adolescent risk years and beyond." The trial wasn't randomized, and it's possible that results from the intervention in Seattle schools might not be generalizable to other communities. In addition, very few eligible students and offspring participated in the study. Even so, the results suggest that the cost of interventions aimed at school aged children should be measured against potential benefits that extend far beyond graduation, said Arthur Reynolds, director of the Human Capital Research Collaborative at the University of Minnesota in Minneapolis. The results reinforce the importance of teacher professional development in classroom management and socio-emotional skill development, supporting children's interpersonal problem-solving skills, and parent training to support children's development and learning at home, Reynolds, who wasn't involved in the study, said by email. "The study also indicates that the field has underestimated the economic returns of effective prevention programs, given that intergenerational and offspring impacts are routinely ignored in cost-benefit studies," Reynolds said. "The study reinforces the need to more comprehensively assess program impacts over time and especially for multicomponent, ecologically-based programs." SOURCE: https://bit.ly/2N4qUpn JAMA Pediatrics, online June 8, 2020.
638
L1N2DT1ZG
513139068
SCHOOL-INTERVENTION/GENERATIONS
Elementary school intervention can improve kids' behavior across multiple generations
3
[]
[]
['Attention Deficit Hyperactivity Disorder', 'Children / Youth Issues', 'Clinical Medicine', 'Education', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Mental Illness', 'Paediatric Medicine', 'Psychology', 'Public Health', 'Society / Social Issues']
['ADHD', 'CHLD', 'CLIMED', 'EDU', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'MENTIL', 'PEDMED', 'PSYCHO', 'PUBHEA', 'SOCI']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DT22D:203042724
0
By Marilynn Larkin NEW YORK (Reuters Health) - In patients with stage III-IV cancer, patient-controlled subcutaneous analgesia (PCSA) with sufentanil led to better pain control and quality of life than morphine in a randomized trial. Dr. Tao Song of China Medical University in Shenyang and colleagues randomly assigned 120 patients (mean age, about 63; almost all women) with stage III-IV cancers to receive PCSA with morphine or sufentanil. Before PCSA and on days 1, 3, 7, 14, 28, and 56 after treatment, the numeric rating scale (NRS) and 36-item Short Form health survey (SF-36) were completed for each patient, and side effects were recorded. As reported in Cancer Medicine, no significant between-group differences were observed in the mean NRS score (7.3 in both groups) or in SF-36 parameters prior to treatment with the study drug. However, patients achieved better pain relief with sufentanil, as indicated by lower NRS scores at days 14 (3.1 vs. 3.6), 28 (3.3 vs. 3.8), and 56 (3.6 vs.4.4) after PCSA catheter implantation. They also achieved a better quality of life, as indicated by scores for physical function, general health, social function and mental health on the same days. No significant between-group differences were seen in adverse reaction rates; however, the sufentanil group had lower levels of nausea and somnolence. Dr. Anurag Singh, professor of oncology and director of radiation research at Roswell Park Comprehensive Cancer Center in Buffalo, New York, told Reuters Health by email, "This is an interesting study, but one not likely to have much impact on clinical practice in the U.S." "In the context this study involved, use of the PCSA is quite sensible. Of note, it took 14 days to see a difference in the mean NRS score," he said. "I would have liked to see the statistics corrected for multiple comparisons, but the body pain data would likely have been significant still." Nonetheless, he added, "Given the potency of sufentanil - 10 times more potent than its parent drug, fentanyl - and the extremely high risk of respiratory depression, I would not be likely to prescribe this drug for my patients." Dr. Serife Eti, Medical Director, Palliative Medicine Program at Montefiore and Clinical Associate Professor at Albert Einstein College of Medicine in New York City, also commented by email, "The randomized clinical trial is nice, but there is no clear information about type of cancer, or cancer pain syndrome, which makes the interpretation of the intervention's indication or effectiveness hazy." Further, she said, "It is not clear why sufentanil was not compared to fentanyl instead of morphine infusion." Like Dr. Singh, she noted that sufentanil is 10 times more potent than fentanyl and carries a higher risk for chest wall rigidity and respiratory arrest. "There is insufficient evidence to draw conclusions from this study or prior studies," she said. "In the hands of clinicians lacking expertise, however, this drug can cause higher mortality, and early demise of patients." Dr. Song did not respond to requests for a comment. SOURCE: https://bit.ly/2YJyzyX Cancer Medicine, online June 4, 2020.
506
L1N2DT22D
203042724
CANCER-PAIN/SUFENTANIL
Patient-controlled subcutaneous sufentanil bests morphine in advanced cancer
3
[]
[]
['Clinical Medicine', 'Cancer', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Neurological Disorders', 'Pain Management', 'Pharmaceuticals & Medical Research', 'Terminal Care']
['CLIMED', 'CNCER', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'NEUROL', 'PAINMG', 'PHMR', 'TERMCA']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DT2M5:1874842137
0
By Linda Carroll (Reuters Health) - Switching from general to regional anesthesia may substantially cut greenhouse gas emissions and help reduce global warming, a new study suggests. Researchers determined that if all the hip and knee arthroplasties performed in the U.S. in 2009 had been done with regional anesthesia, the nation could saved the equivalent in greenhouse gas emissions of 3,260,000 pounds of coal burned, according to the report published in Regional Anesthesia and Pain Medicine. "The take home message from our study is that anesthesiologists have the opportunity to make a personal difference in decreasing greenhouse gases in their practices through the use of regional anesthesia," said coauthor Dr. Christopher Wu, a clinical professor of anesthesiology at the Hospital for Special Surgery at Weill Cornell Medicine in New York. "In this day and age we are all trying to make personal contributions to decreasing greenhouse gases." Unlike general anesthesia, regional anesthesia doesn't use volatile halogenated agents such as desflurane or nitrous oxide, Wu explained. In 2019, the Hospital for Special Surgery decided to use regional anesthesia in as many hip and knee replacements as possible. Out of the 10,485 procedures carried out at during 2019, just 419, or 4%, were done under general anesthesia. By using general anesthesia less often than the average rate for the U.S., which is 75%, Wu and his colleagues estimate that the Hospital for Special Surgery saved the equivalent of 26,900 pounds of coal burned, 2,750 gallons of gasoline consumed, or 60,500 miles driven by an average passenger vehicle. "The impact of anesthetics on greenhouse gases is pretty well established," said Dr. Andrew Leibowitz, chair of the department of anesthesiology, perioperative and pain medicine at The Mount Sinai Health System in New York. Most anesthesiologists in academic hospitals use regional anesthesia whenever it's appropriate, he said, but that's not always the case nationwide. Regional anesthesia is "very safe and effective for patients and most are very accepting of it," he said. "It's a mystery to me why almost half the country insists on doing general anesthesia" when regional anesthesia would be possible. "Having said that, there are ways you can do general anesthesia that would not use those gases and be safe for the environment," Leibowitz said. "Total intravenous anesthesia is very effective and safe." That said, the gases used in anesthesia aren't the only environmental issues at the nation's hospitals, Leibowitz said. "Hospitals make an enormous amount of non-biodegradable waste," Leibowitz said. "They do very little recycling. It's kind of shocking. I'm an environmentalist at home where we are very careful to (recycle). Here we make around 10 bags of waste per operation and I have no idea what happens to it." What goes into those bags? "It includes the disposable thick paper covering of the OR table, the outer paper coverings of all the instrument trays, everyone's gloves, gowns, masks, maybe the patient's disposable paper gown and then the various "dirty" things like lap pads, 4x4's, disposable intubation equipment, used IV bags, vials that contained medication, etc. and then also the laundered blankets and sheets," Leibowitz said. "So even a simple operation like a knee arthroscopy or cholecystectomy makes three to four very large garbage bags of waste and a more complex operation like a liver transplant could make 10-15 bags." SOURCE: https://bit.ly/3e9fCw5 Regional Anesthesia and Pain Medicine, online June 16, 2020.
560
L1N2DT2M5
1874842137
ANESTHESIA-CLIMATE/GREENHOUSE-GAS
Greenhouse gas emissions significantly lower with regional vs general anesthesia
3
[]
[]
['Bone Muscle Joint Diseases', 'Climate Change', 'Clinical Medicine', 'Environment', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Orthopaedics', 'Pain Management', 'Surgery']
['BMJDIS', 'CLC', 'CLIMED', 'ENV', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'ORTHOP', 'PAINMG', 'SURGER']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DU0QF:486466192
0
By Reuters Staff (Reuters) - The World Health Organization (WHO) said it was moving to update its guidelines on treating people stricken with COVID-19 to reflect results of a clinical trial that showed a cheap, common steroid can help save critically ill patients. Trial results announced on Tuesday by researchers in Britain showed dexamethasone, used since the 1960s to reduce inflammation in diseases such as arthritis, cut death rates by around a third among the most severely ill COVID-19 patients admitted to hospital. Britain has increased the amount of dexamethasone it has in stock and on order to 240,000 doses, health minister Matt Hancock said. But some doctors were cautious, citing possible side effects and asking to see more data. The WHO's clinical guidance for treating patients infected with the new coronavirus is aimed at doctors and other medical professionals and seeks to use the latest data to inform clinicians on how best to tackle all phases of the disease, from screening to discharge. Although the dexamethasone study's results are preliminary, the researchers behind the project said it suggests the drug should immediately become standard care in severely stricken patients. For patients on ventilators, the treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was cut by about one fifth, according to preliminary findings shared with WHO. The benefit was only seen in patients seriously ill with COVID-19 and was not observed in patients with milder disease. The positive news comes as coronavirus infections accelerated in some places including the United States and as Beijing cancelled scores of flights to help contain a fresh outbreak in China's capital. "This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support," WHO Director-General Tedros Adhanom Ghebreyesus said in a statement late on Tuesday. The agency said it was looking forward to the full data analysis of the study in coming days. "WHO will coordinate a meta-analysis to increase our overall understanding of this intervention. WHO clinical guidance will be updated to reflect how and when the drug should be used in COVID-19," the agency added. South Korea's top health official cautioned about the use of the drug for COVID-19 patients due to potential side effects. "Some experts have warned of the drug not only reducing the inflammatory response in patients, but also the immune system and may trigger side effects," said Jeong Eun-kyeong, head of Korea Centers for Disease Control and Prevention. "We have been burned before, not just during the coronavirus pandemic but even pre-COVID, with exciting results that when we have access to the data are not as convincing," said Dr. Kathryn Hibbert, director of the medical intensive care unit at Harvard's Massachusetts General Hospital.
462
L1N2DU0QF
486466192
HEALTH-CORONAVIRUS/STEROID-WHO
WHO moves to update COVID-19 guidance after 'great news' in drug study
3
[]
[]
['Clinical Medicine', 'Communicable Diseases', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Immunology', 'Infectious Diseases', 'Pharmaceuticals & Medical Research', 'Public Health', 'Respiratory Conditions']
['CLIMED', 'COMDIS', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'IMMOGY', 'INFDIS', 'PHMR', 'PUBHEA', 'RESPIR']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DU0R2:1683834717
0
By Kirsty Needham SYDNEY (Reuters) - Australia will take a more activist role in reshaping global bodies such as the World Health Organization (WHO) after the coronavirus pandemic dealt an unexpected blow to international stability, its foreign minister said on Tuesday. The WHO's decision-making body backed an independent review of the crisis last month, after lobbying by Australia and the European Union. U.S. President Donald Trump has accused the WHO of being beholden to China and cut funding to it. The pandemic has drawn attention to the strengths and weaknesses of the United Nations system, Australian Foreign Minister Marise Payne said in a major policy speech, adding that no other body could do the health security work the WHO does. "Australia wants to see a stronger WHO that is more independent and transparent," Payne said at the National Security College of Australian National University. "We cannot let the vital and practical work that the WHO does on the ground be overshadowed by questions about the approach of its headquarters in Geneva." Payne, critical of disinformation campaigns by China and Russia, said it was "troubling (that) some countries are using the pandemic to undermine liberal democracy and promote their own, more authoritarian models". A U.S. security ally, Australia strained ties with its largest trading partner, China, by pushing for an international inquiry into the source and spread of the virus that first emerged in the central Chinese city of Wuhan late last year. After studying its involvement with multilateral bodies, Australia had decided to target its efforts at preserving fundamental aspects such as rules that protect sovereignty, curb excessive use of power and enable trade, Payne said. Standards on health, transport and telecoms will be vital to economic recovery after the pandemic, she said, calling for new rules in emerging areas such as cyber technology, artificial intelligence, critical minerals and outer space. It was not a time for quiet diplomacy but a time to voice concerns, Payne added, dismissing fears that Australia had made itself a target, incurring "an unnecessary cost", by urging the virus review. "The COVID-19 crisis has given democracy a contemporary stage on which to demonstrate its strength," she said, referring to the respiratory disease caused by the virus.
371
L1N2DU0R2
1683834717
HEALTH-VIRUS/AUSTRALIA-DIPLOMACY
Australia says pandemic prompts greater effort to revamp global bodies
3
[]
[]
['Corporate Events', 'Communicable Diseases', 'Economic Indicator Published', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Economic Events', 'Public Health', 'Regulation / Compliance']
['BACT', 'COMDIS', 'ECI', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MCE', 'PUBHEA', 'REGS']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DU0U3:822185942
0
By Reuters Staff BERLIN (Reuters) - Germany's smartphone app to help trace coronavirus infections has been downloaded 6.5 million times in the first 24 hours since its launch, the chief executive of software company SAP said on Wednesday. Christian Klein said the strong public reception was testimony to the collaboration between teams from SAP and Deutsche Telekom that readied the Corona-Warn-App in just six weeks. "It's a big success, it scales, it's user friendly and it helps society," Klein told journalists in a video briefing. Germany joins European countries like Italy, Poland and Latvia in launching apps that use Bluetooth wireless to measure contacts between people and issue a warning should one of them later test positive for COVID-19. Although the technology is untested, governments have rushed to deploy it in the absence of a cure for COVID-19, seeking instead to achieve a kind of digital 'herd immunity' against the flu-like disease. Widespread take-up is needed, however, to increase the chance that both people in a risk event - spending 15 minutes within 2 metres (6.56 ft) of each other - use the app. In field tests, the app successfully recorded 80% of such encounters. Most apps being rolled out in Europe are based on technology from Apple and Alphabet's Google that logs contacts securely on a device and encrypts Bluetooth exchanges. Such privacy by design appears to have won public trust in Germany, a country of 84 million. France's app, which stores data centrally and is not supported by Apple, has been activated by just 2% of the population.
260
L1N2DU0U3
822185942
HEALTH-CORONAVIRUS/GERMANY-APP (PIX, TV)
German coronavirus tracing app downloaded 6.5 million times
3
[]
[]
['Corporate Events', 'Communicable Diseases', 'Epidemiology', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Public Health', 'Regulation / Compliance', 'Technology', 'Technology', 'Technology / Media / Telecoms']
['BACT', 'COMDIS', 'EPMEOL', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'PUBHEA', 'REGS', 'TECH', 'TECH08', 'TMT']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DU10P:427147207
0
By Anne Harding NEW YORK (Reuters Health) - Type-2-low asthmatics have higher expression of the SARS-CoV-2 receptor ACE2 in bronchial epithelium, as well as characteristics associated with increased risk of severe COVID-19, according to new findings. The findings suggest that these patients may be at especially high risk of contracting COVID-19, and developing severe disease if they do become infected, Dr. Sally Wenzel, director of the Asthma and Environmental Lung Health Institute at the University of Pittsburgh Medical Center (UPMC), told Reuters Health by phone. "They should not be putting themselves into high-risk situations, they should be continuing to work at home as much as they can," Dr. Wenzel said. "We would certainly want them to have their asthma under the best possible control." The question of whether asthma increases the risk of severe COVID-19, or might even be protective, is controversial, she noted. "One of the reasons for that uncertainty is that asthma is a very heterogenous disease, and there are very likely to be subgroups of people with asthma that are high risk." Dr. Wenzel and her team studied two large cohorts of asthma patients with stable disease to investigate whether ACE2 expression was associated with immune polarization. Low absolute blood eosinophil count, a marker of Type 2 inflammation, was associated with increased ACE2 expression in bronchial epithelial cells (BEC), they found. ACE2 expression also correlated with expression of genes upregulated in viral infections, the team reports in the Journal of Allergy and Clinical Immunology. When patients were clustered into four groups based on BEC gene expression, the authors found that levels of blood eosinophils varied with ACE2 expression. Patient cluster 1 (PC1), which had the highest mean Type-1-gene expression score, also had the highest level of ACE2 transcripts and the lowest mean Type-2-gene expression. PC1 was all male, with higher mean resting diastolic pressure and a trend toward a greater likelihood of having been diagnosed with hypertension. Patients in this group also had a higher neutrophil-to-lymphocyte ratio and lower absolute levels of lymphocytes and eosinophils, characteristics also associated with COVID-19. They also had elevated lymphocytes in bronchoalveolar lavage (BAL). "One of the surprising things from the findings was that we were able to so clearly link what was going on with the epithelial lining in the lung with the signature in the peripheral blood," Dr. Matthew J. Camiolo, a clinical instructor at UPMC and the study's lead author, told Reuters Health by phone. "It may give us some insight into things we can test for in the blood." He added: "This is very much a pilot study, and there will have to be confirmatory work to give us a sense of what's going on at the protein level." Allergist Dr. Brian Modena of National Jewish Health in Denver told Reuters Health, "This is an important study to highlight how heterogeneous asthmatic responses to COVID might be." The fact that the study looked at gene expression at one point in time is limiting, he added. "The gene expression is a marker, but it doesn't indicate the actual protein levels. That's one assumption that's not quite connected yet," Dr. Modena said by phone. "The other assumption is that having higher levels of ACE2 translates to a worse COVID infection, and that's not necessarily proven by any means." SOURCE: https://bit.ly/3hEX7lt Journal of Allergy and Clinical Immunology, online June 10, 2020.
560
L1N2DU10P
427147207
COVID19-ASTHMA/
Expression of SARS-CoV-2 receptor ACE2 higher in Type-2-low asthma patients
3
[]
[]
['Asthma', 'Clinical Medicine', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Internal Medicine', 'Respiratory Conditions']
['ASTHM', 'CLIMED', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'INTMED', 'RESPIR']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DU1LG:484432116
0
By Will Boggs MD NEW YORK (Reuters Health) - Viability testing during normothermic machine perfusion (NMP) can identify transplantable livers that would otherwise be discarded, researchers report. "In these times of organ shortage, far too many organs are turned down for concerns about initial nonfunction based on what are very subjective criteria," said Dr. Darius F. Mirza of the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, in the U.K. "This trial has shown that with the help of objective criteria derived during normothermic perfusion, we can safely ascertain that these liver grafts will work, and that these initially discarded livers can be used to help in helping overcome the gap between liver need and liver availability," he told Reuters Health by email. The mortality of patients waitlisted for liver transplantation approaches 32% in the U.S. and 19% in the U.K., prompting moves to use more marginal liver grafts. Currently, this requires matching high-risk livers to lower-risk recipients to achieve acceptable patient survival rates. NMP reduces preservation-related graft injury (compared with static cold storage), and objective parameters measurable during NMP can be used to assess viability. Dr. Mirza and colleagues evaluated the potential of NMP to provide objective assessment of the viability of livers currently deemed unsuitable for transplantation and the results of transplantation of those that met predetermined criteria in 22 patients waitlisted for liver transplantation. During the NMP procedure, 25 of 31 discarded livers quickly recovered metabolic activity and cleared lactate to the target level, but three livers deteriorated within the first four hours, with increasing lactate. Overall, 22 livers (71%) met the viability criteria and were transplanted following a median total preservation time of 17 hours and 53 minutes, the team reports in Nature Communications. All 22 patients were alive at day 90 posttransplantation, with 90-day graft survival of 100%. Seven patients (32%) developed early allograft dysfunction and seven patients developed grade 3 or worse complications. The median duration of stay was 3.5 days in the intensive-care unit and 10 days in the hospital. At one year, patient survival was 100% and graft survival was 86%. These rates were similar to those of 44 contemporary matched controls (95.5% and 86%, respectively). The incidence of early allograft dysfunction was higher in the study group (32%) than in the matched controls (9%), as was the incidence of clinically manifest nonanastomotic biliary strictures (18% vs. 2%, respectively). "This trial demonstrated that NMP provides a way of objectively assessing high-risk organs, and allowed transplantation in a significant proportion of currently unutilized livers without any incidence of primary non-function," the authors conclude. "The use of perfusion technology was associated with increased graft utilization, considerably extended preservation time, and greatly improved transplant logistics." "Adoption of functional assessment of high-risk livers can increase access to lifesaving transplantation and reduce waiting list mortality," they add. Dr. Annemarie Weissenbacher of Medical University of Innsbruck, in Austria, and Oxford University Hospitals, in the U.K., recently discussed the future of organ perfusion and reconditioning. She told Reuters Health by email, "This study has to be seen from the perspective that none of these livers would have been transplanted otherwise - they would have been discarded. Therefore, this trial has a 100% success rate as it has to be compared to patients becoming unfit for transplant or dying on the waiting list." "By applying NMP, viability assessment is possible in DBD (donor after brainstem death) and DCD (donor after circulatory death) livers leading to better organ utilization resulting in successful liver transplantation," she said. "Long-term results and a higher number of livers assessed by NMP in a similar setting will prove if it would be safe to transplant such livers into higher risk recipients," said Dr. Weissenbacher, who was not involved in the study. She added, "As suspected, nonanastomotic bile duct strictures in DCD organs are not preventable by using more optimal preservation techniques, as the damage probably caused by warm ischemia cannot be resolved. However, the NMP platform provides the amazing opportunity to study such organs and to think about repair mechanisms, stem-cell administration, pharmacological studies, etc., to counteract/avoid this severe complication." SOURCE: https://go.nature.com/3hC9SwP Nature Communications, online June 16, 2020.
694
L1N2DU1LG
484432116
LIVER-TRANSPLANT/NORMOTHERMIC-PERFUSION
Many discarded livers could be safely transplanted
3
[]
[]
['Clinical Medicine', 'Gastric Disorders', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Hepatitis', 'Human Diseases / Conditions', 'Infectious Diseases', 'Liver Disease', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Transplant']
['CLIMED', 'GASTRI', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HEPATI', 'HUMDIS', 'INFDIS', 'LIVDIS', 'MRCH', 'PHMR', 'TRANSP']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DU1MC:1504824027
0
By Reuters Staff NEW YORK (Reuters Health) - There is minimal risk of SARS-CoV-2 spreading through veno-venous extracorporeal membrane oxygenation (VV-ECMO) or continuous renal replacement therapy (CRRT), according to a French study believed to be the first to assess this potential risk. "Our findings are reassuring regarding the risk of ICU professionals contamination when treating patients on VV-ECMO or CRRT," report Dr. Martin Dres of Sorbonne University and Pitie-Salpetriere Hospital, in Paris, and colleagues in the American Journal of Respiratory and Critical Care Medicine. The clinicians evaluated 27 consecutive patients with severe SARS-CoV-2 infection admitted to three ICUs in Paris. All 27 patients were on mechanical ventilation and 25 were supported by VV-ECMO and eight by CRRT. They investigated the risk of virus spreading within 48 hours after ECMO and CRRT initiation as the viral load, if present in plasma, is expected to progressively decline afterward, they point out. SARS-CoV-2 RNA was present in lower-respiratory-tract samples from all patients and in plasma from 13 patients. However, SARS-CoV-2 RNA was not detected in the membrane oxygenator gas outlet condensate, nor in the dialysis effluent, whether plasma RNA was positive or negative. Therefore, the estimated probability of a positive SARS-CoV-2 RNA in either location was zero, they report. These findings "do not support the routine use of a viral filter on the exhaust of the commonly used polymethylpentene-based ECMO membrane lungs," the researchers say. "Prevention and education of health care workers should therefore remain focused on limiting the risks of virus spreading during invasive respiratory procedures such as high flow oxygenation, mouth care, intubation or microbiological sampling of nasopharyngeal, tracheal or broncho-alveolar secretions," they conclude. The study had no specific funding. Dr. Dres has received fees from Lungpacer Medical . SOURCE: https://bit.ly/2UONpTC American Journal of Respiratory and Critical Care Medicine, online June 11, 2020.
302
L1N2DU1MC
1504824027
COVID19-ECMO/TRANSMISSION
No evidence of SARS-CoV-2 spread through ECMO or dialysis membranes
3
[]
[]
['Clinical Medicine', 'Communicable Diseases', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Nephrological Disorders', 'Respiratory Conditions']
['CLIMED', 'COMDIS', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'NEPHRO', 'RESPIR']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DU1WF:889066768
0
(Corrects to show 79% of hospitalized patients were black, not 79% of black patients were hospitalized, in second paragraph) By Reuters Staff (Reuters) - A study of coronovirus patients in Atlanta has found that black patients are more likely to be hospitalized than white patients, highlighting racial disparities in the U.S. healthcare system, researchers from the Centers for Disease Control and Prevention (CDC) said on Wednesday. About 79% of patients hospitalized for COVID-19 were black while 13% were white, according to the study across six metropolitan hospitals and outpatient clinics in Atlanta, Georgia, between March and April 2020. (https://bit.ly/3fEWlmF) The researchers found an association between being black and rates of hospitalization in Atlanta, even after adjusting for underlying conditions such as diabetes, according to the results published in the CDC's Morbidity and Mortality Weekly Report. This suggested that other factors like healthcare access, social determinants of health, or the possibility of bias might explain higher rates of hospitalization for black Americans, the authors conclude. Hospitalized patients tended to be older, male, black, and have underlying conditions, said the researchers. They added that black Americans were more likely to be frontline industry or essential workers, raising their risks for coronavirus infection. Apart from age, race and underlying conditions, lack of insurance, smoking and obesity were independently associated with the likelihood of hospitalization for the 531 Atlanta patients studied, researchers said. "The COVID-19 pandemic has highlighted persistent health disparities in the United States," said the authors, including those from CDC's COVID-19 Emergency Response Team and Epidemic Intelligence Service. SOURCE: https://bit.ly/3fEWlmF MMWR, online June 17, 2020.
263
L1N2DU1WF
889066768
HEALTH-CORONAVIRUS/RACE (CORRECTED)
CORRECTED-Black patients with COVID-19 in Atlanta more likely to be hospitalized -CDC
3
['Americas', 'United States', 'North America']
['AMERS', 'US', 'NAMER']
['Economic Indicator Published', 'Epidemiology', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Economic Events', 'Public Health', 'Race Relations / Ethnic Issues', 'Society / Social Issues']
['ECI', 'EPMEOL', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MCE', 'PUBHEA', 'RACR', 'SOCI']
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[]
en
English
tag:reuters.com,2020:newsml_L1N2DU1WR:108767781
0
(Adds details, byline, updates headline) By Kate Kelland and Emma Farge (Reuters) - A cheap steroid that can help save the lives of patients with severe COVID-19 should be reserved for serious cases in which it has been shown to provide benefits, the World Health Organization said on Wednesday. WHO chief Tedros Adhanom Ghebreyesus said research was at last providing "green shoots of hope" in treating the virus, which has killed more than 400,000 people worldwide and infected more than 8 million. Trial results announced on Tuesday by researchers in Britain showed dexamethasone, a generic drug used since the 1960s to reduce inflammation in diseases such as arthritis, cut death rates by around a third among the most severely ill coronavirus patients admitted to hospital. That makes it the first drug proved to save lives in fighting the disease. Countries are rushing to ensure that they have enough of it on hand, although medical officials say there is no shortage. Some doctors were cautious, citing possible side-effects and asking to see more data. A patient in Denmark received dexamethasone on Wednesday, local news agency Ritzau reported. The doctor who prescribed the drug said the medical profession was well acquainted with its side-effects. The head of the WHO's emergencies programme, Mike Ryan, said the drug should only be used in those serious cases where it has been shown to help. "It is exceptionally important in this case, that the drug is reserved for use in severely ill and critical patients who can benefit from this drug clearly," he told a briefing. Britain has increased the amount of dexamethasone it has in stock and on order to 240,000 doses, Health Minister Matt Hancock said. Methylprednisolone, a steroid similar to but less potent than dexamethasone, has been used in Sweden since March, a Stockholm-based doctor told media. The steroid was introduced to standard practice after it proved effective on a coronavirus patient who wasn't showing signs of recovery with other treatments, Lars Falk, of the New Karolinska Hospital, told Sweden's Dagens Nyheter. The dexamethasone study's results are preliminary, but the researchers behind the trial said it suggests the drug should become standard care in severely stricken patients. 'NO SILVER BULLET' For patients on ventilators, the treatment was shown to reduce mortality by about a third, and for patients requiring only oxygen, deaths were cut by about one fifth, according to preliminary findings shared with the WHO. "This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support," Tedros said in a statement late on Tuesday. "WHO will coordinate a meta-analysis to increase our overall understanding of this intervention. WHO clinical guidance will be updated to reflect how and when the drug should be used in COVID-19," the agency added. South Korea's top health official expressed caution about dexamethasone and the European Union and Switzerland both said they were awaiting more information. An Italian expert said that dexamethasone was no silver bullet. "The study showed a marginal reduction in deaths," said Lorenzo Dagna, immunology head at IRCCS San Raffaele Scientific Institute in Milan. "We're light years away from being able to say we've found the cure against COVID." On the positive side, he added, the drug is cheap and plentiful. As the new coronavirus has wreaked havoc on global economies, some countries have moved quickly to authorise emergency use of medicines only to later backtrack. The U.S. Food and Drug Administration, for instance, withdrew emergency authorisation for hydroxychloroquine, a malaria drug touted by U.S. President Donald Trump and others against COVID-19, after studies showed it did not help. The WHO said on Wednesday that testing of hydroxychloroquine in its large multi-country trial of treatments for COVID-19 patients had been halted after research showed no benefit. "We have been burned before," Dr. Kathryn Hibbert, director of the medical intensive care unit at Harvard's Massachusetts General Hospital, said, expressing caution about dexamethasone.
655
L1N2DU1WR
108767781
HEALTH-CORONAVIRUS/STEROID-WHO (UPDATE 1)
UPDATE 1-Steroid should be kept for serious coronavirus cases, WHO says
3
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[]
['Clinical Medicine', 'Communicable Diseases', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Immunology', 'Infectious Diseases', 'Pharmaceuticals & Medical Research', 'Public Health', 'Respiratory Conditions']
['CLIMED', 'COMDIS', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'IMMOGY', 'INFDIS', 'PHMR', 'PUBHEA', 'RESPIR']
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[]
en
English
tag:reuters.com,2020:newsml_L1N2DU2FV:1341708245
0
By Deena Beasley (Reuters) - Proposed changes to requirements that state-run Medicaid programs are given the best drug prices would clear the way for commercial health insurers to enter into "value-based" payment schemes, the U.S. Centers for Medicare & Medicaid Services said on Wednesday. Drug manufacturers by law must give Medicaid their "best price," meaning the lowest price they negotiate with any other buyer. But health plans have expressed concerns that the requirement prevents them from linking drug prices to patient outcomes - a practice known as "value-based" pricing. "The problem has been that the Medicaid best price regulations are a barrier. ... Today we are announcing that we are updating them to allow for more value-based pricing," CMS Administrator Seema Verma told Reuters in a telephone interview. The proposed changes are being driven by the increasing availability of very expensive, potentially curative, gene therapy treatments, she said. Spark Therapeutics Inc, now owned by Roche Holding AG, in 2018 launched its Luxturna treatment for an inherited genetic mutation that causes blindness at a price of $850,000. Novartis AG last year won U.S. approval for its gene therapy Zolgensma for spinal muscular atrophy, pricing the one-time treatment at a record $2.125 million. Commercial health insurers have considered linking reimbursement of such drugs to health outcomes, but have been stymied by the Medicaid best price rules, Verma said. "If a drug didn't work in 20% of cases, in those cases the payment might be zero, which could completely alter the Medicaid best price," she explained. The changes proposed include calculating the best price based not just on one discount, but as a comprehensive blend of prices. They would also allow for price calculations outside of the current three-year window. CMS said the aim is to provide greater flexibility for payers and manufacturers to enter into value-based agreements while ensuring Medicaid always gets the best deal. The proposed changes will be open for a 30-day comment period.
324
L1N2DU2FV
1341708245
USA-HEALTHCARE/MEDICAID (URGENT)
'Medicaid best price' changes aimed at value-based gene therapy contracts -U.S. agency
3
['Americas', 'United States', 'North America']
['AMERS', 'US', 'NAMER']
['Agriculture', 'Corporate Events', 'Commodities', 'Economic Indicator Published', 'Financials (Legacy)', 'Financials', 'Financials', 'General News', 'General Health', 'Genetically Modified Organisms', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Healthcare Services & Equipment', 'Managed Healthcare', 'Healthcare Providers & Services', 'Industrials', 'Industrials', 'Insurance', 'Life & Health Insurance', 'Economic Events', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Regulation / Compliance', 'Science']
['AGRI', 'BACT', 'COM', 'ECI', 'FIN', 'FINS', 'FINS08', 'GEN', 'GENHLT', 'GMO', 'HCPOL', 'HEA', 'HECA', 'HLTHSE', 'HMOS', 'HPAS', 'INDS', 'INDS08', 'INSR', 'LINS', 'MCE', 'MRCH', 'PHMR', 'REGS', 'SCI']
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[]
en
English
tag:reuters.com,2020:newsml_L1N2DU2GZ:56284039
0
By Lisa Rappaport (Reuters Health) - Older adults with high atherosclerosis burden who report high levels of physical activity have lower mortality rates than counterparts who get little or no exercise, a recent study suggests. Researchers examined data on 2,318 patients ranging in age from 65 to 84 years old who underwent coronary artery calcium (CAC) scanning from 1998 to 2016. At the time of their scans, patients completed questionnaires about chest pain and other cardiac symptoms, cardiac risk factors, medication use, and physical activity levels (rated on a scale from 0 to 10, representing "none" to "always"). After a mean follow-up of 10.6 years, 533 patients (23%) had died. The annualized mortality for the entire cohort was 2.3% per year, with the highest mortality (2.9% per year) among people with the lowest activity levels and the lowest mortality (1.7% per year) among those with the highest activity levels. Physical activity levels didn't appear to alter survival in patients with low CAC scores (0-99). However, in patients with moderate CAC scores (100-399), the risk for all-cause mortality increased 2.07-fold among those with low physical activity compared to patients with high physical activity. In patients with CAC scores over 400, all-cause mortality increased 2.35-fold for patients with low versus high activity. "Exercise does not reduce the amount of calcium in the coronary arteries, but it improves patients' heart health and reduces future mortality through a number of established mechanisms," said Dr. Alan Rozanski, a professor of medicine at Icahn School of Medicine at Mount Sinai and chief academic officer for the Department of Cardiology at Mount Sinai Morningside Hospital in New York City. When people are completely sedentary, they experience an increased risk for insulin resistance and diabetes, inflammation, hypertension, visceral fat accumulation, and loss of muscle strength and function," Dr. Rozanski, who led the study, noted in an email. "Exercise does all the opposite, thus reducing the risk of both heart disease and other chronic illnesses," he said. Among all clinical parameters, age and the magnitude of CAC score were the most potent predictors of mortality, followed by physical activity, the researchers report in Mayo Clinic Proceedings. Patients who reported higher activity levels were less likely than those with the lowest activity to have hypertension (40.5% vs 51%), obesity (7.6% vs 25.6%), diabetes (5.6% vs 11.7%), or to be smokers (2.9% vs 7.7%). One limitation of the study is that physical activity was self-reported, and not independently verified. In addition, comorbidities unmeasured in the study might have impacted patients' outcomes, Dr. Jamal Rana, chief of cardiology in the East Bay for the Permanente Medical Group in Oakland, California, commented by email. Even so, the findings support the consensus that regular exercise improves heart health and longevity, said Thijs Eijsvogels, an exercise physiologist at Radboud University Medical Center in Nijmegen, the Netherlands, who wasn't involved in the study. "The underlying mechanisms of the association between exercise and coronary atherosclerosis is currently not fully understood, but it is expected that cardiovascular risk factors such as blood pressure, lipid levels and inflammatory status play a role," Eijsvogels said by email. "Exercise improves these factors, whereas there is also a link between these factors and the magnitude of calcium deposits in the coronary arteries as well as the risk of all-cause mortality." SOURCE: https://bit.ly/3ebOOLF Mayo Clinic Proceedings, online June 5, 2020.
557
L1N2DU2GZ
56284039
ATHEROSCLEROSIS-ACTIVITY/MORTALITY
Higher activity levels tied to lower mortality rate with atherosclerosis
3
[]
[]
['Cardio', 'Epidemiology', 'Exercise & Fitness', 'General News', 'General Health', 'Geriatrics / Ageing', 'Health / Medicine', 'Heart / Cardiac Disease', 'Healthcare', 'Human Diseases / Conditions', 'Internal Medicine', 'Living / Lifestyle', 'Public Health', 'Society / Social Issues']
['CARDIO', 'EPMEOL', 'EXEFIT', 'GEN', 'GENHLT', 'GERIAT', 'HEA', 'HEARCA', 'HECA', 'HUMDIS', 'INTMED', 'LIF', 'PUBHEA', 'SOCI']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DU2K9:1405952411
0
By Lisa Rappaport (Reuters Health) - Most candidates for the U.S. House of Representatives don't promote specific pediatric health policies on their websites, although larger political trends may drive wide variation in the prominence of these issues from year to year, a new study suggests. For the study, researchers analyzed data from a total of 37,948 issue pages about health care and education on websites for Democratic and Republican candidates for the U.S. House of Representatives for election cycles from 2008 to 2018. The analysis included archived webpages, and focused on website content within three weeks of each election. Overall, 631 of 4,574 candidate websites (13.8%) included pediatric health policy discussions on pages dedicated to health or education. By contrast, 1,523 candidate websites (33.3%) mentioned Medicare on healthcare pages. "Leaders in pediatric health have suggested that children's health issues are under-emphasized in policy discussions and political debates, and our study supports this view," said lead study author Tyler Benning of the Mayo Clinic Alix School of Medicine in Rochester, Minnesota. "Previous studies have suggested that better childhood health is associated with long-term improvements in educational attainment, socioeconomic status, and adult health," Benning said by email. "Therefore, policies that promote childhood health can have positive long-term impacts on both individuals and communities." Specific pediatric health policies were mentioned on just 508 websites (11.1%) out of 4,574 in the analysis, researchers report in JAMA Pediatrics. However, most websites (80.5%) that did discuss pediatric health included specific childhood health policy proposals. Democrats featured specific pediatric health policies more often than Republicans, with 18.5%) of websites for Democratic candidates including specific pediatric health policies, compared with 3.7% of sites for Republican candidates. The prominence of pediatric health policy proposals on candidate websites has varied over time, the authors note. In 2008, for example, 26% of websites had any mention of pediatric health and 18.7% cited specific policies. Mentions of pediatric heath policy declined in subsequent years, reaching as low as 6.7% and 4.8%, respectively, for general or specific references to pediatric health policies in 2014. By 2018, references to pediatric heath rebounded, with general mentions on 19% of websites and specific proposals on 15.7% of websites. One of the limitations of the study is a lack of data on what factors were responsible for the overall low levels of pediatric health discussion overall or the variation from one year to the next, the authors note. "Future research can help us understand how candidates' personal characteristics, the characteristics of their constituents, and the electoral dynamics of their races all might play a role in determining whether candidates campaign on pediatric health issues," Benning said. It's also not clear from the study how much pediatric health discussions on candidates' websites might reflect their level of advocacy for pediatric health policies once they're in office, Benning said. "Politicians have a primary interest in re-election and thus prioritize issues of the voting age population instead of those too young to vote," said Timothy Callaghan, an assistant professor in the department of health policy and management at Texas A&M University School of Public Health in College Station. Politicians may mention Medicare more often than pediatric health because older Americans are a prominent voting bloc, Callaghan, who wasn't involved in the study, said by email. They may also mention pediatric health less often simply because they're not as knowledgeable about these issues. "Few members of Congress have professional backgrounds in public health or medical professions that would help them to recognize the importance of pediatric health," Callaghan said. "While many representatives recognize the importance of health generally regardless of prior health experience, they may not recognize the importance of child health topics in particular." SOURCE: https://bit.ly/3fy5SM3 JAMA Pediatrics, online June 1, 2020.
622
L1N2DU2K9
1405952411
PEDIATRIC-POLICY/ELECTION
Few U.S. House candidates push specific child health policies online
3
['Americas', 'United States', 'North America']
['AMERS', 'US', 'NAMER']
['General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Paediatric Medicine', 'Public Health']
['GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'PEDMED', 'PUBHEA']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DU2Q9:1059700598
0
By Kate Kelland and Emma Farge LONDON/GENEVA (Reuters) - The World Health Organization said on Wednesday that testing of the malaria drug hydroxychloroquine in its large multi-country trial of treatments for COVID-19 patients had been halted after new data and studies showed no benefit. WHO expert Ana Maria Henao-Restrepo said investigators leading the so-called Solidarity Trial testing the drug - which had been promoted by U.S. President Donald Trump - had reviewed recent evidence and decided to stop recruiting new patients. "After deliberation, they have concluded that the hydroxychloroquine arm will be stopped from the Solidarity Trial," Henao-Restrepo told a media briefing. In a statement issued later on Wednesday, the WHO said the decision was based on evidence from the Solidarity Trial itself, as well as from a UK-led trial that had found the drug did not help COVID-19 patients, and from a review of other evidence on hydroxychloroquine. Data from those studies "showed that hydroxychloroquine does not result in the reduction of mortality of hospitalised COVID-19 patients," the WHO statement said. It said Solidarity Trial investigators would not add any more patients to the hydroxychloroquine arm. But it added: "Patients who had already started hydroxychloroquine but who have not yet finished their course in the trial may complete their course or stop at the discretion of the supervising physician." Data from a UK-led clinical trial known as the Recovery trial found last week that the anti-malaria drug showed no benefit for patients with COVID-19. The U.S. Food and Drug Administration on Monday revoked its emergency use authorization for hydroxychloroquine to treat COVID-19, saying it was no longer reasonable to believe that hydroxychloroquine and the related drug chloroquine would be effective in treating the disease.
285
L1N2DU2Q9
1059700598
HEALTH-CORONAVIRUS/WHO-HYDROXYCHLOROQUINE
WHO halts trial of hydroxychloroquine in COVID-19 patients
3
[]
[]
['Corporate Events', 'Clinical Medicine', 'Economic Indicator Published', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Economic Events', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health', 'Regulation / Compliance']
['BACT', 'CLIMED', 'ECI', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MCE', 'MRCH', 'PHMR', 'PUBHEA', 'REGS']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DV0RK:1877127800
0
By Kate Kelland and Stephanie Nebehay LONDON/GENEVA (Reuters) - Large multi-country trials of the combination HIV drug lopinavir/ritonavir to treat COVID-19 have recruited thousands of patients and the World Health Organization is now looking at interim data, the UN agency's chief scientist said on Thursday. Soumya Swaminathan said several thousand patients had been enrolled in the lopinavir/ritonavir arm of the WHO-led Solidarity Trial and in a separate UK-led COVID-19 trial of the drug combination. "This is already a huge number and should be enough to tell us whether this drug is actually having a mortality benefit or a benefit on disease severity," she told a media briefing. Another arm of the WHO-led trial, looking at the potential effect of Gilead's antiviral drug remdesivir in COVID-19, might need more patients, she said. "(We are) looking at ways to maximise the generation of knowledge about drugs which are promising," she said. "On the drug remdesivir, we still do not have a definitive answer on its impact on mortality - which is what we would like to see." The Solidarity Trial started out with five arms looking at possible treatment approaches to COVID-19: standard care; remdesivir; the malaria drug hydroxychloroquine; the HIV drugs lopinavir/ritonavir; and lopanivir/ritonavir combined with interferon. "We will come back very soon on further decisions on the Solidarity Trial. It's an adaptive design - you can change and adapt as you go on," Swaminathan said. On Wednesday the WHO stopped the arm testing hydroxychloroquine as a treatment for COVID-19 patients, after studies indicated it showed no benefit in those who have the disease. Swaminathan said more studies are still needed to see whether hydroxchloroquine may be effective as a preventative medicine. U.S. President Donald Trump has touted the benefits of hydroxychloroquine, and said he took it to prevent infection.
299
L1N2DV0RK
1877127800
HEALTH-CORONAVIRUS/WHO-LOPINAVIR
WHO says looking at interim trial data on HIV drugs to treat COVID-19
3
[]
[]
['Clinical Medicine', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health', 'Respiratory Conditions']
['CLIMED', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MRCH', 'PHMR', 'PUBHEA', 'RESPIR']
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[]
en
English
tag:reuters.com,2020:newsml_L1N2DV0RM:1430620176
0
By Emilio Parodi and Carl O'Donnell (Reuters) - Roche's rheumatoid arthritis drug Actemra failed to help patients with early-stage COVID-19 pneumonia in an Italian study, the latest instance in which an anti-inflammatory drug has fallen through in a coronavirus trial. Despite the setback, the Swiss drugmaker said that it is pressing ahead with testing Actemra in another trial against COVID-19, the disease caused by the new coronavirus. Actemra did not reduce severe respiratory symptoms, intensive care visits, or death any better than standard treatments, the Italian Medicines Agency (Aifa), Italy's drugs regulator which authorized the study, said in a statement on Wednesday. The trial, which enrolled 126 patients, about a third of the intended number, was stopped early after an interim analysis raised doubts about the anti-inflammatory medicine's effectiveness. "Although not effective in all patients with COVID-19 pneumonia, it is possible that selected subgroups of patients may have a better response," Aifa said. Sales of Actemra jumped 30% in the first quarter, Roche said in April, on hopes it would help in the fight against the new coronavirus. Its failure to do so in the Italian study now adds to questions about the role of drugs like Actemra, which are designed to inhibit interleukin-6 (IL-6) proteins associated with dangerous inflammation, in treating COVID-19. A similar IL-6 inhibitor, Sanofi and Regeneron's arthritis drug Kevzara, failed in a trial in April to help a group comprised of severely ill and critically ill patients, leading the drugmakers to continue to test high doses of Kevzara only in those considered critically ill with COVID-19. Detailed data from the Italian Actemra study, which involved 24 medical centres, will be sent to a scientific journal. Meanwhile, Roche has completed enrolment of its own Actemra study in patients hospitalized with severe COVID-19 pneumonia. That "will provide robust evidence about the benefit/ risk profile", a Roche spokesman said, with data expected in the next few months. Last month Roche also announced plans to study whether combining Actemra with Gilead Sciences Inc's antiviral treatment remdesivir works better against severe COVID-19 pneumonia than remdesivir alone. Remdesivir has shortened hospital stays of COVID-19 patients.
353
L1N2DV0RM
1430620176
HEALTH-CORONAVIRUS/ROCHE HLDG
Roche rheumatoid arthritis drug fails to help COVID-19 patients in Italian study
3
[]
[]
['Clinical Medicine', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health', 'Respiratory Conditions', 'Rheumatic Conditions']
['CLIMED', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MRCH', 'PHMR', 'PUBHEA', 'RESPIR', 'RHEUMA']
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[]
en
English
tag:reuters.com,2020:newsml_L1N2DV0RO:2138097885
0
By Reuters Staff GENEVA (Reuters) - The World Health Organization hopes hundreds of millions of doses of coronavirus vaccine can be produced this year and 2 billion doses by the end of 2021, chief scientist Soumya Swaminathan said on Thursday. The WHO is drawing up plans to help decide who should get the first doses once a vaccine is approved, she said. Priority would be given to frontline workers such as medics, those who are vulnerable because of age or other illness, and those who work or live in high-transmission settings such as prisons and care homes. "I'm hopeful, I'm optimistic. But vaccine development is a complex undertaking, it comes with a lot of uncertainty," she said. "The good thing is, we have many vaccines and platforms so even if the first one fails, or the second ones fails, we shouldn't lose hope, we shouldn't give up." Around 10 potential vaccines are now undergoing trials in humans, in the hope that a shot to prevent infection can become available in coming months. Countries have already begun making deals with pharmaceutical companies to order doses, even before any vaccines have been proven to work. Swaminathan described the ambition for hundreds of millions of doses this year as optimistic, and the hope for up to 2 billion doses of up to three different vaccines next year as a "big if". She added that genetic analysis data collected so far showed that the new coronavirus has not yet mutated in any ways that would alter the severity of the illness it causes.
259
L1N2DV0RO
2138097885
HEALTH-CORONAVIRUS/WHO-VACCINE-PLAN (PICTURES)
WHO hopes for hundreds of millions of vaccine doses this year, 2 billion next year
3
[]
[]
['Communicable Diseases', 'Drug & Device Development', 'Economic Indicator Published', 'Epidemiology', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Economic Events', 'Medical Ethics', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health', 'Vaccines']
['COMDIS', 'DRUDEV', 'ECI', 'EPMEOL', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MCE', 'MEDETH', 'MRCH', 'PHMR', 'PUBHEA', 'VACCIN']
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[]
en
English
tag:reuters.com,2020:newsml_L1N2DV0TP:1417990791
0
By Johan Ahlander STOCKHOLM (Reuters) - Sweden's hopes of getting help from herd immunity in combating the coronavirus received a fresh blow on Thursday, when a new study showed fewer than anticipated had developed antibodies. Sweden's has opted for a more liberal strategy during the pandemic, keeping most schools, restaurants, bars and businesses open as much of Europe hunkered down behind closed doors. While Health Agency officials have stressed so-called herd immunity is not a goal in itself, it has also said the strategy is only to slow the virus enough for health services to cope, not suppress it altogether. However, the study, the most comprehensive in Sweden yet, showed only around 6.1% of Swedes had developed antibodies, well below levels deemed enough to achieve even partial herd immunity. "The spread is lower than we have thought but not a lot lower," Chief Epidemiologist Anders Tegnell told a news conference, adding that the virus spread in clusters and was not behaving like prior diseases. "We have different levels of immunity on different parts of the population at this stage, from 4 to 5% to 20 to 25%," he said. Herd immunity, where enough people in a population have developed immunity to an infection to be able to effectively stop that disease from spreading, is untested for the novel coronavirus and the extent and duration of immunity among recovered patients is equally uncertain as well. Sweden surpassed 5,000 deaths from the coronavirus on Wednesday, many times higher per capita than its Nordic neighbours but also lower than some countries that opted for strict lockdowns, such as Britain, Spain and Italy.
269
L1N2DV0TP
1417990791
HEALTH-CORONAVIRUS/SWEDEN-IMMUNITY
New study casts more doubt on Swedish coronavirus immunity hopes
3
['Europe']
['EUROP']
['Communicable Diseases', 'Economic Indicator Published', 'Epidemiology', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Immunology', 'Infectious Diseases', 'Economic Events', 'Biotechnology & Medical Research', 'Pharmaceuticals & Medical Research', 'Public Health']
['COMDIS', 'ECI', 'EPMEOL', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'IMMOGY', 'INFDIS', 'MCE', 'MRCH', 'PHMR', 'PUBHEA']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DV135:1662473438
0
By Angela Moore, Maria Caspani and Arlene Washington NEW YORK/LOS ANGELES (Reuters) - Raising black boys in America involves "constant mental anguish," Danielle Pattillo, a special education teacher in New York City and mother to two sons, ages 14 and 22, said. Every day Pattillo told her sons they were unique, wanted, valued, and loved - "each step in their life, each plateau of their life." But she also prepared them. "I let them know that the world does not love them," Pattillo said. "And just because they don't love you doesn't mean you're not great. And it doesn't mean that you're not important. And it doesn't mean that you don't exist." The death of George Floyd, a 46-year old black man who died in May after a white Minneapolis police officer kneeled on his neck for nearly nine minutes, has triggered widespread protests in the United States and around the world against police brutality and racism. It has also been a painful reminder to black mothers in the U.S. how vulnerable their children, and especially their sons, are to police brutality, at least five women Reuters interviewed said. Police-involved fatalities in the United States average nearly three deaths per day, a 2018 study https://www.reuters.com/article/us-health-race-police-deaths/police-involved-deaths-vary-by-race-and-place-idUSKBN1KL2M4 in the American Journal of Public Health showed, and black men are more than twice as likely to be killed during them than white men. One in every 1,000 black men in the United States will be killed by a police officer, vs. one in every 2,000 men overall, a 2019 study https://www.pnas.org/content/116/34/16793 by the National Academy of Sciences found. Floyd's death follows a string of other high profile deaths of unarmed African Americans at the hands of police, including the shooting of 12-year-old Tamir Rice in Ohio in 2014, the choking death of Eric Garner in New York City in 2014, and the March shooting of Breonna Taylor in Kentucky during a "no knock" arrest that targeted the wrong house. On June 12, Rayshard Brooks, a black man, was fatally shot in the back by police in Atlanta, after being found asleep in a parking lot. DREADING 'THE TALK' FOR YEARS Pattillo said she sobbed the first time she sat down her younger son, then 12 years old, to have what's known in the black community as "The Talk" - about how to behave when you are inevitably stopped by police, so you don't become another statistic. Speak slowly, keep your school I.D. on you, but don't put your hand in your pocket to reach for it without asking. Don't give the officer anything that could be considered sass. "These are not conversations that you should be having with your children who are 12," she said. The Talk is so ubiquitous that the National Black Police Association (NBPA) holds a dramatized version with police officers, judges and prosecutors in high schools, and distributes a written guide https://542b2294-673b-4866-8ef1-b8424d1a03f3.filesusr.com/ugd/c725f7_2a8e3072c4d14e59a05272a8c370ed05.pdf entitled "What to Do When Stopped by the Police." "We show how quickly it can go bad," explained Regina Holman, a retired police officer in Las Vegas, president of the NBPA in Nevada, and mother and grandmother. Officers teach students "they have a very good chance that their cars are going to be ransacked, and they're not going to be treated right." "When they become non-compliant, that's when things go wrong," Holman said. "We teach them you cannot fight your battles at that moment." Neakai Lewis, an event producer in Los Angeles, lives in upscale neighborhood View Park nicknamed "The Black Beverly Hills," that has been home to entertainers Ray Charles and Tina Turner. Lewis created "The Mom Group," for black women in Los Angeles to address additional stresses they face as parents. Even though her son is only 21 months old, she's already planning The Talk. "It's years of just drilling it in that everybody is beautiful, everybody deserves respect but you have a certain tone to your skin that for some reason is going to make you a threat - so here are the things that you're going to need to do to survive and this is real," said Lewis. "It's my duty as his mom to prepare him." Chantal Bonitto, 38, is raising a five-year-old son, and gave birth to a second baby boy with her white husband in New York earlier this month. Race has always been a part of family conversations, and she's already guiding her son's behavior due to fear of racial biases. "He can't be the wild kid. He wants to be the class clown. You cannot be the class clown," she said. "I fear the day when he turns 10, and that admiration for this cute little curly-haired boy turns into fear," she said. Bonitto said she's trying to instill the same confidence in her son her parents instilled in her as a black girl growing up in Brooklyn. "Most of all, that if someone does discriminate against him or makes him feel like he is 'lesser than,' in his heart he knows that's not true." Bonitto's father was a corrections officer, she said. "I know and respect that his job paid for my college tuition, it provided me with healthcare and benefits, but the compromise was that he saw a flawed criminal justice system that locked up men that looked like him." Bonitto said she wants her son to be "wary of all authority figures who wear a badge and a gun." "I don't deny that there are good cops," Lewis said. But, she added, "How can you respect or how can you look up to somebody that you constantly have to fear?" POLICE GRAPPLE WITH THEIR ROLE Floyd's death has prompted an unprecedented national conversation about the role of police in America, and their treatment of African Americans. On June 15, New York Governor Andrew Cuomo signed a police reform bill, flanked by mothers who has lost their black sons to police violence. Some black mothers who made their careers in law enforcement find they're struggling for answers. "My grandson is 17," said Holman, who served on the Las Vegas police force for over 27 years. "He said to me, 'You taught me to respect the police. You always told me to comply. But look at George Floyd. He respected the police, and now he's dead. What do I do now?'" The fear that black boys and their parents are feeling "is something that is hard to fight," said Zsakhiem James, a police captain in Camden, New Jersey, a city that has reformed https://www.reuters.com/article/us-minneapolis-police-protests-camden/one-american-citys-model-of-policing-reform-means-building-social-currency-idUSKBN23J2RU law enforcement in recent years to focus on de-escalation and community policing. "Especially in light of the George Floyd incident," James said. "It's not just a fear of the Camden County Police. It's a fear of all police." 'WE CAN'T DO IT ALONE' Black women in the United States are under a unique set of stresses, said Lori Hoggard, associate professor of psychology and director of the Racism, Identity, Coping, and Health Lab at Rutgers University in New Brunswick, New Jersey. The stress they experience contributes to the disproportionately high levels of depression and cardiovascular disease, among other health problems, Hoggard said. Pattillo and other mothers say they feel pressure to fix the impacts of systemic racism on the men in her life, and especially their sons. "Black women have been tasked with having to be trauma surgeons for situations that we are not trained for... This is not something that only the black community can do, because the black community didn't put the black community in this predicament. So we can't do it alone."
1262
L1N2DV135
1662473438
MINNEAPOLIS-POLICE/BLACK WOMEN (TV)
Mothers as 'trauma surgeons:' the anguish of raising black boys in America
3
['Americas', 'United States', 'North America']
['AMERS', 'US', 'NAMER']
['Anxiety Disorders', 'Cardio', 'Cyclical Consumer Services', 'Crime / Law / Justice', 'Crime', 'Consumer Cyclicals', 'Cyclical Consumer Goods & Services', 'Depression', 'Economic Indicator Published', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Heart / Cardiac Disease', 'Healthcare', 'Human Diseases / Conditions', 'Economic Events', 'Media & Publishing', 'Media & Publishing', "Men's Health", 'Mental Illness', 'Paediatric Medicine', 'Psychology', 'Media / Publishing (Legacy)', 'Public Health', 'Race Relations / Ethnic Issues', 'Society / Social Issues', 'Technology / Media / Telecoms', "Women's Health"]
['ANXIET', 'CARDIO', 'CCOS', 'CLJ', 'CRIM', 'CYCS', 'CYCS08', 'DEPRES', 'ECI', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HEARCA', 'HECA', 'HUMDIS', 'MCE', 'MDIA', 'MDIA08', 'MENHEA', 'MENTIL', 'PEDMED', 'PSYCHO', 'PUB', 'PUBHEA', 'RACR', 'SOCI', 'TMT', 'WOMHEA']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DV18F:1991398240
0
By David Douglas NEW YORK (Reuters Health) - Patients undergoing surgical aortic-valve replacement (SAVR) following problems with an initial transcatheter aortic-valve replacement (TAVR) appear to have particularly poor outcomes, according to a retrospective analysis. As Dr. Oliver K. Jawitz told Reuters Health by email, "SAVR after early failure of TAVR devices appears to be a complex, technically demanding procedure associated with long operative times, increased perioperative morbidity, and higher than expected operative mortality." In a paper in JACC: Cardiovascular Interventions, Dr. Jawitz of Duke University School of Medicine, in Durham, North Carolina, and colleagues observe that as TAVR grows more popular, management of device failure will become increasingly important. "However," they say, "the outcomes of re-operation for TAVR failure are unknown." Out of about 40,000 TAVR procedures in the Society of Thoracic Surgeons Adult Cardiac Surgery Database, the researchers identified 123 patients with a history of prior TAVR who underwent SAVR between 2011 and 2015. "This dataset," they write, "is a unique mix of patients who were considered either intermediate or high-risk at the time of the initial TAVR procedure, but still low enough risk that they were candidates for a SAVR at the time of TAVR failure." Paravalvular leak, failed repair and structural prosthetic deterioration were among the most common reasons for surgical re-intervention. Median time to re-operation was 2.5 months. To examine how patients fared after SAVR, the researchers compared the Society of Thoracic Surgeons predicted mortality rate (PROM) with actual mortality. Seventeen percent of patients had a PROM of less than 4%, 24% had one of 4% to 8% and 59% had a higher PROM. The operative mortality rate was 17%, "higher than would be expected in a similar population of patients undergoing repeat SAVR," the researchers write. For all levels of preoperative risk, the observed mortality was higher than what would have been expected. "Further research is needed to define the role of SAVR versus valve-in-valve TAVR as well as refine operative techniques for explanting failed TAVR devices, especially as the population of patients undergoing TAVR become younger, healthier, and structural valve deterioration becomes more common," Dr. Jawitz concluded. Dr. Michael J. Reardon of Houston Methodist Hospital, in Texas, co-author of an accompanying editorial, told Reuters Health by email, "This study suggests that a TAVR first followed by a surgical valve may be risky." "Young patients who choose a biologic valve AVR to treat severe aortic stenosis will likely require more than one valve in their lifetime," he said. "Do they choose surgical AVR and then surgical redo AVR if the valve fails?" These techniques "are well worked out but involve two open-heart surgeries," he added. Dr. Reardon points out in his editorial that the possible need in younger patients for multiple valves in their lifetime "has led some to suggest the strategy of TAVR for the initial aortic valve replacement. If and when the first TAVR valve fails, the patient is still a reasonable candidate for a first time SAVR. If this SAVR fails when the patient is much older, then a TAVR in SAVR might be considered." However, "This strategy hinges on the presumption that the first time SAVR after a TAVR will be of no more risk than a first time SAVR alone. The answer to that assumption is unknown." SOURCE: https://bit.ly/2zEAkF9 and https://bit.ly/30O83qJ JACC: Cardiovascular Interventions, online June 10, 2020
558
L1N2DV18F
1991398240
AORTIC VALVE-REPLACEMENT/
SAVR following TAVR may present extra risks
3
[]
[]
['Cardiac Intervention', 'Cardio', 'Clinical Medicine', 'General News', 'General Health', 'Health / Medicine', 'Heart / Cardiac Disease', 'Healthcare', 'Human Diseases / Conditions', 'Surgery']
['CARDIN', 'CARDIO', 'CLIMED', 'GEN', 'GENHLT', 'HEA', 'HEARCA', 'HECA', 'HUMDIS', 'SURGER']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DV1HD:425970682
0
(Changes "specific" to "synthetic" in para 6 of 6-19 story) By Megan Brooks NEW YORK (Reuters Health) - Patients with some inflammatory rheumatic conditions are at higher risk for hospital-diagnosed COVID-19 infection compared with the general population, but it depends on the condition and therapy used to treat it, according to a study from Spain. It's now clear that older patients and those with some common diseases are at increased risk for more severe COVID-19 disease, "but we did not know about patients with rheumatic diseases," coauthor Dr. Jose Pablos of the Research Institute Hospital 12 de Octubre, in Madrid, told Reuters Health by email. For their study, Dr. Pablos and colleagues used data from more than 26,000 patients being followed in hospital rheumatology departments for positive SARS-CoV-2 PCR tests and a reference population of 2.9 million adults. Overall, patients with any rheumatic disease had 1.32-fold greater odds of hospital-diagnosed COVID-19 than the reference population (0.76% vs. 0.58%), the researchers report in Annals of the Rheumatic Diseases. However, not all diseases conferred the same risk. Patients with rheumatoid arthritis or psoriatic arthritis showed similar COVID-19 rates compared with the reference population despite their older age. However, specific groups of inflammatory arthritis, including patients with spondyloarthritis (0.89%; odds ratio, 1.54) and those on targeted-synthetic and biologic disease-modifying antirheumatic drug therapy (0.94%; OR, 1.60) had higher rates of COVID-19. "This suggests that these specific immunomodulators may increase the risk for COVID-19, similarly as for other viral infections," the authors report. Conventional DMARDS did not seem to increase the risk of COVID-19. COVID-19 prevalence was relatively low in patients with systemic lupus erythematosus (0.62%; OR, 1.07), despite an expected greater use of corticosteroids and immunosuppressants. A possible explanation is the frequent use of antimalarials, which may provide some protection, the researchers suggest. The relatively low prevalence in SLE contrasts with the significant increase observed in all other autoimmune or immune-mediated inflammatory diseases (AI/IMID overall prevalence, 1.11%; OR, 1.92; AI/IMID non-SLE, 1.54%; OR, 2.69). Patients with polymyalgia rheumatica giant cell arteritis (PMR-GCA) also had an increased rate of COVID-19 (1.45%; OR, 2.53). COVID-19 was associated with older age in some but not all diagnostic groups. Dr. Pablos said this information could help "tailor specific recommendations on COVID-19 to rheumatic patients. The mentioned groups (autoimmune, biologic therapy) are at higher risk to get more severe COVID-19 than the general population" and should adhere to general prevention measures and seek early medical care if they develop symptoms. "Other groups of patients (lupus, arthritis on conventional therapy) should also know that they are not at increased risk. We also always recommend maintaining previous therapies to avoid worsening of the rheumatic disease that may also increase the risks for infections and many other complications," said Dr. Pablos. The study had no commercial funding and the authors declared no conflicts of interest. SOURCE: https://bit.ly/2zJZySy Annals of the Rheumatic Diseases, online June 12, 2020.
484
L1N2DV1HD
425970682
COVID19-RHEUMATOLOGY/ (CORRECTED)
REFILE-Some rheumatic diseases tied to higher risk of severe COVID-19
3
[]
[]
['Arthritis', 'Bone Muscle Joint Diseases', 'Clinical Medicine', 'Dermatological Disorders', 'Epidemiology', 'General News', 'General Health', 'Health / Medicine', 'Human Diseases / Conditions', 'Immunology', 'Infectious Diseases', 'Psoriasis', 'Rheumatic Conditions']
['ARTHRI', 'BMJDIS', 'CLIMED', 'DERMAT', 'EPMEOL', 'GEN', 'GENHLT', 'HEA', 'HUMDIS', 'IMMOGY', 'INFDIS', 'PSOR', 'RHEUMA']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DV1OJ:1568565748
0
By Will Boggs MD NEW YORK (Reuters Health) - Astrocytes can be infected with HIV and release virus that can move from the brain to the rest of the body, according to a new study in mice. "We were surprised that a small fraction of infected astrocytes (roughly 2,500 infected astrocytes in a mouse brain that has millions of astrocytes) can still facilitate HIV extravasation from the brain back to the periphery," said Dr. Lena Al-Harthi of Rush University Medical Center, in Chicago. "Interestingly, the human brain has billions of astrocytes," she told Reuters Health by email. "As such, even with a low rate of HIV infection of astrocytes and mechanisms that induce HIV latency in these cells, bursts of HIV from astrocytes can contribute to the overall viral reservoir outside of the brain." HIV is known to infect the brain in acute disease, but it has remained unclear whether long-lived infected brain cells release productive virus that can egress from the brain to reseed peripheral organs and whether astrocytes are productively infected in vivo. Dr. Al-Harthi and colleagues developed a chimeric human astrocytes/human peripheral blood mononuclear cell (PBMC) mouse model to assess the role of astrocytes in supporting productive HIV replication in vivo and their role in disseminating HIV to tissues outside of the brain. HIV-infected human astrocytes engrafted into NSG mice brains survived and supported HIV replication in vivo without disrupting the blood-brain barrier. Transplantation of HIV-infected astrocytes into neonatal or adult NSG mice brain resulted in HIV egress from the brain into peripheral organs, the researchers report in PLOS Pathogens. Virus initiated from astrocytes continued to replicate and evolve/mutate to mimic the viral evolution observed in early peripheral infection. Depleting PBMCs of both CD4+ T cells and monocytes prior to reconstitution of HIV-infected astrocytes in NSG mice significantly reduced HIV egress into peripheral organs, suggesting that trafficking of infected T cells is responsible for HIV egress out of brain in this model. Additional experiments showed that astrocytes can be infected as a result of systemic HIV infection and that HIV-infected astrocytes can support low levels of HIV egress from the brain during antiretroviral therapy. Human brain from HIV-infected donors under effective combination antiretroviral therapy (cART) showed evidence of HIV infection in as many as 7% of astrocytes. "As astrocytes, microglia/macrophages have all been shown to harbor productive HIV, the brain must be considered as an important reservoir/sanctuary site that under the appropriate signal(s) may become reactivated and spread HIV to peripheral organs, further complicating HIV cure efforts," the authors conclude. "People living with HIV (PLWH) under anti-HIV therapy and maximum viral suppression experience viral blips and the virus does come back after treatment interruption," Dr. Al-Harthi said. "The field has largely focused on the role of resting memory T cells as a reservoir of HIV, which is targeted for HIV cure strategies. While this focus is justified, it does not address the overall picture of sanctuary sites and especially the role of the brain as an HIV reservoir nor consequence of treatments on the brain." "The brain is impacted by HIV, both due to direct (virus infection) and indirect (inflammation) effects on the brain, and these effects persist even in the era of" combination antiretroviral therapy, she said. "PLWH may complain of depression and/or neurocognitive impairment, and it is important for physicians to seek the support of neurologists specializing in HIV treatment to support these patients." SOURCE: https://bit.ly/30QMLsz PLoS Pathogens, online June 11, 2020.
577
L1N2DV1OJ
1568565748
HIV-BRAIN/
HIV infects astrocytes, moves from brain to periphery
3
[]
[]
['AIDS / HIV', 'General News', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Immunology', 'Infectious Diseases', 'Neurological Disorders', 'Science', 'STDs']
['AIDSHI', 'GEN', 'HEA', 'HECA', 'HUMDIS', 'IMMOGY', 'INFDIS', 'NEUROL', 'SCI', 'SEXTRA']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DV1OZ:992974421
0
By Will Boggs MD NEW YORK (Reuters Health) - Enzalutamide improves five-year survival in men with chemotherapy-naive metastatic castration-resistant prostate cancer (mCRPC), but increases the risk of fatal adverse events, according to final results from the PREVAIL trial. "When docetaxel was FDA (Food and Drug Administration) approved as the first life-prolonging therapy for men with metastatic castration resistant disease back in 2004, the 5-year survival was less than 5% of these men," said Dr. Andrew J. Armstrong of Duke Cancer Institute, in Durham, North Carolina. "The gratifying data from this PREVAIL trial of enzalutamide shows that many more men with mCRPC are living past 5 years, with 42% of lower-risk men and nearly a quarter of intermediate-risk men," he told Reuters Health by email. PREVAIL was stopped after a preplanned interim analysis revealed enzalutamide superiority compared with placebo in terms of survival and radiographic progression-free survival. At that point, eligible placebo patients were invited to cross over to enzalutamide in an open-label extension. In the current study, Dr. Armstrong and colleagues evaluated long-term safety and efficacy of enzalutamide and five-year survival estimates based on pretreatment prognostic factors and risk groups, as well as posttreatment declines in PSA. Placebo patients who crossed over to enzalutamide in the extension study were included in the placebo group for the final analysis of overall survival. At the five-year overall survival analysis, enzalutamide reduced the hazard of death by 17% compared with placebo (P<0.001). At a median follow-up of 69 months, median overall survival was 36 months in the enzalutamide group versus 31 months in the placebo group, the researchers report in European Urology. Enzalutamide maintained a long-term survival advantage over placebo despite 68% of placebo-treated men receiving subsequent enzalutamide or abiraterone. Only among men with baseline liver metastases did enzalutamide not appear to confer an overall survival advantage. Based on an updated 11-factor prognostic model, five-year survival rates decreased with increasing risk group, from 42% for the low-risk group to 24% for the intermediate-risk group and 5% for the high-risk group. Similarly, five-year survival rates increased with greater drops in prostate-specific antigen (PSA) after treatment (from 9% for men with no PSA decline to 67% for men whose PSA declined to undetectable levels). Men treated with enzalutamide had higher rates of treatment-emergent adverse events leading to death (6.9% vs. 3.8% with placebo), fatal cardiovascular treatment-emergent adverse events (1.6% vs. 0.4%), and drug-related fatal cardiovascular events (two cases, or 0.2%, vs. none with placebo). The prognostic model used to stratify patients in this study is available as an online calculator that can provide patient-specific information to guide communications and goals for care at https://www.mdcalc.com/prevail-model-prostate-cancer-survival. "While no prognostic model is perfect, and treatment advances every year are pushing survival beyond current expectations, it is important to have the most up-to-date estimates of risk for patient communications," Dr. Armstrong said. "This calculator can also be invaluable for the design of new treatments which intend to beat these expectations, particularly in those men with higher risk metastatic prostate cancers." "We still need better treatment for high-risk men in this setting, as these patients still have a less than 5% 5-year survival," he said. Dr. Philip Kantoff of Memorial Sloan Kettering Cancer Center and Weill Cornell Medical School, in New York City, who studies advanced prostate cancer, told Reuters Health by email, "Enzalutamide has life-prolonging effect in men with metastatic castration-resistant prostate cancer but has toxicity including increased rates of non-cancer death. Risks and benefits need to be balanced and individualized." He added that enzalutamide is "one of multiple options for men, including abiraterone, apalutamide, and darolutamide." Pfizer Inc. funded the study and had financial ties to all of the authors. SOURCE: https://bit.ly/37CGvWJ European Urology, online June 9, 2020.
620
L1N2DV1OZ
992974421
PROSTATE-CANCER/ENZALUTAMIDE
Enzalutamide improves survival in men with metastatic prostate cancer
3
[]
[]
['Clinical Medicine', 'Cancer', 'Drug Safety', 'General News', 'General Health', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', "Men's Health", 'Pharmaceuticals & Medical Research', 'Prostate Cancer', 'Urological Disorders']
['CLIMED', 'CNCER', 'DRUSAF', 'GEN', 'GENHLT', 'HEA', 'HECA', 'HUMDIS', 'MENHEA', 'PHMR', 'PROSCA', 'UROLOG']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DV1Q4:236103670
0
By Megan Brooks NEW YORK (Reuters Health) - Treatment with the sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin for heart failure (HF) may help prevent the onset of type 2 diabetes (T2D), according to a planned exploratory analysis of the DAPA-HF trial. "While the major role of dapagliflozin in patients with heart failure with reduced ejection fraction is to reduce cardiovascular mortality and worsening heart failure, decreasing the incidence of type 2 diabetes may be considered an additional benefit, especially since incident diabetes is associated with greater mortality," said lead researcher Dr. Silvio Inzucchi of Yale University School of Medicine, in New Haven, Connecticut, in presenting the findings at the American Diabetes Association (ADA) 2020 virtual scientific sessions. SGLT-2 inhibitors were originally developed to treat type 2 diabetes. "DAPA-HF is the first trial to demonstrate a diabetes prevention effect from an SGLT-2 inhibitor," Dr. Inzucchi said. In the original DAPA-HF trial, 4,744 adults with HF and reduced ejection fraction, with or without T2D, were randomly assigned to take either 10 mg of dapagliflozin or placebo once daily. Dapagliflozin reduced the risk for worsening HF and cardiovascular death by 26% over a median of 18.2 months (https://bit.ly/2BfsOAT). The planned exploratory analysis focused on patients in the trial who did not have T2D at baseline. Of these, 1,298 were in the dapagliflozin group, and 1,307 in the placebo group. New-onset T2D was defined as hemoglobin (Hb)A1C at or above 6.5% on two consecutive visits during follow-up. Altogether, 157 people developed T2D, most of whom had pre-diabetes at baseline (HbA1C of 5.7% to 6.4%). Individuals who developed T2D had higher average HbA1C levels, greater BMI and lower level of kidney function than those who did not develop T2D. Treatment with dapagliflozin reduced the risk of T2D onset by 32% (HR 0.68; 95% CI 0.50 to 0.94; 4.9% of patients in the dapagliflozin arm developed T2D during follow-up, compared with 7.1% in the placebo arm. In an additional exploratory analysis, compared with individuals who did not develop T2D during the trial, those that did had a 70% increased risk of dying from any cause, after adjustment for baseline features. "Dapagliflozin is the first medication demonstrated to reduce both incident T2D and mortality in a single trial," Dr. Inzucchi said. The DAPA-HF trial was sponsored by AstraZeneca, which makes dapagliflozin. Dr. Inzucchi has financial relationships with the company. SOURCE: https://bit.ly/3ec1F09 American Diabetes Association (ADA) 2020 Virtual Scientific Sessions.
401
L1N2DV1Q4
236103670
HEART FAILURE-DIABETES/DAPAGLIFLOZIN
Dapagliflozin for heart failure protects against type 2 diabetes
3
[]
[]
['Cardio', 'Clinical Medicine', 'Diabetes', 'Endocrinology', 'General News', 'General Health', 'Health / Medicine', 'Heart Failure / ACS', 'Heart / Cardiac Disease', 'Healthcare', 'Human Diseases / Conditions', 'Pharmaceuticals & Medical Research']
['CARDIO', 'CLIMED', 'DIABET', 'ENDOCR', 'GEN', 'GENHLT', 'HEA', 'HEAFAL', 'HEARCA', 'HECA', 'HUMDIS', 'PHMR']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DV1SL:1262186725
0
(Updates with quotes from news conference) By Reuters Staff LONDON (Reuters) - Britain will switch to the Apple and Google model for its COVID-19 test-and-trace app, ditching an attempt to develop an app by itself after the homegrown system did not work well enough on Apple's iPhone, the government said on Thursday. The test-and-trace programme is key to reopening the country but has been dogged by problems. A smartphone app developed by the National Health Service (NHS) was initially expected to be rolled out nationwide in May but did not materialise. Health minister Matt Hancock appeared to blame Apple in part for the pivot, adding that the decentralised Google-Apple system would benefit from work done on the abortive NHS app. "As it stands, our app won't work because Apple won't change their system, but it can measure distance. And their app can't measure distance well enough, to a standard we are satisfied with," he said at the daily news conference. "So we've agreed to join forces with Google and Apple, to bring the best bits of both systems together." Dido Harding, head of the test-and-trace programme has described the app as the "cherry on the cake" of the overall test-and-trace system, playing down its centrality to the programme. But figures for the second week of England's test-and-trace showed that while over 85,000 people who had tested positive for the new coronavirus had been reached in the first two weeks, over 25% of positive cases could not be reached. Officials running the programme admitted that the change of tack on the app was unplanned but denied that it was a setback, emphasising that they did not want to rush out an app which fell short of standards. But the opposition Labour party said that warnings about the homegrown app had not been heeded. "This is unsurprising and yet another example of where the government’s response has been slow and badly managed. It’s meant precious time and money wasted," Labour health spokesman Jon Ashworth said. Britain's adoption of the 'decentralised' approach for its app followed a growing number of European countries, including Italy, Switzerland, Germany and Austria. But Apple and Google's model has frustrated governments, as they undercut the technology's usefulness by prioritising user privacy. The pivot happened after the NHS app, which was being tested on the Isle of Wight off the southern coast of England, was found to work well on Google's Android operating systems but not on Apple iPhones. However, Britain wants further improvements to the Google-Apple platform, meaning that the original hope of a launch in May is set to be missed by months rather than weeks. "We're not going to put a date on it I'm afraid because I'm absolutely determined that whilst this technology can help, it's got to be working effectively," Hancock said.
468
L1N2DV1SL
1262186725
HEALTH-CORONAVIRUS/BRITAIN-APP (UPDATE 1)
UPDATE 1-UK ditches homegrown COVID-19 tracing app to use Google-Apple model
3
[]
[]
['Corporate Events', 'Communicable Diseases', 'Economic Indicator Published', 'Epidemiology', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Economic Events', 'Medical Ethics', 'Public Health', 'Regulation / Compliance', 'Technology', 'Technology', 'Technology / Media / Telecoms']
['BACT', 'COMDIS', 'ECI', 'EPMEOL', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MCE', 'MEDETH', 'PUBHEA', 'REGS', 'TECH', 'TECH08', 'TMT']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DV23K:1661418980
0
By Suzanne Barlyn (Reuters) - Commercial insurers are scrutinizing building managers' efforts to avoid outbreaks of Legionnaires' disease as they re-open movie theaters, gyms, schools and offices that had been closed for months due to the coronavirus pandemic, industry sources told Reuters. Legionnaires' disease is a severe, sometimes-lethal form of pneumonia caused by the Legionella bacteria that builds up in pipes. Environmental insurers, which collect roughly $2 billion in annual premiums, would be on the hook for damages if there are outbreaks at buildings they cover. "Legionella could be the deadliest waterborne illness in the U.S. and another deadly consequence of COVID," said Veronica Benzinger, environmental service group leader for insurance broker Aon PLC, referring to the illness caused by the novel coronavirus. The pandemic shutdown of businesses and schools has led to an unprecedented amount of stagnant water in dormant buildings. It becomes a breeding ground for Legionella bacteria, which can be spread from toilets, sinks, showers and air-conditioning systems. Some insurers are intensifying Legionnaire's precautions before adding new clients or renewing coverage, insurers and brokers said. For instance, they may ask customers to document how they maintain plumbing and cooling systems. Large commercial office buildings and manufacturing plants have professional maintenance staff who likely kept water flowing throughout the crisis. Smaller buildings that insurers cover are at higher risk, experts said. To avoid contamination, they must flush and sanitize pipes and disinfect cooling towers that use water to lower air temperature, they said. The bacteria and disease get their name from a deadly outbreak following a 1976 American Legion convention in a Philadelphia hotel. The bacteria was ultimately discovered in the cooling tower of the hotel's air conditioning system. Nearly 50,000 people have been infected with Legionnaires' disease between 2000 and 2015, according to the U.S. Centers for Disease Control and Prevention. Allianz SE has added Legionnaires' prevention to broader discussions with large industrial clients about the coronavirus pandemic, said Scott Steinmetz, global head of risk consulting within an Allianz specialty insurance. Allianz has engineers helping customers prepare for reopening, he said. Allianz and AXA SA are also sending bulletins to clients about water system maintenance. Insurers might limit Legionnaire's coverage amounts or impose higher deductibles if building systems are outdated, brokers said. Insurers were already worried about possible outbreaks, because of elevated lawsuits and claims. They are stepping up their scrutiny even more due to the coronavirus pandemic. In April, Illinois agreed to pay $6.4 million to families of patients who died of Legionnaires' disease at a state-run veterans home. Other deaths have occurred in New York and Michigan.
432
L1N2DV23K
1661418980
HEALTH-CORONAVIRUS/INSURANCE-LEGIONNAIRES (PIX)
U.S. insurers eye Legionnaires' disease safeguards as buildings re-open from pandemic shutdowns
3
[]
[]
['Corporate Events', 'Economic Indicator Published', 'Financials (Legacy)', 'Financials', 'Financials', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Insurance', 'Life & Health Insurance', 'Economic Events', 'Public Health', 'Regulation / Compliance', 'Respiratory Conditions']
['BACT', 'ECI', 'FIN', 'FINS', 'FINS08', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'INSR', 'LINS', 'MCE', 'PUBHEA', 'REGS', 'RESPIR']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DV2F6:2070433930
0
By Reuters Staff LOS ANGELES (Reuters) - California on Thursday ordered residents to wear masks in "most settings outside the home," saying the new rule was necessary because too many Californians were neglecting to cover their faces during the coronavirus pandemic. Residents must wear masks outdoors and "in any indoor space," with exceptions made for diners while they are eating or drinking and people engaging in outdoor recreation, as long as they maintain 6 feet of physical distance. "Science shows that face coverings and masks work," Governor Gavin Newsom said in a statement. "They are critical to keeping those who are around you safe, keeping businesses open and restarting our economy." It was not immediately clear how the order would be enforced. California was the first U.S. state to impose statewide stay-at-home restrictions and mandatory workplace closures, on March 19.
140
L1N2DV2F6
2070433930
HEALTH-CORONAVIRUS/USA-CALIFORNIA
California orders residents to wear masks in 'most settings outside the home'
3
['Americas', 'United States', 'North America']
['AMERS', 'US', 'NAMER']
['Communicable Diseases', 'Economic Indicator Published', 'Epidemiology', 'Epidemics', 'General News', 'General Health', 'Healthcare Policy', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases', 'Economic Events', 'Medical Law', 'Public Health', 'Respiratory Conditions']
['COMDIS', 'ECI', 'EPMEOL', 'EPMICS', 'GEN', 'GENHLT', 'HCPOL', 'HEA', 'HECA', 'HUMDIS', 'INFDIS', 'MCE', 'MEDLAW', 'PUBHEA', 'RESPIR']
[]
[]
en
English
tag:reuters.com,2020:newsml_L1N2DW0SN:1862420637
0
By Will Boggs MD NEW YORK (Reuters Health) - The use of personal protective equipment (PPE) can increase the risk of overheating, but several strategies can reduce this risk, researchers in the Netherlands report. "Cooling strategies can be used prior to, during, or after working activities and could reduce thermal strain, improve thermal discomfort, reduce the cardiovascular strain, and reduce dehydration (i.e. rehydration effect of ice slurry ingestion)," said Dr. Coen C. W. G. Bongers of Radboud University Medical Center, in Nijmegen. "As a result, healthcare providers (HCP) will be better able to cope with the negative consequences of wearing PPE and work-tolerance times might be extended," he told Reuters Health by email. Dr. Bongers and colleagues describe thermal regulatory challenges associated with PPE use, along with cooling strategies and their effects, in an infographic in the British Journal of Sports Medicine. PPE creates a microclimate around the skin that reduces its capacity for heat loss. That, combined with longer shifts, can result in increased core temperature, increased sweat rates and dehydration. Cooling devices worn under PPE have been shown to decrease the physiological and subjective strain in a simulated hot and humid laboratory environment. Any cooling strategy must be safe and hygienic, rapidly scalable and accessible for every hospital, and easy to implement in clinical settings. Two examples of cooling strategies that could be used in clinical settings are cold water/ice slurry ingestion and cooling vests. The type, frequency, and extent of cooling interventions can be optimized depending on the setting, PPE wear time, physical duties and personal preferences. These cooling strategies can be applied prior to, during and after working activities with PPE, but there is less evidence for the benefits of postcooling compared with precooling and cooling during activities. "Wearing PPE during COVID-19 medical duties leads to an additional thermal burden for HCP, which could decrease their physical and cognitive performance, but can be easily counteracted by implementing cooling strategies prior to, during, or after working activities," Dr. Bongers said. "The infographic that we developed can help healthcare personnel to implement these strategies into daily practice." As temperatures rise in the northern hemisphere during summer, he added, "the need to counteract this heat stress proactively using cooling strategies is very important." SOURCE: https://bit.ly/3e9c8tr British Journal of Sports Medicine, online June 10, 2020.
385
L1N2DW0SN
1862420637
COVID19-PPE/OVERHEATING
Cooling strategies can prevent overheating while wearing PPE
3
[]
[]
['Clinical Medicine', 'Communicable Diseases', 'General News', 'General Health', 'Healthcare Professional Development', 'Health / Medicine', 'Healthcare', 'Human Diseases / Conditions', 'Infectious Diseases']
['CLIMED', 'COMDIS', 'GEN', 'GENHLT', 'HCPROF', 'HEA', 'HECA', 'HUMDIS', 'INFDIS']
[]
[]
en
English

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