Podcasts about preventive services task force

In Kennedy v. Braidwood Management, Inc. the Supreme Court will consider "Whether the U.S. Court of Appeals for the 5th Circuit erred in holding that the structure of the U.S. Preventive Services Task Force violates the Constitution's appointments clause and in declining to sever the statutory provision that it found to unduly insulate the task force from the Health & Human Services secretary’s supervision."In Kennedy v. Braidwood Management, Inc., several Christian-owned businesses, along with six individuals in Texas, brought suit alleging that the Affordable Care Act's preventative services coverage requirement was illegal and unconstitutional. They contend it violates the Religious Freedom Restoration Act, as the ACA required them to fund preventative services that conflicted with their religious beliefs, and that it violates the Constitution’s Appointments Clause, given the controlling effect of a non-appointed advisory body over which preventative treatments were required. Given those issues, the case sits at an interesting intersection of health law, religious liberty law, and administrative procedure, and the Supreme Court is set to hear oral argument on April 21, 2025.Join us for a Courthouse Steps program where we break down and analyse how oral argument went before the Court.Featuring:Timothy Sandefur, Vice President for Legal Affairs, Goldwater Institute

This Day in Legal History: Mutiny on the BountyOn April 28, 1789, one of the most famous acts of rebellion at sea occurred aboard the HMS Bounty. Captain William Bligh and 18 loyal crew members were forcibly set adrift in the Pacific Ocean by mutineers led by Fletcher Christian. The incident exposed deep tensions over leadership, working conditions, and authority in the Royal Navy. British law at the time treated mutiny as a capital offense, reflecting the critical importance of discipline aboard ships. After the mutiny, an intense search for the culprits began, with some mutineers eventually captured and returned to England to stand trial.The ensuing court-martial proceedings offered early insight into naval justice and the balancing act between maintaining strict command and recognizing crew grievances. Defendants argued that Bligh's harsh leadership provoked the uprising, but the Admiralty was unwavering in its stance against insubordination. Of those captured, three were found guilty and hanged, while others were acquitted or pardoned. The legal handling of the mutiny reinforced the severe consequences for undermining maritime authority. It also prompted discussions about humane treatment of sailors, subtly influencing later reforms in naval discipline.The Mutiny on the Bounty became a lasting symbol in both legal and cultural history, illustrating how law functions as both a tool of control and a response to the realities of human endurance and dissent at sea.Seven Democratic senators on the U.S. Senate Judiciary Committee have requested information from the Justice Department regarding recent changes within its civil rights division under President Donald Trump's administration. In a letter sent Friday, they expressed concern over the reassignment of several career officials, suggesting these moves could be an attempt to pressure staff into leaving and shift the division's enforcement priorities. Since Trump's return to office and the appointment of Pam Bondi as Attorney General, the department has paused investigations into police misconduct, launched a gun rights investigation in Los Angeles, and altered its approach to transgender rights cases. It has also opened investigations into antisemitism related to pro-Palestinian protests at colleges. The senators emphasized the importance of nonpartisan career staff in maintaining the integrity of civil rights enforcement. About a dozen senior attorneys specializing in voting, police, and disability rights were among those reassigned. The Justice Department has not yet commented on the senators' letter.Democratic senators question US Justice Department on civil rights changes | ReutersThe U.S. Drug Enforcement Administration announced that federal law enforcement agencies raided a nightclub in Colorado Springs, arresting over 100 individuals who were in the U.S. illegally. The operation resulted in 114 arrests out of more than 200 people present at the venue, making it one of the largest immigration-related raids since President Donald Trump's second term began. Attorney General Pam Bondi stated that the raid also led to the seizure of cocaine, methamphetamine, and "pink cocaine," and two individuals were arrested on outstanding warrants. Bondi mentioned links to gangs like Tren de Aragua and MS-13, although she did not directly confirm whether those arrested were affiliated with them. The DEA noted that occupants were given multiple warnings before the raid was executed. This action is part of an intensifying crackdown on illegal immigration under Trump's renewed immigration policies. Separately, ICE recently reported nearly 800 immigration-related arrests in Florida during a multi-agency operation.Over 100 migrants in the US illegally arrested in Colorado nightclub | ReutersThe Supreme Court has requested additional briefing in a case challenging the Affordable Care Act's mandate that insurers cover preventive services, like cancer screenings, at no cost. The justices specifically want the parties to address whether the Secretary of Health and Human Services has the legal authority to appoint members of the U.S. Preventive Services Task Force, which advises on covered treatments. During arguments on April 21, Justice Neil Gorsuch questioned whether the power to remove officials necessarily implies the power to appoint them, an issue the lower court had not considered. The Fifth Circuit Court of Appeals previously ruled that the task force's structure violated the Constitution's appointments clause, arguing its members must be nominated by the president and confirmed by the Senate. The Trump administration contends the task force members are merely "inferior officers" under the HHS Secretary's control. The case also involves objections by Texas businesses and residents to mandatory coverage of HIV prevention drugs, claiming unconstitutional imposition by unelected officials. Supplemental briefs are due by May 5, and while rare, this is not the first time the Court has asked for more information after oral arguments, as seen in past cases like Zubik v. Burwell and Citizens United v. FEC.Supreme Court Orders New Briefs After Obamacare Case Argued (1) This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.minimumcomp.com/subscribe

When a public school adds stories with LGBT themes to its elementary reading curriculum, do religious parents have a First Amendment right to opt out? And did ObamaCare evade a constitutional check when it delegated power to the Preventive Services Task Force? The Supreme Court debates those points in Mahmoud v. Taylor and Kennedy v. Braidwood Management. Learn more about your ad choices. Visit megaphone.fm/adchoices

Each month, a panel of constitutional experts convenes to discuss the Court’s upcoming docket sitting by sitting. The cases covered in this preview are listed below.Kennedy v. Braidwood Management (April 21) - Appointments Clause; Issue(s): Whether the U.S. Court of Appeals for the 5th Circuit erred in holding that the structure of the U.S. Preventive Services Task Force violates the Constitution's appointments clause and in declining to sever the statutory provision that it found to unduly insulate the task force from the Health & Human Services secretary’s supervision.Parrish v. United States (April 21) - Federal Civil Procedure; Issue(s): Whether a litigant who files a notice of appeal after the ordinary appeal period under 28 U.S.C. § 2107(a)-(b) expires must file a second, duplicative notice after the appeal period is reopened under subsection (c) of the statute and Federal Rule of Appellate Procedure 4.Commissioner of Internal Revenue v. Zuch (April 22) - Taxes; Issue(s): Whether a proceeding under 26 U.S.C. § 6330 for a pre-deprivation determination about a levy proposed by the Internal Revenue Service to collect unpaid taxes becomes moot when there is no longer a live dispute over the proposed levy that gave rise to the proceeding.Mahmoud v. Taylor (April 22) - Religious Liberties, Education Law, Parental Rights; Issue(s): Whether public schools burden parents’ religious exercise when they compel elementary school children to participate in instruction on gender and sexuality against their parents’ religious convictions and without notice or opportunity to opt out.Diamond Alternative Energy LLC v. EPA (April 23) - Standing, Redressibility; Issue(s): (1) Whether a party may establish the redressability component of Article III standing by relying on the coercive and predictable effects of regulation on third parties.Soto v. United States (April 28) - Financial Procedure; Issue(s): Given the U.S. Court of Appeals for the Federal Circuit’s holding that a claim for compensation under 10 U.S.C. § 1413a is a claim “involving … retired pay” under 31 U.S.C. § 3702(a)(1)(A), does 10 U.S.C. § 1413a provide a settlement mechanism that displaces the default procedures and limitations set forth in the Barring Act?A.J.T. v. Osseo Area Schools, Independent School District No. 279 (April 28) - ADA; Issue(s): Whether the Americans with Disabilities Act of 1990 and Rehabilitation Act of 1973 require children with disabilities to satisfy a uniquely stringent “bad faith or gross misjudgment” standard when seeking relief for discrimination relating to their education.Martin v. U.S. (April 29) - Supremacy Clause, Torts; Issue(s): (1) Whether the Constitution’s supremacy clause bars claims under the Federal Tort Claims Act when the negligent or wrongful acts of federal employees have some nexus with furthering federal policy and can reasonably be characterized as complying with the full range of federal law; and 2) whether the discretionary-function exception is categorically inapplicable to claims arising under the law enforcement proviso to the intentional torts exception.Laboratory Corporation of America Holdings v. Davis (April 29) - Civil Procedure; Issue(s): Whether a federal court may certify a class action pursuant to Federal Rule of Civil Procedure 23(b)(3) when some members of the proposed class lack any Article III injury.Oklahoma Statewide Charter School Board v. Drummond (April 30) Establishment Clause, Education Law, Federalism and Separation of Powers; Issue(s): (1) Whether the academic and pedagogical choices of a privately owned and run school constitute state action simply because it contracts with the state to offer a free educational option for interested students; and (2) whether a state violates the First Amendment's free exercise clause by excluding privately run religious schools from the state’s charter-school program solely because the schools are religious, or instead a state can justify such an exclusion by invoking anti-establishment interests that go further than the First Amendment's establishment clause requires. Featuring: Thomas A. Berry, Director, Robert A. Levy Center for Constitutional Studies, Cato InstituteProf. Brian T. Fitzpatrick, Milton R. Underwood Chair in Free Enterprise, Vanderbilt University Law SchoolSarah Parshall Perry, Vice President & Legal Fellow, Defending EducationTim Rosenberger, Fellow, Manhattan InstituteProf. Gregory Sisk, Pio Cardinal Laghi Distinguished Chair in Law, Professor and Co-director of the Terrence J. Murphy Institute for Catholic Thought, Law, and Public Policy, University of St. Thomas School of LawFrancesca Ugolini, Former Chief, DOJ Tax Division, Appellate Section(Moderator) Elle Rogers, General Counsel, United States Senator Jim Banks

Administrative Law: Does the U.S. Preventive Services Task Force violate the Appointments Clause? - Argued: Mon, 21 Apr 2025 11:23:10 EDT

A case in which the Court will decide whether the structure of the U.S. Preventive Services Task Force violates the Constitution's Appointments Clause, and whether the provision that insulates the task force from the Health & Human Services secretary's supervision is severable from the rest of the statute.

In the latest episode of Ask Michelle, Michelle provided crucial updates, including the upcoming April Supreme Court ruling regarding the U.S. Preventive Services Task Force's (USPTF) authority on preventative care recommendations, the San Francisco Health Care Security Ordinance (HCSO) annual reporting deadline of May 2, 2025, and the CMS 2025 Marketplace Integrity and Affordability Proposed Rule. Michelle also addressed listener questions, such as the legality of adding an international prescription drug sourcing program to a self-funded medical plan, the necessity of issuing a Summary of Material Modifications (SMM) after a plan and carrier change on January 1, 2025, and whether a fully insured group health plan needs to conduct a Non-Quantitative Treatment Limitation (NQTL) analysis for MHPAEA compliance. Are you curious about a compliance issue? Please submit your questions to AskMichelle@imacorp.com, and Michelle will answer them in the next episode.

A Survivor's Call to Action: Understanding Colorectal CancerThe discussion centers on the critical importance of colorectal cancer awareness, particularly during the month dedicated to its recognition. I emphasize the significance of early detection, underscoring that the survival rate markedly improves when the disease is identified at its localized stage. With colorectal cancer being the second leading cause of cancer-related mortality in the United States, it is paramount for individuals to engage in regular screenings, which the U.S. Preventive Services Task Force recommends starting at the age of 45. Moreover, I highlight the alarming increase in colorectal cancer incidence among adults under 50, which necessitates urgent attention and advocacy for improved healthcare access. The Colorectal Cancer Alliance plays a vital role in this endeavor, providing resources, education, and support to patients and their families while advocating for necessary policy changes.Takeaways: Colorectal Cancer Awareness Month is crucial for educating the public about this disease. Early detection significantly enhances survival rates, particularly when cancer is diagnosed at a localized stage. Regular screenings for colorectal cancer should commence at age 45, or earlier for those at higher risk. The Colorectal Cancer Alliance provides vital resources and support for patients and their families. Awareness and education efforts are essential in combating the rising incidence of colorectal cancer among younger adults. Participating in events and sharing information can greatly contribute to colorectal cancer advocacy and research funding. Links referenced in this episode:ratethispodcast.com/resessions

Episode 183: Colorectal Cancer in Young AdultsFuture Dr. Avila and Dr. Arreaza present evidence-based information about the screening and diagnosis of colorectal cancer and explain the increasing incidence among young adult and the importance to screen early in high risk groups.  Written by Jessica Avila, MS4, American University of the Caribbean School of Medicine. Edits and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.IntroductionJessica: Although traditionally considered a disease only affecting older adults, colorectal cancer (CRC) has increasingly impacted younger adults (defined as those under 50) at an alarming rate. According to the American Cancer Society, CRC is now the leading cause of cancer-related death in men under 50 and the second leading cause in women under 50 (American Cancer Society, 2024). Arreaza: Why were you motivated to talk about CRC in younger patients?Jessica: Because despite advancements in early detection and treatment, younger patients are often diagnosed at later stages, resulting in poorer outcomes. We will discuss possible causes, risk factors, common symptoms, and why early screening and prevention are important. Arreaza: This will be a good reminder for everyone to screen for colorectal cancer because 1 out of every 5 cases of colorectal cancer occur in adults between the ages of 20 and 54. The Case of Chadwick BosemanJessica: Many people know Chadwick Boseman from his role as T'Challa in Black Panther. His story highlights the worrying trend of increasing CRC in young adults. He was diagnosed with stage III colorectal cancer at age 39. This diagnosis was not widely known until he passed away at 43. His case shows how silent and aggressive young-onset CRC can be. Like many young adults with CRC, his symptoms may have been missed or thought to be less serious issues. His death drew widespread attention to the rising burden of CRC among young adults and emphasized the critical need for increased awareness and early screening efforts.Arreaza: Black Panther became a hero not only in the movie, but also in real life, because he raised awareness of the problem in young AND in Black adults. EpidemiologyJessica: While rates of CRC in older populations have decreased since the 1990s, adults under 50 have seen an increase in CRC rates of nearly 50%. (Siegel et al., 2023). Currently, one in five new CRC diagnoses occurs in individuals younger than 55 (American Cancer Society, 2024).Arreaza: What did you learn about the incidence by ethnic groups? Are there any trends? Jessica: Yes, certain ethnic groups are shown to have higher rates of CRC. Black Americans, Native Americans, and Alaskan Natives have the highest incidence and mortality rates from CRC (American Cancer Society, 2024). Black Americans have a 20% higher incidence and a 40% higher mortality rate from CRC compared to White Americans, primarily due to disparities in access to screening, healthcare resources, and early diagnosis. Hispanic and Asian American populations are also experiencing increasing CRC rates, though to a lesser extent.Arreaza: It is important to highlight that Black Americans have the highest rate of both diagnoses and deaths of all groups in the United States. Who gets colorectal cancer?Risk FactorsJessica: Anyone can get colorectal cancer, but some are at higher risk. In most cases, environmental and lifestyle factors are to blame, but early-onset CRC are linked to hereditary conditions. Arreaza: There is so much to learn about colorectal cancer risk factors. Tell us more.Jessica: The following are key risk factors:Modifiable risk factors:Diet and processed foods: A diet high in processed meats, red meat, refined sugars, and low fiber is strongly associated with an increased risk of CRC. Fiber is essential for gut health, and its deficiency has been linked to increased colorectal cancer risk (Dekker et al., 2023).Obesity and sedentary lifestyle: Obesity and physical inactivity contribute to CRC risk by promoting chronic inflammation, insulin resistance, and metabolic disturbances that promote tumor growth (Stoffel & Murphy, 2023).Gut microbiome imbalance: Disruptions in gut microbiota, especially an overgrowth of Fusobacterium nucleatum, have been noted in CRC pathogenesis, potentially causing tumor development and progression (Brennan & Garrett, 2023).Arreaza: As a recap, processed foods, obesity, sedentarism, and gut microbiome. We also have to mention smoking and high alcohol consumption as major risks factors, but the strongest risk factor is a family history of the disease.Non-modifiable risk factors:Genetic predisposition: Although only 20% of early-onset CRC cases are linked to hereditary syndromes such as Lynch syndrome and familial adenomatous polyposis (FAP), individuals with a first-degree relative with CRC are at a significantly higher risk and should undergo earlier and more frequent screening (Stoffel & Murphy, 2023).Arreaza: Also, there is a difference in incidence per gender assigned at birth, which is also not modifiable. The rate in the US was 33% higher in men (41.5 per 100,000) than in women (31.2 per 100,000) during 2015-2019. So, if you are a man, your risk for CRC is slightly higher. Protective factors, according to the ACS, are physical activity (no specification about how much and how often) and dairy consumption (400g/day). Jessica, let's talk about how colon cancer presents in our younger patients.Clinical Presentation and Challenges in DiagnosisJessica: Young-onset CRC is often diagnosed at advanced stages due to delayed recognition of symptoms. Common symptoms include:Rectal bleeding (often mistaken for hemorrhoids)Young individuals may ignore it, believe they do not have time to address it, or lack insurance to cover a comprehensive evaluation.Unexplained weight lossFatigue or weaknessChanges in bowel habits (persistent diarrhea or constipation)This may also be rationalized by dietary habits.Abdominal pain or bloatingIron deficiency anemia.Arreaza: All those symptoms can also be explained by benign conditions, and colorectal cancer can often be present without clear symptoms in its early stages. Jessica: Yes, in young adults, symptoms may be dismissed by healthcare providers as benign conditions such as irritable bowel syndrome (IBS), hemorrhoids, or dietary intolerance, leading to significant diagnostic delays. Arreaza: We must keep a low threshold for ordering a colonoscopy, especially in patients with the risks we mentioned previously. Jessica: We may also be concerned about the risk/benefit of colonoscopy or diagnostic methods in younger adults, given the traditional low likelihood of CRC. Approximately 58% of young CRC patients are diagnosed at stage III or IV, compared to 43% of older adults (American Gastroenterological Association, 2024). Early recognition and prompt evaluation of persistent symptoms are crucial for improving outcomes. Empowering and informing young adults about concerning symptoms is the first step in better recognition and better outcomes for these individuals.Arreaza: This is when the word “follow up” becomes relevant. I recommend you leave the door open for patients to return if their common symptoms worsen or persist. Let's talk about screening. Screening and PreventionJessica: Due to the trend of CRC being identified in younger populations, the U.S. Preventive Services Task Force (USPSTF) lowered the recommended screening age for CRC from 50 to 45 in 2021 (USPSTF, 2021). Off the record, some Gastroenterologists also foresee the USPSTF lowering the age to 40. Arreaza: That is correct, it seems like everyone agrees now that the age to start screening for average-risk adults is 45. It took a while until everyone came to an agreement, but since 2017, the US Multi-Society Task Force had recommended screening at age 45, the American Cancer Society recommended the same age (45) in 2018, and the USPSTF recommended the same age in 2021. This podcast is a reminder that the age of onset has been decreased from 50 to 45, for average-risk patients, according to major medical associations.Jessica: For individuals with additional risk factors, including a family history of CRC or chronic gastrointestinal symptoms, screening starts at age 40 or 10 years before the diagnosis of colon cancer in a first-degree relative. Dr. Arreaza, who has the lowest and the highest rate of screening for CRC in the US? Arreaza: The best rate is in Massachusetts (70%) and the lowest is California (53%). Let's review how to screen:Jessica: Recommended Screening Methods:Colonoscopy: Considered the gold standard for CRC detection and prevention, colonoscopy allows for identifying and removing precancerous polyps.Fecal Immunochemical Test (FIT): A non-invasive stool test that detects hidden blood, recommended annually.Stool DNA Testing (e.g., Cologuard): This test detects genetic mutations associated with CRC and is recommended every three years.Arreaza: Computed tomographic colonography (CTC) is another option, it is less common because it is not covered by all insurance plans, it examines the whole colon, it is quick, with no complications. Conclusion:Colorectal cancer is rapidly emerging as a serious health threat for young adults. The increase in cases over the past three decades highlights the urgent need for increased awareness, early symptom detection, and proactive screening. While healthcare providers must weigh the risk/benefit of testing for CRC in younger adults, patients must also be equipped with knowledge of concerning signs so that they may also advocate for themselves. Early detection remains the most effective tool in preventing and treating CRC, emphasizing the importance of screening and risk factor modification.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:American Cancer Society. (2024). Colorectal Cancer Statistics, 2024. Retrieved fromhttps://www.cancer.orgAmerican Gastroenterological Association. (2024). Delays in Diagnosis of Young-Onset Colorectal Cancer: A Systemic Issue. Gastroenterology Today.Brennan, C. A., & Garrett, W. S. (2023). Gut Microbiota and Colorectal Cancer: Advances and Future Directions. Gastroenterology.Dekker, E., et al. (2023). Colorectal Cancer in Adolescents and Young Adults: A Growing Concern. The Lancet Gastroenterology & Hepatology.Siegel, R. L., et al. (2023). Colorectal Cancer Statistics, 2023. CA: A Cancer Journal for Clinicians.Stoffel, E. M., & Murphy, C. C. (2023). Genetic and Environmental Risk Factors in Young-Onset Colorectal Cancer. JAMA Oncology.U.S. Preventive Services Task Force. (2021). Colorectal Cancer Screening Guidelines.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

In this episode, we review the high-yield topic U.S. Preventive Services Task Force Recommendations⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠from the Stats section at ⁠⁠⁠⁠⁠⁠Medbullets.com⁠⁠⁠⁠⁠⁠ Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

In this episode of Everyday Health Stories, Dr. Kota Reddy and Anna dive into the surprising truth about calcium and vitamin D supplements for bone health. Backed by research from the U.S. Preventive Services Task Force, they discuss why routine supplementation may not significantly reduce fracture risk for healthy, independent adults—and the potential risks, like kidney stones, of overdoing it. Instead, they highlight practical, science-backed tips for maintaining strong bones naturally, including nutrient-rich foods, sunlight exposure, and weight-bearing exercises. Tune in to learn how small, consistent lifestyle changes can make a big difference for your bone health!

The NACE Journal Club with Dr. Neil Skolnik, provides review and analysis of recently published journal articles important to the practice of primary care medicine. In this episode Dr. Skolnik and guests review the following publications:1. Insulin Efsitora versus Degludec in Type 2 Diabetes without Previous Insulin Treatment. Discussion by: Guest:Carol Wysham, M.D, Clinical Associate Professor of Medicine University of Washington School of Medicine  Section Head of the Department of Diabetes and EndocrinologyRockwood Clinic in Spokane, Washington.2. Cervical Cancer: Screening – Draft statement of the U.S. Preventive Services Task Force. Discussion by:Guest: Amy Clouse Associate Clinical Professor Sidney Kimmell Medical College of Thomas Jefferson University  Associate Director - Family Medicine Residency ProgramJefferson Health – Abington3. Chocolate intake and risk of type 2 diabetes: prospective cohort studies. The British Medical Journal 2024. Discussion by: Guest:Elyssa Heisey, DO Resident– Family Medicine Residency Program Jefferson Health – AbingtonMedical Director and Host, Neil Skolnik, MD, is an academic family physician who sees patients and teaches residents and medical students as professor of Family and Community Medicine at the Sidney Kimmel Medical College, Thomas Jefferson University and Associate Director, Family Medicine Residency Program at Abington Jefferson Health in Pennsylvania. Dr. Skolnik graduated from Emory University School of Medicine in Atlanta, Georgia, and did his residency training at Thomas Jefferson University Hospital in Philadelphia, PA. This Podcast Episode does not offer CME/CE Credit. Please visit http://naceonline.com to engage in more live and on demand CME/CE content.

USA TODAY Justice Department Correspondent Bart Jansen looks at the decision by FBI Director Christopher Wray to resign.House Republicans pass a defense policy bill that includes a contentious provision to ban certain types of medical care for transgender children of military service members.USA TODAY Investigative Reporter Chris Quintana discusses how post-grad football lures players with a second shot at glory.The U.S. Preventive Services Task Force recommends self-tests to screen for cervical cancer.Episode Transcript available hereAlso available at art19.com/shows/5-ThingsSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Links/ResourcesU.S. Preventive Services Task Force- https://www.uspreventiveservicestaskforce.org/uspstf/American Cancer Society- https://www.cancer.org/American College of Gastroenterology -https://gi.org/ Feedback or episode ideas email the show at wnlpodcast@copic.comDisclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient's specific condition.

The U.S. Preventive Services Task Force and the World Health Organization recommend primary HPV screening, starting at age 25, as an option (some as preferred) for cervical cancer screening. Although primary HPV screening is as effective as cotesting at detecting cervical cancer, primary HPV screening decreases the number of lifetime screenings needed. The primary HPV screening tests approved by the U.S. Food and Drug Administration (FDA) are the Roche Cobas and BD Onclarity tests. HPV results for the Roche and BD tests can be reported as a pooled result. This means the physician receives a result of negative or positive, in which positive indicates that at least one, but possibly more, types of high-risk HPV were identified in the sample. HPV genotyping options differ by manufacturer. Roche Cobas reports HPV 16 and 18 individually and groups 12 other types (i.e., positivity means at least one of the 12 types triggered the positive result). BD Onclarity reports six individual HPV types (16, 18, 31 [the highest risk going immediately to colposcopy], 45, 51, and 52), and combined types (33/58), (35/39/68). Now, as of March/April 2024, the ASCCP has recognized another important and clinically useful HPV and co-test TRIAGE tool, the DUAL STAIN. This pertains only to the ROCHE COBAS HPV test. In this episode, we will review this latest ENDURING GUIDELINES update to the 2019 ASCCP management algorithms (already updated in the ASCCP app).

In this episode, we speak with Dr. Natalie Lui, Assistant Professor of Cardiothoracic Surgery at Stanford University, about lung cancer screening and the importance of early detection. Since lung cancer is often diagnosed in advanced stages, yearly low-dose computed tomography (LDCT) screening is crucial, especially for heavy smokers. We discuss risk factors, screening criteria from the U.S. Preventive Services Task Force, National Comprehensive Cancer Network, and the American Cancer Society, and why screening isn't universal despite its importance. Additionally, we explore current research, recent updates to guidelines, barriers to screening in underserved communities, and the potential of emerging technologies, such as AI, to enhance lung cancer screening in the future. Read Transcript CME Information: https://stanford.cloud-cme.com/medcastepisode92 Claim CE: https://stanford.cloud-cme.com/Form.aspx?FormID=3122

Dr. Lauren Burkard-Mandel discusses the importance of breast cancer screening at age 40 with guest Dr. Debra Monticciolo. They explore the 2023 U.S. Preventive Services Task Force's draft statement advocating for the initiation of biennial mammograms at age 40, down from the previous age of 50. Tune in for an insightful discussion that could impact women's health decisions for years to come! Articles discussed: https://doi.org/10.1093/jbi/wbad103 https://doi.org/10.1002/cncr.33846

The U.S. Preventive Services Task Force updated its screening mammogram recommendations. Having a double mastectomy after being diagnosed with breast cancer in one breast doesn't lower the risk of dying from the disease. Certain types of exercise can reduce the risk of metastatic recurrence and neuropathy caused by chemotherapy.  What does all this mean? Breastcancer.org Professional Advisory Board member Dr. Holly Pederson discusses the details of these studies and how they may affect you. Listen to the episode to hear Dr. Pederson discuss these studies: updated U.S. Preventive Services Task Force breast cancer screening recommendations double mastectomy after a cancer diagnosis in one breast reduces the risk of cancer in the other breast, but doesn't decrease the risk of dying from breast cancer neuromuscular training reduces chemotherapy-induced peripheral neuropathy exercise reduces the risk of metastatic recurrence of hormone receptor-negative breast cancer hormonal therapy doesn't increase dementia risk Scroll down to below the “About the guest” information to read a transcript of this podcast.

The U.S. Preventive Services Task Force has updated its recommendations for breast cancer screening once again. The recommendations now stipulate that women and people assigned female at birth should begin getting mammograms at age 40, and continue every other year until age 74. The previous guidelines recommended beginning screening at age 50. These guidelines carry a lot of weight because they determine if mammography will be considered preventive care by health insurance and therefore covered at no cost to the patient.Why have the guidelines changed? And how are these decisions made in the first place? To answer those questions and more Ira Flatow talks with Dr. Janie Lee, director of breast imaging at the Fred Hutchinson Cancer Center and professor of radiology at the University of Washington School of Medicine.Transcript for this segment will be available the week after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

New guidance from the U.S. Preventive Services Task Force recommends women should get a mammogram every other year starting at age 40 and continuing until age 74. With so much at stake, it's important to stay in the know. Soundside spoke with Dr. Janie Lee, professor of Radiology at the University of Washington and the director of breast imaging services for the UW and Fred Hutch Cancer Center, to learn more.

A key scientific panel updated its recommendations on breast cancer screenings and the changes could potentially save thousands of lives. The U.S. Preventive Services Task Force now recommends that all women start getting biennial mammograms at age 40. The previous guidelines started at age 50. Ali Rogin discussed more with Dr. Wanda Nicholson. PBS NewsHour is supported by - https://www.pbs.org/newshour/about/funders

A new abortion law goes into effect in Florida on Wednesday. It will sharply restrict the procedure after six weeks. Florida's new law includes exceptions for rape, incest, fetal abnormalities and the life of the mother.New York City Mayor Eric Adams talks about the protests at Columbia University after pro-Palestinian demonstrators were removed by police from an academic building on campus.The U.S. Preventive Services Task Force is recommending women get a mammogram every other year, starting at age 40. Dr. Celine Gounder, a CBS News medical contributor and editor-at-large for public health at KFF Health News, explains.New Yorkers got a front-row seat to a one-of-a-kind show by one of racing's biggest stars yesterday. Seven-time Formula One World Champion Lewis Hamilton sped down Fifth Avenue, even stopping to do donuts right outside the iconic Empire State Building. The stunt was planned to promote a partnership with WhatsApp and Hamilton's Mercedes F1 team, and their growth here in the U.S. Gayle King sat down exclusively with the global superstar right after the stunt.Author Emily Oster, known for her influential book "Expecting Better," introduces her fourth book, "The Unexpected: Navigating Pregnancy During and After Complications."First on CBS Mornings, Dame Judi Dench shares memories from her 70-year-career playing Shakespearean roles as she discusses her new book, "Shakespeare: The Man Who Pays the Rent" with CBS News' Anthony Mason.In our "Changing the Game" series, we celebrate Asian American and Pacific Islander Heritage Month by spotlighting Lulu Cheng and Lacey Benard. After identifying a gap in Chinese learning resources for children, they founded Bitty Bao in 2020. Their company has since produced 15 bilingual board books and innovative educational toys like a Hot Pot kit.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

May 1, 2024 ~ As Women's Health Month, the U.S. Preventive Services Task Force announced mammograms should begin at 40. Stephanie Vandertill, Oncology Nurse Navigator at DMC Huron-Valley- Sinai Grace Hospital in Commerce Township, joins Kevin and Marie to explain why this is.

What is a preventive screening? Does USPSTF screen for mental health? What are the best preventive screenings? Plus, why an anxiety screening for adults is now recommended. Our guest is Michael Barry, MD, chair of the U.S. Preventive Services Task Force. American Medical Association CXO Todd Unger hosts.

In this episode of the Black Health 365 podcast, Jackie and Britt are joined by Dr. Esa Davis, a U.S. Preventive Services Task Force member. Dr. Davis is a professor of medicine and family and community medicine and holds the positions of Associate Vice President for community health and senior dean of population and community medicine at the University of Maryland School of Medicine. During the podcast, Dr. Davis explains the importance of the US Preventive Services Task Force for hypertensive disorders of pregnancy. She shares how screenings can help diagnose hypertensive disorders like preeclampsia and hypertension. The nationwide initiative can assist expectant mothers and decrease the black maternal death rate in our community. Jackie and Britt hope this information will inspire our community to learn about the U.S. Preventative Services Task Force recommendations and seek medical attention sooner during pregnancy. Dr. Esa Davis is a Task Force member and a professor of medicine and family and community medicine, the associate vice president for community health, and the senior associate dean of population and community medicine at the University of Maryland School of Medicine. She is the lead health equity strategist for the University of Maryland Institute for Health Computing. Dr. Davis is also the director of the Transforming Biomedical Research and Academic Faculty Through Leadership Opportunities, Training, and Mentorship (TRANSFORM) program.See omnystudio.com/listener for privacy information.

Steven Woloshin is a professor of medicine and the director of the Center for Medicine and the Media at the Dartmouth Institute and a member of the Dartmouth Cancer Center. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. S. Woloshin and Others. The New USPSTF Mammography Recommendations — A Dissenting View. N Engl J Med 2023;389:1061-1064.

On May 9 the U.S. Preventive Services Task Force issued new mammogram guidelines. Starting at age 40, women are urged to get screened every other year. Dr. Date will explain the new guidelines and how they were developed.

New York-based integrative healing clinic, Thermography Solutions (516-676-0200), uses a high-resolution thermal sensing medical device for breast health screening - in line with the latest U.S. Preventive Services Task Force new recommendations. For more information, please visit https://www.kristineblanche.com/thermography Thermography Solutions 23 Green St. Suite 100A, Huntington, NY 11743, United States Website https://www.kristineblanche.com/thermography Phone +1-516-676-0200 Email info@getintegrativeHealth.com

Colon cancer is the most common type of gastrointestinal cancer and rates of diagnosis have nearly doubled in people under the age of 55. Because of this rise, in 2021 the U.S. Preventive Services Task Force issued the recommendation that the screening age for colonoscopies be lowered to 45 for those at an average risk for developing colorectal cancer. Today, our dietitians will add some nutritional information and lifestyle habits to the cancer conversation to help with the stress and questions that might come up with a diagnosis or a goal for prevention.

Colon cancer is the most common type of gastrointestinal cancer and rates of diagnosis have nearly doubled in people under the age of 55. Because of this rise, in 2021 the U.S. Preventive Services Task Force issued the recommendation that the screening age for colonoscopies be lowered to 45 for those at an average risk for developing colorectal cancer. Today, our dietitians will add some nutritional information and lifestyle habits to the cancer conversation to help with the stress and questions that might come up with a diagnosis or a goal for prevention.

On a hot day in late May, Abdifatah Ali walks through a community health and wellness fair at Currie Park in the Cedar-Riverside area of Minneapolis. As kids run in the fountains and play in the bounce house, Ali, an assistant professor at the University of Minnesota, is searching for someone who might be willing to leave the festivities and go across the street to fill out a survey about cancer.Cancer is one of the leading causes of death in Minnesota, and nationally. As with other aspects of health, there can be vast racial disparities in prevention and treatment. A Nov. 2022 report from the MN Community Measurement survey found that “[e]xcept for white patients, patients from all other race categories had significantly lower rates of colorectal cancer screening compared to the statewide rate.”“There's disparities across the spectrum,” said Ivan Wu, an assistant professor at the U's School of Public Health working on the project with Ali, who specializes in organizational psychology. “You can start from knowledge and awareness — sometimes perceptions of screening are different from what they actually should be. Folks may not even know how to get screened.”On top of that, people may not have insurance, transportation or be able to get time off for medical appointments. And then there's the actual interaction with the physician, where there may be cultural and language barriers. People may also lack accurate information.Colon cancer, like some other cancers, can have a higher survival rate when caught early. Which is why testing regularly, especially if you're high-risk, is crucial. The U.S. Preventive Services Task Force recommends screenings for adults aged 45 to 75.“One time I was having a conversation with an elderly Somali male about colonoscopy, and colon cancer. And, you know, there's a lot of stigma around getting [a] colonoscopy and health procedures done. Some people don't understand the extent of the procedure; if it's a full surgery, or if it's something that, you know, can be done while the individual is awake,” Ali said. “So just having those talks and conversations, we've realized that there is a need for education and an opportunity to help our people understand.”In an effort to address some of those disparities, Wu and Ali, along with their community partners, are embarking on a study to better understand what people in the East African community know about cancer, and develop better education to help prevent it. An ongoing conversationThe idea for the research came up organically. Wu and Ali have known each other for years, since they were students at Michigan State University. Both were peer mentors, assigned to the same session.“I remember him asking certain questions, and I was asking certain questions, and we were like, ‘wow, we think alike. I need to know who this guy is.'” Wu said.They bonded over their mutual interests. They were in the same department, and both from California.“We just hit it off. And ever since then [we] talk about research, and we've collaborated over the years,” Ali said. So when they both ended up at the U of M, they continued their conversations.The idea for this research came up over cups of tea.“I was like: I'm personally not aware of any assessments or this type of research that's been done, when it comes to the East African Community,” Ali said. “Maybe there's an opportunity for us to look into some of these issues.”Then there was a funding call at the Masonic Cancer Center. The two have $100,000 for a two-year study. Ali and Wu expect to have data collected and analyzed by early next year.The aim of the project is to reduce cancer disparities by building knowledge in community health workers. They want to find the gaps, in terms of what services are being provided, and train trusted people in the community so they can provide the best interventions possible.While Wu says that similar research exists for Latino communities, they don't know if the same approach will work for the East African community. The preliminary survey has basic questions: Have you ever heard about cancer? How knowledgeable do you feel about preventing cancer? What are common signs and symptoms of cancer?The researchers said it's important to start from this baseline level.“We can't come in with assumptions,” Ali said. “I think, oftentimes, we're coming from a place of knowledge as academics. And so when you have all that knowledge, you can maybe make some assumptions — some faulty assumptions — about where the community is.” A community-centered approachAli and Wu say it's important to partner with community organizations from the beginning. The researchers are working with the Twin Cities nonprofit Metro Youth Diversion Center.“We have a lot of community members that really are lacking the access to resources,” said Executive Director Rashad Ahmed. “So they're coming to us asking us for help. I know there's a language barrier, there's a cultural barrier. And that is where we fit in. We come in because we understand the languages and the cultures. And that makes it easy for them to trust us.”Ahmed said if people don't understand something, they won't be able to trust it. “So we are here to provide that opportunity for community to connect with the providers, and then be the liaison between the health care system and the community.”They also know the kinds of challenges that the community is facing. Whether that's getting insurance, finding providers or learning more about cancer treatment and options.“We are the ones that are connected to the community, we are the ones that see all the issues are coming up — all the complaints, all the situations that our people are facing,” he said. “So I think having [community organizations] at the table, and being part of the research project is very crucial. And I think that's the key to finding solutions to some of our pressing issues.”

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-331 Overview: Current recommendations for when to start breast cancer screening do not consider race or ethnicity, which may be a source of racial disparity in breast cancer outcomes. In this installment, we take a closer look at these recommendations and how you can incorporate them into individualized patient care. Episode resource links: Chen T, Kharazmi E, Fallah M. Race and Ethnicity-Adjusted Age Recommendation for Initiating Breast Cancer Screening. JAMA Netw Open. 2023;6(4):e238893. Published 2023 Apr 3. Siu AL; U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement [published correction appears in Ann Intern Med. 2016 Mar 15;164(6):448]. Ann Intern Med. 2016;164(4):279-296 Oeffinger KC, Fontham ET, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society [published correction appears in JAMA. 2016 Apr 5;315(13):1406]. JAMA. 2015;314(15):1599-1614.  Draft Update of USPSTF Screening for Breast Cancer: https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/breast-cancer-screening-adults Guest: Alan M. Ehrlich MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-331 Overview: Current recommendations for when to start breast cancer screening do not consider race or ethnicity, which may be a source of racial disparity in breast cancer outcomes. In this installment, we take a closer look at these recommendations and how you can incorporate them into individualized patient care. Episode resource links: Chen T, Kharazmi E, Fallah M. Race and Ethnicity-Adjusted Age Recommendation for Initiating Breast Cancer Screening. JAMA Netw Open. 2023;6(4):e238893. Published 2023 Apr 3. Siu AL; U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement [published correction appears in Ann Intern Med. 2016 Mar 15;164(6):448]. Ann Intern Med. 2016;164(4):279-296 Oeffinger KC, Fontham ET, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society [published correction appears in JAMA. 2016 Apr 5;315(13):1406]. JAMA. 2015;314(15):1599-1614.  Draft Update of USPSTF Screening for Breast Cancer: https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/breast-cancer-screening-adults Guest: Alan M. Ehrlich MD, FAAFP   Music Credit: Richard Onorato

Americans are racking up credit card debt at unprecedented rates, approaching $1 trillion, surpassing the pre-pandemic high. CBS News business analyst Jill Schlesinger joins "CBS Mornings" to explain what's driving the increase, and what you should do if you're struggling with credit card debt.The U.S. Preventive Services Task Force issued updated draft breast cancer screening guidelines recommending all women at average risk should start getting screened for breast cancer every other year starting at age 40, a decade earlier than previous guidelines. CBS News medical contributor and editor-at-large for Public Health at KFF, Dr. Celine Gounder, joins "CBS Mornings" to discuss.A Utah woman who wrote a children's book to help her three sons process their father's sudden death has been arrested for his murder. Prosecutors said she poisoned him with a lethal dose of fentanyl.For more than half a century, student "quiz bowlers" have faced the pressure of the buzzer and showed off their knowledge in front of cameras. But as CBS News' Scott MacFarlane shows us, times have changed and now it's the quiz shows themselves facing pressure to survive."CBS Mornings" co-host Gayle King sits down with Lady A's Charles Kelley and his wife Cassie Kelley in an exclusive interview about his path to sobriety.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

The draft recommendations from the U.S. Preventive Services Task Force state that women who are ages 40 to 74 should have screening mammograms every two years. Sandford Health's Dr. Andrea Kaster provides her insight as to why this change dropped from 50 years old to 40.See omnystudio.com/listener for privacy information.

Libby Znaimer is joined by  Dr. Malcolm Moore,  Medical Oncologist, Princess Margaret Cancer Centre,  Dr. Alisa Naiman,  Family Physician and Founder and Medical Director of The Medical Station in Toronto,  and Dr. Jamie Spiegelman,  Internal medicine and critical care physician at Humber River Hospital This week: Ontario passes the controversial Bill 60 that would see the expansion of certain surgeries and diagnostic tests in private care clinics. Meanwhile, doctors and breast cancer survivors are urging Ottawa to lower the regular mammogram screenings to age 40 following a recommendation by the U.S. Preventive Services Task Force. And, it's national nursing week and provinces across Canada are licensing nurses who are foreign trained. Our panel has the latest. ---- COMMUNITY LITTER CLEANUPS Libby Znaimer is now joined by Diane Saxe, Toronto City Councillor for University Rosedale and Wesley Reibeling, Toronto Program Manager, Park People. Have you noticed lots of litter in your neighbourhood at all? It seems these days that everywhere you go you can find a lot of it whether your walking on the sidewalk or relaxing in a park. You might even find it on your own front lawn! Community cleanups exist to combat the issue, but what else can Toronto residents do to tackle the abundance of garbage that doesn't end up into properly established garbage bins? Our guests weigh in. ---- NATHANIEL ERSKINE-SMITH IS RUNNING FOR LEADER OF THE ONTARIO LIBERALS Libby Znaimer is now joined by Nathaniel Erskine-Smith, Liberal MP for Beaches-East York who is running for leader of the Ontario Liberal Party. MP Erskine Smith is officially the first official candidate to be running for leader of the Ontario Liberals. He's been successfully elected three times at the federal level since 2015. But, does he have what it takes to rebuild the party? Listen live, weekdays from noon to 1, on Zoomer Radio!

New guidelines say women should begin getting regular mammograms every two years starting at age 40 if they are at average risk of breast cancer. That's a significant change from previous guidance by the U.S. Preventive Services Task Force that said women could start routine mammograms at 50. Stephanie Sy reports. PBS NewsHour is supported by - https://www.pbs.org/newshour/about/funders

Women should be receiving regular mammograms starting at age 40, according to new draft guidance from the U.S. Preventive Services Task Force. Americans have conflicting views on anti-trans policies being pushed in Republican states, says a new Washington Post-KFF poll. KCRW looks at the nuances. The killer in the mass shooting at a Dallas-area mall was Latino, and according to reports, may have held white supremacist beliefs. Is that common? More than a dozen universities have closed in Japan due to its declining population. Could the U.S. be in store for the same fate, as college enrollment slips here? In Netflix's “Beef,” two strangers get into a dispute in a parking lot, and the random encounter devolves into catfishing, kidnapping, and more.

New guidelines say women should begin getting regular mammograms every two years starting at age 40 if they are at average risk of breast cancer. That's a significant change from previous guidance by the U.S. Preventive Services Task Force that said women could start routine mammograms at 50. Stephanie Sy reports. PBS NewsHour is supported by - https://www.pbs.org/newshour/about/funders

Dr. Jeffrey Kopin, Chief Medical Officer for Northwestern Medicine Lake Forest Hospital, joins John Williams to talk about the WHO declaring an end to COVID-19 as a public health emergency, the Federal COVID-19 Public Health Emergency Declaration ending on Thursday, if this is a bad season for allergies, and the U.S. Preventive Services Task Force recommending that […]

Dr. Jeffrey Kopin, Chief Medical Officer for Northwestern Medicine Lake Forest Hospital, joins John Williams to talk about the WHO declaring an end to COVID-19 as a public health emergency, the Federal COVID-19 Public Health Emergency Declaration ending on Thursday, if this is a bad season for allergies, and the U.S. Preventive Services Task Force recommending that […]

Dr. Jeffrey Kopin, Chief Medical Officer for Northwestern Medicine Lake Forest Hospital, joins John Williams to talk about the WHO declaring an end to COVID-19 as a public health emergency, the Federal COVID-19 Public Health Emergency Declaration ending on Thursday, if this is a bad season for allergies, and the U.S. Preventive Services Task Force recommending that […]

"This is a monumental day for breast health," said Dr. Matt Miller, a guest on the Rick Dayton Show Tuesday afternoon. The U.S. Preventive Services Task Force now recommends women should get screened for breast cancer every other year starting at age 40 instead of 50. Dr. Miller is a radiologist and breast imaging specialist with Allegheny Health Network.

This episode, Long-Acting Injectable PrEP and HIV Treatment, is the second in a three-episode series about new evidence-based strategies for addressing HIV and AIDS.Guests featured in this episode:Jeremiah JohnsonProgram ManagerPrep4All Amy Killelea, J.D., Killelea Consulting Aviva Cantor, PA-C, AAHIVS, PhD, Callen-Lorde Community Health CenterModerator: Alexandra Walker, Digital Communications Director, NACHCAlexandra: Hello and welcome to Health Centers on the Frontlines, the podcast of the National Association of Community Health Centers. Today is the second in a three-episode series we're doing about an epidemic that the nation's health centers have been battling for decades: HIV and AIDS. During these episodes, we're sharing promising news about how community health centers, health center controlled networks and primary care associations are employing the latest strategies to link people to ongoing HIV prevention, treatment, and care services. Today, we're happy to be joined by a panel of experts, Jeremiah Johnson, who is the Program Manager at Prep4All, an organization of professionals and patients based in New York City who advocate for greater access to lifesaving medication for HIV. Also joining us is Amy Killelea, JD, an expert in policy, medication access, and health care financing to develop sustainable HIV and Hepatitis programs. And Dr. Aviva Cantor, HIV specialist and primary care provider at Callen-Lorde Community Health Center, which serves New York City's lesbian, gay, bisexual, and transgender communities. So in late 2021, the US public was introduced to a bi-monthly injectable form of PrEP, which stands for Pre-Exposure Prophylaxis. Taken in pill form and now also available as an injectable this medication reduces the chance of getting HIV from sex or injection drug use. When taken as prescribed, PrEP is highly effective for preventing HIV, a landmark push to end the HIV epidemic. At the same time, people living with HIV have been introduced to a monthly injectable form of treatment that similarly puts them in charge of their healthcare needs without having to remind themselves to take a daily oral medication. This is revolutionizing the field of treatment and prevention of HIV because we never have had a form of either that was this long lasting. Also, it's exciting news because it expands the number of tools we have in our hands to fight HIV. Health centers have been taking their first steps in implementing these tools. So, starting with our health center guest. Aviva, can you explain to our audience the two types of injectable antiretroviral medication? We've heard that one can be used as PrEP for people who are HIV negative and the other as an HIV treatment for people who are living with HIV. Can you tell us about the similarities and differences?Aviva: Sure. Yeah. So the two medications and we use brand names here. I normally don't like to use brand names, but we'll use them so that they're more clear for patients in the community. So one is called Cabenuva. That's the medication that's used for HIV treatment. And the other is called Apretude. That is the medication that's used for HIV prevention. What they both have in common are that they are both what I describe to patients and my colleagues as deep intramuscular injections. So they're a little different than your regular intramuscular injections. They have to be done by nurses who have been trained just a little bit differently to make sure they do it the right way. So they're both these deep intramuscular injections. They're actually both now available as bi-monthly or every-two-month injections. They actually sort of follow the same schedule where you're given your initial injection, you're given one one month later as a loading dose, and then you take an injection every two months, every eight weeks, essentially. The big difference between these medications is, first of all, for HIV treatment (Cabenuva), it's two (injections;) it's a combination of two medications. So it's two separate injections, one in each buttock (one medication in each buttock). For HIV treatment, for Apretude, for prevention, it's just the one injection in one buttock.Alexandra: Yeah, that's a good first start. We can get back to some of those issues in more depth. Jeremiah, drawing from your experience as a community member and advocate, what do you think is important for the community health centers that we represent around the country to know and consider as they see these new options for prevention and treatment?Jeremiah: Yeah, happy to talk about that. Thanks for having me on the podcast today. And really, you know, I think, Dr. Cantor, you really set us up really well because I think you clearly have a clear sort of centering of your patients and the way that you're sort of talking about things. Because I think one of the first things that I'll say about long acting injectable is it is exciting. I also, as a community advocate, am very cognizant of the price issue with this, so when you're looking at $22,500 a year for Apretude compared to less than $20 a month for generic TDF FTC (Tenofovir/emtricitabine) or generic Truvada, this is going to be a complicated intervention to get to people. And I do worry as a community advocate, given that there's such important adherence requirements if you're going to be on this, that, you know, community health centers are checking with patients and really making sure that they're not going to run into any sort of unexpected coverage issues or anything that's going to interrupt their ability to continue with their treatment in terms of all of this. And so, you know, one thing that I like to put out there at these sorts of conversations is that, you know, sometimes I think we get really excited about the new modality. We get excited about the new way to sort of put things out there and forget the old classics, you know, and in this case, we have, you know, new sort of access to these generic medications that can be more nimble in a complicated health care system to get to people and we can be more creative in terms of getting that out to people. And so, you know, one thing that we're working a lot here at PrEP4all right now is to try and build a national PrEP program calling for a federal program with centralized reimbursement of laboratory costs and medications, particularly for uninsured and underinsured individualsAlexandra: Thank you. Some really good points there. I want to turn it to Amy. As health centers consider delivering these services, what are the financial or policy hurdles that they need to be aware of?Amy: Yeah. So I think this is a really good question. And, and, you know, the short answer is that there are a lot. So, I think the first one is that, and this has been mentioned several times, the price of the drug and combined with the fact that it is a provider- administered injectable product, so that is just a different administration route than the vast majority of the antiretrovirals that are available right now. And those two things, both apart and combined, do, I think, add some complexity to the finances and the procurement and delivery of both Apretude and Cabenuva. And I'm going to go through some of these challenges and note throughout that the challenges are different depending on what population you're talking about, whether the population is insured or uninsured. So I'm going to try to underscore what some of those differences look like. And, you know, the number one piece and to sort of tie this to specifically for community health centers, so that the price of both drugs was raised, and it is, you know, pretty, it could be higher. Right? But in the grand scheme of things, over $22,000 a year for a list price for an ARV is in the upper threshold of ARVs that are available for HIV treatment and prevention, so it's not an insignificant list price. If we talk about community health centers and their status as 340B entities, there is a discount available to purchase that drug for your uninsured population, and yet even with the discount, the price is still fairly significant. So that's an important factor as community health centers look at budgeting and programmatic decisions on both routes, on both Apretude and Cabenuva. And when we talk about the insured, I think even now when these products have been on the market and available in the case of Apretude for, you know, a little less than a year and for Cabenuva longer than that, we still have sort of complexity challenges and, and murkiness, I would say, with regard to payer behavior for insured clients.You know, on the PrEP side, we don't have a U.S. Preventive Services Task Force grade for long-acting Cabotegravir. The grade A that we have is based on the oral products for PrEP. We are waiting for a USPSTF grade and that would carry with it a requirement that the vast majority of payers cover long-acting Cabotegravir/Apretude without cost sharing.Alexandra: Thank you. Would you like to add to that in terms of considerations that other community health centers who are considering offering these should factor in?Aviva: Yeah, I mean, Amy brought up a lot of things that we are currently dealing with. I present on PrEP and on long-acting medications for PrEP and HIV a lot. And I have this slide (Slide 1) that shows how incredibly excited we are for these medications to be here. And then the next slide (Slide 2) is just total chaos because that's what it feels like. It's sort of like, “Hold up, wait, yes we're excited, but let's be realistic about this.” This is really hard. It's really hard right now. You know, you need the people to do the work, but you also need the fuThis show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/5468540/advertisement

Un nouvel épisode du Pharmascope est maintenant disponible! Dans de ce 113ème épisode, Sébastien, Nicolas et Isabelle débutent une série d'épisodes sur l'ostéoporose. Dans ce premier épisode, on aborde le dépistage, l'évaluation et le diagnostic de l'ostéoporose, une maladie qui n'en est peut-être pas vraiment une…   Les objectifs pour cet épisode sont les suivants: Définir l'ostéoporose Identifier les patients nécessitant un dépistage de l'ostéoporose Expliquer les avantages et les limites d'une ostéodensitométrie Évaluer le risque de fracture d'un patient Ressources pertinentes en lien avec l'épisode National Institute for Health and Care Excellence (NICE). Osteoporosis: assessing the risk of fragility fracture. London; 2017. US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319:2521-31. Viswanathan M et coll. Screening to Prevent Osteoporotic Fractures: An Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018. (Evidence Synthesis, No. 162. Papaioannou A et coll. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010;182:1864-73. Korownyk C, McCormack J, Allan GM. Who should receive bone mineral density testing? Can Fam Physician. 2015;61:612. Choisir avec soin. L'ostéodensitométrie. Canada. Management of Osteoporosis in Postmenopausal Women: The 2021 Position Statement of The North American Menopause Society'' Editorial Panel. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28:973-97. Calculateur FRAXCentre for Metabolic Bone Diseases. FRAX: Fracture Risk Assessment Tool. University of Sheffield, UK.

Amidst the battle of the mental health crisis, major depressive disorder stands out as an all-too-common reality for many children and adolescents, but the forces of science and medicine can stand against this foe. Dr. Christopher Drescher, a clinical child psychologist, joins pediatric resident Dr. Daniel Allen and medical student Vuk Lacmanovic to remove the cape from this increasingly common condition and discuss its symptoms, diagnosis, and treatment. Specifically, they will: Define major depressive disorder (MDD) and recognize the common symptoms in both children and adolescents. Formulate a differential diagnosis for patients presenting with depressive symptoms. Recognize validated screening tools for depression in both children and adolescents. Review cognitive behavioral therapy and pharmacotherapy as treatment options. Review appropriate referral to a mental health specialist. Free CME Credit (requires sign-in): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=12493  References: Bhatia SK, Bhatia SC. Childhood and adolescent depression. Am Fam Physician. 2007 Jan 1;75(1):73-80. PMID: 17225707. Brent DA, Maalouf F. Depressive Disorders (in Childhood and Adolescence). In: Ebert MH, Leckman JF, Petrakis IL. eds. Current Diagnosis & Treatment: Psychiatry, 3e. McGraw-Hill; Accessed November 17, 2020. https://accessmedicine.mhmedical.com/content.aspx?bookid=2509§ionid=200807606 Clark MS, Jansen KL, Cloy JA. Treatment of childhood and adolescent depression. Am Fam Physician. 2012 Sep 1;86(5):442-8. PMID: 22963063. Fendrich M, Weissman MM, Warner V. Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children. Am J Epidemiol. 1990 Mar;131(3):538-51. doi: 10.1093/oxfordjournals.aje.a115529. PMID: 2301363. (PDF of CES-DC here) Forman-Hoffman V, McClure E, McKeeman J, Wood CT, Middleton JC, Skinner AC, Perrin EM, Viswanathan M. Screening for Major Depressive Disorder in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016 Mar 1;164(5):342-9. doi: 10.7326/M15-2259. Epub 2016 Feb 9. PMID: 26857836. Hathaway EE, Walkup JT, Strawn JR. Antidepressant Treatment Duration in Pediatric Depressive and Anxiety Disorders: How Long is Long Enough? Curr Probl Pediatr Adolesc Health Care. 2018 Feb;48(2):31-39. doi: 10.1016/j.cppeds.2017.12.002. Epub 2018 Jan 12. PMID: 29337001; PMCID: PMC5828899. March JS, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry. 2007 Oct;64(10):1132-43. doi: 10.1001/archpsyc.64.10.1132. Erratum in: Arch Gen Psychiatry. 2008 Jan;65(1):101. PMID: 17909125. Meister R, Abbas M, Antel J, Peters T, Pan Y, Bingel U, Nestoriuc Y, Hebebrand J. Placebo response rates and potential modifiers in double-blind randomized controlled trials of second and newer generation antidepressants for major depressive disorder in children and adolescents: a systematic review and meta-regression analysis. Eur Child Adolesc Psychiatry. 2020 Mar;29(3):253-273. doi: 10.1007/s00787-018-1244-7. Epub 2018 Dec 8. PMID: 30535589; PMCID: PMC7056684. Rachel A. Zuckerbrot, Amy Cheung, Peter S. Jensen, Ruth E.K. Stein, Danielle Laraque and GLAD-PC STEERING GROUP. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics March 2018, 141 (3) e20174081; DOI: https://doi.org/10.1542/peds.2017-4081 Scott K, Lewis CC, Marti CN. Trajectories of Symptom Change in the Treatment for Adolescents With Depression Study. J Am Acad Child Adolesc Psychiatry. 2019 Mar;58(3):319-328. doi: 10.1016/j.jaac.2018.07.908. Epub 2019 Jan 8. PMID: 30768414; PMCID: PMC6557284. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ. 2016 Jan 27;352:i65. doi: 10.1136/bmj.i65. PMID: 26819231; PMCID: PMC4729837. Siu AL; US Preventive Services Task Force. Screening for Depression in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics. 2016 Mar;137(3):e20154467. doi: 10.1542/peds.2015-4467. Epub 2016 Feb 8. PMID: 26908686. Weersing VR, Brent DA, Rozenman MS, Gonzalez A, Jeffreys M, Dickerson JF, Lynch FL, Porta G, Iyengar S. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry. 2017 Jun 1;74(6):571-578. doi: 10.1001/jamapsychiatry.2017.0429. PMID: 28423145; PMCID: PMC5539834. Weersing VR, Shamseddeen W, Garber J, Hollon SD, Clarke GN, Beardslee WR, Gladstone TR, Lynch FL, Porta G, Iyengar S, Brent DA. Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects. J Am Acad Child Adolesc Psychiatry. 2016 Mar;55(3):219-26. doi: 10.1016/j.jaac.2015.12.015. Epub 2016 Jan 18. PMID: 26903255; PMCID: PMC4783159. Xu Y, Bai SJ, Lan XH, Qin B, Huang T, Xie P. Randomized controlled trials of serotonin-norepinephrine reuptake inhibitor in treating major depressive disorder in children and adolescents: a meta-analysis of efficacy and acceptability. Braz J Med Biol Res. 2016 May 24;49(6):e4806. doi: 10.1590/1414-431X20164806. PMID: 27240293; PMCID: PMC4897997. Zhou X, Cipriani A, Zhang Y, Cuijpers P, Hetrick SE, Weisz JR, Pu J, Giovane CD, Furukawa TA, Barth J, Coghill D, Leucht S, Yang L, Ravindran AV, Xie P. Comparative efficacy and acceptability of antidepressants, psychological interventions, and their combination for depressive disorder in children and adolescents: protocol for a network meta-analysis. BMJ Open. 2017 Aug 11;7(8):e016608. doi: 10.1136/bmjopen-2017-016608. PMID: 28801423; PMCID: PMC5629731. Zhou X, Teng T, Zhang Y, Del Giovane C, Furukawa TA, Weisz JR, Li X, Cuijpers P, Coghill D, Xiang Y, Hetrick SE, Leucht S, Qin M, Barth J, Ravindran AV, Yang L, Curry J, Fan L, Silva SG, Cipriani A, Xie P. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. Lancet Psychiatry. 2020 Jul;7(7):581-601. doi: 10.1016/S2215-0366(20)30137-1. PMID: 32563306; PMCID: PMC7303954.

Although there are many effective treatments for depression, rates of depression are not going down. The National Academies of Science, Engineering, and Medicine have recommended that we implement currently known effective preventive interventions for depression to reduce the number of new cases. This talk will present a personal 50-year path committed to preventing mental disorders and influencing major health-science institutions to implement practices to prevent depression; examples of the types of prevention interventions currently available, with illustrations of the methods that have been found most useful (so that lay persons in a broad audience can envision what can be done to prevent clinical depression); a focus on preventing depression during pregnancy and postpartum, the benefit to the mother and to the baby, and how the U.S. Preventive Services Task Force has recommended that pregnant persons at risk for depression be provided with preventive interventions that have been shown to be effective—and how doing this can have lifetime impact on the health of the babies; how digital tools can be harnessed to reach as many people as possible with these interventions, making it possible to “think globally, act locally and share globally.” Given that we can now prevent half the cases of clinical depression, what needs to be done to prevent the other half? Bottom Line: The health sciences have made major progress in terms of learning how to prevent depression. We now need to act by putting these methods into practice and reduce much of the suffering due to depression. About the Speaker Ricardo F. Muñoz, Ph.D., emigrated from Perú at age 10. He obtained his B.A. from Stanford in 1972 and his Ph.D. in clinical psychology at the University of Oregon in 1977. He was named distinguished professor of clinical psychology at Palo Alto University in 2012, where he is the founding director of i4Health, the Institute for International Internet Interventions for Health (i4health.paloaltou.edu). He is professor of psychology, emeritus, at the School of Medicine of the University of California, San Francisco, based at San Francisco General Hospital, where he taught and did clinical work and research for 35 years, and adjunct clinical professor at Stanford University. Muñoz has served on three U.S. National Academies of Science, Engineering, and Medicine Consensus Committees on prevention of mental disorders. He is a fellow of the American Psychological Association, the Association for Psychological Science, and of the American Association for the Advancement of Science “for distinguished contributions towards the prevention of major depression and the development of Internet interventions to improve mental health worldwide.” SPEAKERS Ricardo F. Muñoz Ph.D., Founding Director, i4Health; Professor of Psychology, Emeritus, School of Medicine, University of California San Francisco Patrick O'Reilly Ph.D., Chair, Psychology Member-led Forum, The Commonwealth Club of California—Moderator In response to the COVID-19 pandemic, we are currently hosting all of our live programming via YouTube live stream. This program was recorded via video conference on December 8th, 2022 by the Commonwealth Club of California. Learn more about your ad choices. Visit megaphone.fm/adchoices

VIDEOS: Video Emerges Where Fauci and Others Planned for a “Universal mRNA Flu Vaccine” Which Became the “COVID-19 mRNA Vaccine” Because People were not Afraid Enough of the Flu Virus (1:51) You're Not Going To Believe This! | Mark Steyn & Eva Vlaardingerbroek (3:03) Neil Oliver – ‘…it's a toxic hell…' (START @ 9:00) Gravitas: Who helped Taliban repair the abandoned American aircraft? (7:25)   Healthy plant-based diets associated with lower colorectal cancer risk in men Kyung Hee University, South Korea, November 28, 2022 Eating a plant-based diet rich in healthy plant foods—such as whole grains, vegetables, and legumes—and low in unhealthy plant foods—including refined grains, fruit juices, and added sugars—is associated with a lower risk of colorectal cancer in men. The findings are published in the open access journal BMC Medicine.Jihye Kim, the corresponding author, said, “Colorectal cancer is the third-most common cancer worldwide, and the risk of developing colorectal cancer over a lifetime is one in 23 for men and one in 25 for women. Although previous research has suggested that plant-based diets may play a role in preventing colorectal cancer, the impact of plant foods' nutritional quality on this association has been unclear. Our findings suggest that eating a healthy plant-based diet is associated with a reduced risk of colorectal cancer.” Researchers from Kyung Hee University, South Korea found that among a population of 79,952 American men, those who ate the highest average daily amounts of healthy plant-based foods had a 22% lower risk of colorectal cancer, compared to those who ate the lowest amounts of healthy plant foods. However, the authors did not identify any significant associations between the nutritional quality of plant-based diets and colorectal cancer risk among a population of 93,475 American women. Jihye Kim said, “We speculate that the antioxidants found in foods such as fruits, vegetables, and whole grains could contribute to lowering colorectal cancer risk by suppressing chronic inflammation, which can lead to cancer. As men tend to have a higher risk of colorectal cancer than women, we propose that this could help explain why eating greater amounts of healthy plant-based foods was associated with reduced colorectal cancer risk in men but not women.” The authors found that the association between the nutritional quality of plant-based diets and colorectal cancer risk among men varied by race and ethnicity. Among Japanese American men, colorectal cancer risk was 20% lower for those who ate the highest amount of healthy plant foods per day than for those who ate the lowest amount. Among white men, those who ate the highest amount of highest amount of healthy plant foods had a 24% lower colorectal cancer risk than those who ate the lowest amount. The authors did not identify any significant associations between plant-based diets and colorectal cancer risk among African American, Latino or Native Hawaiian men. (next) Green Mediterranean diet reduces twice as much visceral fat as traditional Mediterranean diet Ben-Gurion University of the Negev (Israel), November 28, 2022 Following the green Mediterranean diet significantly reduces visceral adipose tissue, a type of fat around internal organs that is much more dangerous than the extra “tire” around your waist. Recently, researchers compared the green Mediterranean diet to the traditional Mediterranean diet and a non-Mediterranean healthy diet in a large-scale clinical interventional trial—the DIRECT PLUS. Subsequent analysis found that the green Mediterranean diet reduced visceral fat by 14%, the Mediterranean diet by 7% and the non-Mediterranean healthy diet by 4.5%. The study was published in BMC Medicine. Reducing visceral fat is considered the true goal of weight loss, as it is a more important indicator than a person's weight or the circumference of their waist. Visceral fat aggregates over time between organs, and produces hormones and poisons linked to heart disease, diabetes, dementia and premature death. The DIRECT-PLUS trial research team was the first to introduce the concept of the green Mediterranean diet. This modified Mediterranean diet is further enriched with dietary polyphenols and is lower in red/processed meat than the traditional Mediterranean diet. On top of a daily intake of walnuts (28 grams), the participants consumed 3-4 cups of green tea/day and 100 grams (frozen cubes) of duckweed green shake/day. The aquatic green plant duckweed is high in bioavailable protein, iron, B12, vitamins, minerals, and polyphenols and substituted meat intake. The team has shown in previous studies that the green Mediterranean diet has a variety of salutary effects ranging from the microbiome to age-related degenerative diseases. A group of 294 participants took part in the 18-month long trial. “A 14% reduction in visceral fat is a dramatic achievement for making simple changes to your diet and lifestyle. Weight loss is an important goal only if it is accompanied by impressive results in reducing adipose tissue,” notes Dr. Hila Zelicha. (next) Are older women being over-screened for cervical cancer? University of Illinois at Chicago, November 28, 2022 A new study published in JAMA Internal Medicine suggests that women over the age of 65 may be undergoing unnecessary cervical cancer screenings and that more public health data is needed on the utilization of cervical cancer screening-associated services among older women to prevent potential harm and unnecessary costs. The study, which is authored by experts from the University of Illinois Chicago, the University of California San Francisco and the U.S. Centers for Disease Control and Prevention, looked at Medicare claims data from 1999 to 2019 for fee-for-service care for women over the age of 65. The analysis showed that in 2019 more than 1.3 million women received cervical cancer screening-associated services, such as a Pap test, colposcopy, and other cervical procedures after age 65. While these services cost more than $83 million, the researchers concluded they were of “unclear clinical appropriateness.” “Cervical cancer screening and other preventive services are among our most important tools for keeping people healthy throughout life, but screenings should also follow evidence-based guidelines to prevent overspending, potential complications and patient discomfort,” said study co-author Dr. Hunter Holt, assistant professor of family and community medicine at the University of Illinois Chicago. According to recommendations and guidelines from the U.S. Preventive Services Task Force, the American Cancer Society and the American College of Obstetrics and Gynecology, women considered to be of average risk can stop undergoing routine cervical cancer screening once they reach the age of 65 if they have had adequate prior screening. “The decision to end cervical cancer screening for women after age 65 requires review of past screening results and related medical history. This process can promote cervical cancer prevention and prevent harms and costs from unnecessary tests and procedures,” said Jin Qin, study co-author and epidemiologist in CDC's Division of Cancer Prevention and Control. The researchers say that the high rates of screening among older women is potentially concerning. “It could be that women are getting screened when they do not need to, or that these women are considered to be at higher-than-average risk, for example, because they have not been adequately screened prior to 65. We do not want to see either of these things and unfortunately, there is not enough public health data to shed light on the causes,” said Holt, who is also affiliated with the University of Illinois Cancer Center at UIC. (next) Chemotherapy could increase disease susceptibility in future generations Washington State University, November 28, 2022 A common chemotherapy drug could carry a toxic inheritance for children and grandchildren of adolescent cancer survivors, Washington State University-led research indicates. The study, published online in iScience, found that male rats who received the drug ifosfamide during adolescence had offspring and grand-offspring with increased incidence of disease. While other research has shown that cancer treatments can increase patients' chance of developing disease later in life, this is one of the first-known studies showing that susceptibility can be passed down to a third generation of unexposed offspring. “The findings suggest that if a patient receives chemotherapy, and then later has children, that their grandchildren, and even great-grandchildren, may have an increased disease susceptibility due to their ancestors' chemotherapy exposure,” said Michael Skinner, a WSU biologist and corresponding author on the study. Given this study's implications, the researchers recommend that cancer patients who plan to have children later take precautions, such as using cryopreservation to freeze sperm or ova before having chemotherapy. In the study, researchers exposed a set of young male rats to ifosfamide over three days, mimicking a course of treatment an adolescent human cancer patient might receive. Those rats were later bred with female rats who had not been exposed to the drug. The resulting offspring were bred again with another set of unexposed rats. The first-generation offspring had some exposure to the chemotherapy drug since their fathers' sperm was exposed, but researchers found greater incidence of disease in not only the first- but also the second-generation, who had no direct exposure to the drug. While there were some differences by generation and sex, the associated problems included greater incidence of kidney and testis diseases as well as delayed onset of puberty and abnormally low anxiety, indicating a lowered ability to assess risk. The results of the researchers' analysis showed epigenetic changes in two generations linked to the chemotherapy exposure of the originally exposed rats. The fact that these changes could be seen in the grand-offspring, who had no direct exposure to the chemotherapy drug, indicates that the negative effects were passed down through epigenetic inheritance. (next) Saffron can fight liver cancer, reveal UAE researchers United Arab Emirates University, November 20, 2022 It may be an expensive spice but you cannot put a label or price on health, said Professor Amr Amin who has researched a breakthrough in the properties of saffron in fighting liver cancer. Professor Amin from Cellular & Molecular Biology at United Arab Emirates University said that researchers have investigated and found saffron to have anti-liver cancer properties. “Safranal, a major biomolecule of the golden spice saffron arrests and stops the cancer cell division at two different stages,” he said. The UAE researchers have been working on this project since 2011 when they first published the research in the Hepatology Journal. The study suggests a novel mechanism of anti-proliferative activity of safranal against human liver cancer cells. “This molecule could serve as a novel and/or adjuvant drug to treat liver cancer,” said Dr Amin. The findings are now also published in a Nature journal Scientific Reports. “The ingredient works in two ways; it stops cell division and promotes cell death,” he explained. Prof Amin and colleagues concluded that safranal exerts its anticancer effect in HepG2 cells by inhibiting DNA repair, resulting in increased DNA damage. (next) Japanese researchers say that ultrasound therapy can be used to treat patients with dementia Tohoku University (Japan), November 20, 2022 A new therapy based on ultrasound waves might be able to improve the cognitive powers of patients suffering from Alzheimer's disease and other forms of dementia. According to an article on the Tohoku University news page, the approach improved the condition of mice with symptoms similar to human dementia. In their experiment, the Tohoku University research team sent low-intensity pulsed ultrasound (LIPUS) waves through the brain of the mice. They found that the waves improved the creation of blood vessels and the rate of regeneration of nerve cells. Furthermore, the treatment did not cause any notable side effects on the mice. The results led the researchers to believe that they can replicate their experimental success in actual human patients one day. “The LIPUS therapy is a non-invasive physiotherapy that could apply to high-risk elderly patients without the need for surgery or anaesthesia, and could be used repeatedly,” explained TU researcher Hiroaki Shimokawa. The Tohoku researchers applied LIPUS therapy to the whole brain of mice with symptoms that resemble those of Alzheimer's disease or vascular dementia. They did this three times a day, with each session lasting for 20 minutes. The mice that simulated vascular dementia underwent surgery that reduced the amount of blood that reached the brain. These animals underwent LIPUS treatment on the first, third, and fifth days after that surgery. Meanwhile, the mice that modeled Alzheimer's disease got 11 LIPUS treatments over a three-month-long trial period. By the end of the experiment, the researchers found that LIPUS activated genes involved with the cells that made up the inner lining of blood vessels. Furthermore, an enzyme that promoted blood vessel formation displayed increased activity, as did a protein which helped nerve cells grow. Based on their findings, whole-brain LIPUS therapy can help alleviate the symptoms of certain forms of dementia by encouraging the development of cells that are normally affected by the condition. The technique is currently undergoing initial clinical trials that will determine its efficacy and safety.

Comprehensive, relevant and insightful conversations about health and medicine happen here… on MedStar Health Doc Talk.Lung cancer has historically been the nation's deadliest cancer, claiming the lives of more than 135,000 annually. But with advances in screening for lung cancer in recent years, along with new screening guidelines, the U.S. Preventive Services Task Force is hoping to change these statistics. In fact, the new guidelines nearly double the number of people eligible for lung cancer screening with low-dose computed tomography  (CT) scans. During this podcast, Dr. Duane Monteith, regional director of Thoracic Surgery for MedStar Health in the Baltimore Region, discusses the new screening guidelines and why they beneficial. Dr. Monteith sees patients at MedStar Franklin Square Medical Center and MedStar Health Bel Air Medical Campus. For interviews with Dr. Monteith, or for more information about this podcast, contact Regional Media Relations Director, debra.schindler@medstar.net.

Episode 112: Statins in Primary CareDr. Tiwana explains the use of statins for the primary prevention of cardiovascular disease.Written by Ripandeep Tiwana, MD (Post-Doctoral Research Fellow at Cedar Sinai Medical Center – Heart Institute). Edition of text and comments by Hector Arreaza, MD.____________________________________________You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition.Statins commonly referred to as lipid-lowering medications, are important in primary care as they serve multiple long-term benefits than just lipid lowering alone. They are HMG-CoA reductase inhibitors. As a refresher, this is the rate-controlling enzyme of the metabolic pathway that produces cholesterol. This enzyme is more active at night, so statins are recommended to be taken at bedtime instead of during the day. Statins are most effective at lowering LDL cholesterol. However, they also help lower triglycerides and raise HDL cholesterol.Statins are not limited to just patients with hyperlipidemia. They reduce illness and mortality in those who have diabetes, have a history of cardiovascular disease (including heart attack, stroke, peripheral arterial disease), or are simply at high risk for cardiovascular disease. Statins are used for primary and secondary prevention.Types of statins.How do we determine which statin our patients need?First, we need to know that not all statins are created equal. They vary by intensity and potency thus, and they are categorized as either low, moderate, or high intensity.Several statins are available for use in the United States. They include Atorvastatin (Lipitor), Fluvastatin (Lescol XL), Lovastatin (Altoprev), Pitavastatin (Livalo, Zypitamag), Pravastatin (Pravachol), Rosuvastatin (Crestor, Ezallor), Simvastatin (Zocor)Commonly used in clinics: Simvastatin, Atorvastatin, and Rosuvastatin.Statin Dosing and ACC/AHA Classification of Intensity                                  Low-intensity                                   Moderate-intensity                                     High-intensityAtorvastatin              NA 1                                                          10 to 20 mg                                                   40 to 80 mgFluvastatin                20 to 40 mg                                          40 mg 2×/day; XL 80 mg                                NALovastatin                 20 mg                                                       40 mg                                                                         NAPitavastatin               1 mg                                                          2 to 4 mg                                                                   NARosuvastatin             NA                                                            5 to 10 mg                                                          20 to 40 mgSimvastatin                10 mg                                                      20 to 40 mg                                                             NAOf note, atorvastatin and rosuvastatin are only for moderate or high-intensity use, and do not use simvastatin 80 mg.Identifying patients at risk.How do we determine who needs statin therapy?Once we become familiar with the different statins, we must figure out which intensity is advised for our patient. Recommendations for statin therapy are based on guidelines from The U.S. Preventive Services Task Force (USPSTF), American Diabetes Association (ADA), and the American College of Cardiology/American Heart Association (ACC/AHA) which recommend utilizing the ASCVD risk calculator in those patients who do not already have established cardiovascular disease.ASCVD stands for atherosclerotic cardiovascular disease, defined as coronary heart disease, cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin. ASCVD remains a leading cause of morbidity and mortality in the United States, especially in individuals with diabetes.The ASCVD risk score determines a patient's 10-year risk of cardiovascular complications, such as a myocardial infarction or stroke. This risk estimate considers age, sex, race, cholesterol levels, use of blood pressure medication, diabetic status, and smoking status. Regarding age, this calculator only applies to the age range of 40-79 as there is insufficient data to predict risk outside this age group.There are several online and mobile applications available to calculate this score. Once calculated it gives a recommendation for which intensity statin to use. However, as this is a recommendation, it is essential to use your own clinical judgment to decide what is best for your individual patient. Please refer to the above table as a reference for which statin and dose you may consider using.Keeping the above calculator in mind, additional statin guidelines are recommended by the ACC:Patients ages 20-75 years and LDL-C ≥190 mg/dl use high-intensity statin without risk assessment. (You do not need the calculator.)People with type 2 diabetes and aged 40-75 years use moderate-intensity statins, and risk estimate to consider high-intensity statins. (It means moderate for all diabetics older than 40, high for some.)Age >75 years, clinical assessment, and risk discussion. Age 40-75 years and LDL-C ≥70 mg/dl and 10%. Grade B recommendation: prescribe a statin for the primary prevention of CVD.Grade C – 40-75 years with >= 1 cardiovascular risk factor AND estimated 10-year ASCVD risk 7.5-10%. Grade C recommendation: selectively offer a statin for the primary prevention of CVD. The likelihood of benefit is smaller in this group than in persons with a 10-year risk of 10% or greater.Grade I - The USPSTF found insufficient evidence to recommend for or against initiating a statin for the primary prevention of CVD events and mortality in adults 76 years or older.The USPSTF is also very clear regarding the intensity of statin therapy. They explained that there is limited data directly comparing the effects of different statin intensities on health outcomes. Most of the trials they reviewed used moderate-intensity statin therapy. They conclude that moderate-intensity statin therapy seems reasonable for most persons' primary prevention of CVD.The USPSTF has a broader recommendation, whereas the ACC guidelines are more detailed and individualized and provide guidance on the recommended intensity of statin therapy.Labs needed.Establish baseline labs for serum creatinine, LFTs, and CK only if there is a myopathy risk. Routine monitoring of LFTs, serum creatinine, and CK is unnecessary; only check if clinically indicated.A lipid panel should be checked in 6-8 weeks, and the patient should monitor themselves for any side effects, including myalgias. If LDL-C reduction is adequate (≥30% reduction with intermediate statins and 50% with high-intensity statins), regular interval monitoring of risk factors and compliance with statin therapy is necessary to sustain long-term benefit.Side effects and contraindications.Some common side effects include URI-like symptoms, headache, UTI, and diarrhea. Some patients are very hesitant to take any medications. Warning about side effects may decrease compliance. Major  contraindications for statin therapy include active liver disease, muscle disorders, pregnancy, and breastfeeding.Special considerations.Chronic kidney disease: The preferred statins for CKD with severe renal impairment are atorvastatin and fluvastatin because they do not require dose adjustment. Pravastatin would be a second choice.Chronic liver disease: Statins are contraindicated in patients with decompensated cirrhosis or acute liver failure. Abstinence from alcohol is critical in patients with chronic liver disease who are taking statins. Pravastatin and rosuvastatin are the preferred agents. Check lipid levels to determine if LDL-C reduction is accomplished with no changes in aminotransferases. You may consider stopping, increasing dose, or changing statin as you discuss the risks vs. benefits with your patient.Conclusion: Simply put, if a patient has an LDL of greater than 190, is a diabetic, has an established history of cardiovascular disease, or is at risk for it, then the patient should ideally be taking a statin unless there is a contraindication, allergy, or other special circumstance that limits him/her from doing so. If you have patients that apply to any of the above scenarios and are not already on a statin, determine their risk, and consider starting them on a statin “stat” to reduce morbidity and mortality. On the other hand, be mindful of overprescribing. Do not prescribe statins to patients who do not meet the above criteria.________________________________________Now we conclude our episode number 113, “Statins in Primary Care.” Statins are powerful medications for the prevention of cardiovascular disease. Do not forget to recommend non-pharmacologic measures such as healthy eating and physical activity, but let's also consider adding a statin to patients who are at moderate to high risk for cardiovascular disease.This week we thank Hector Arreaza and Ripandeep Tiwana. Audio by Adrianne Silva.Even without trying, every night, you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you; send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week!______________________________________References:1. Statins, U.S. Food & Drug Administration, 2014, December 16, fda.gov, https://www.fda.gov/drugs/information-drug-class/statins, accessed September 14, 2022.2. Chou R, Cantor A, Dana T, et al. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Aug. (Evidence Synthesis, No. 219.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK583661/3. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; March 17. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/03/07/16/00/2019-acc-aha-guideline-on-primary-prevention-gl-prevention. 4. ASCVD Risk Estimator Plus, published by the American College of Cardiology, https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/, accessed September 14, 2022.5. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication, U.S. Preventive Services Task Force, Final Recommendation Statement, 2022, August 23. https://uspreventiveservicestaskforce.org/uspstf/recommendation/statin-use-in-adults-preventive-medication6.  Videvo. “Distinction.” Https://Www.videvo.net/Royalty-Free-Music-Track/Distinction/227882/, Https://Www.videvo.net/, https://www.videvo.net/royalty-free-music-track/distinction/227882/. Accessed 26 Sept. 2022.

This is episode 1 of our 5-part series Colorectal Cancer: Screening to Save Lives. This episode covers what clinicians need to know regarding the updated colorectal cancer screenings guidance from the U.S. Preventive Services Task Force. In this episode: • David Lieberman, MD, professor of medicine in the division of gastroenterology and hepatology at the Oregon Health & Science University • Chyke Doubeni, MD, chief health equity officer for the Ohio State University Wexner Medical Center and associate director for diversity, equity and inclusion for The Ohio State University Comprehensive Cancer Center This season is supported by an independent medical education grant from Exact Sciences.

Introduction: False positive RPR. By Hector Arreaza, MD. Read by Alinor Mezinord, MS III, Ross University School of Medicine.  Today we will talk about syphilis. Significant research has been done to determine the origin of this ancient infection. Some experts support that syphilis originated in the New World (the Americas) because the first cases in Europe were reported after the Christopher Columbus crew returned from their expeditions. On the other hand, some people defend the idea of the origin of syphilis in the Old World. Whatever its origin, syphilis is still affecting thousands of people worldwide. According to the World Health Organization, “syphilis in pregnancy is the second leading cause of stillbirth globally and also results in prematurity, low birth weight, neonatal death, and infections in newborns.”[1] The cases in the US are not as high as in other countries, but certain areas have cases higher than the national or state average. Such is the case in Kern County. Our incidence of syphilis is higher than the national average.That's why it is important to screen for this disease. RPR is the most common test to screen for syphilis; however, it may not be completely accurate. RPR is a non-treponemal test that can cause false positive results. On December 20, 2021, the CDC released a letter announcing an FDA alert regarding a high RPR false positive rate when done with Bio-Rad Laboratories BioPlex 2200 Syphilis Total & RPR kit. You may not know which kit was used for the test, but you need to know what to do with a positive RPR. Some conditions associated with false positive RPR include COVID-19 vaccines, tuberculosis, endocarditis, rickettsial disease, recent immunizations (smallpox), and pregnancy. In case of RPR positive, you need to confirm syphilis with a treponemal test, which will be more reliable regardless of the possibility of a false positive RPR. We still need to screen because syphilis continues to increase in our nation. I hope you enjoy this episode.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.___________________________Latent Syphilis. By Carol Avila, MD. Comments by Hector Arreaza, MD. Dr. Avila: I had the amazing opportunity to do inpatient pediatrics during my first rotation at a local hospital, and I often treated patients with neonatal syphilis. I was curious to know what is happening in this area (Bakersfield) that made syphilis (seems to me) a very frequent diagnosis of admission in peds, especially because newborns are impacted by a preventable disease.Epidemiology:The latest update available on the CDC website is the 2020 Surveillance Report of Nationally Notifiable STDs which showed:-In 2020, the national rate of syphilis was about 40 per 100,000 population (all stages).-The rate of national congenital syphilis was about 57 cases per 100,000 live births.-During that year, California was ranked #7 for primary and secondary syphilis (P&S), with a 19.5 per 100,000 population. Nevada was the number #1 state.Local data:In 2018 data, the Kern County Public Health Services Department reported:-A total of 1,520 cases of syphilis (all stages) were diagnosed during that year, about 4 cases/day. It is important to mention that there was a spike in the number of cases of syphilis by 86% compared to the prior year, 2017.-In 2020, 250 cases of congenital syphilis per 100,000 live births were reported in Kern County. Significantly higher than the national average (mentioned above, 40 cases per 100,000 residents). -For primary and secondary syphilis, Kern County was 62% higher than the state average, with almost 35 per 100,000 population, and was ranked #6 in the state of California. -San Francisco was ranked #1.-Bottomline: The rate of syphilis and congenital syphilis in Kern County is higher than the state and national average.Definition:Syphilis is a systemic bacterial infection caused by the gram-negative spirochete Treponema pallidum. Transmission:Syphilis is well known as a sexually transmitted disease; however, while many cases happen due to sexual activity, there are a few other ways that syphilis can also be spread.-It can be transmitted during pregnancy, resulting in congenital syphilis.-Also, passing on syphilis via blood transfusions was very common but is now rare thanks to blood supply screening.-Syphilis transmission is also possible through an organ donor, which nowadays is very rare.-Before healthcare providers were wearing gloves as a standard precaution, it was common for syphilis lesions to appear on their fingers and noses.-It can also be transmitted through close and repetitive contact with mucosal or skin lesions of people with active syphilis.Classification:-Syphilis is divided into stages based on clinical findings. Primary, secondary, and tertiary.-The latent phase occurs between secondary and tertiary. -Patients pass through secondary syphilis and may not realize it.-The most contagious stages are primary and secondary, and syphilis could still be contagious in the early latent phase.-Easy classification: Early (primary, secondary, early latent); Late (tertiary and late latent); Neurosyphilis (which occurs any time).Primary syphilis:-It usually happens 3 weeks after the initial contact with the spirochete, but it can also be seen after 90 days. The bacteria will destroy the local tissue when we see the syphilitic chancre, a painless, well-demarcated lesion with firm, indurated margins. It might go unnoticed; without treatment, the bacteria will spread to the bloodstream, and the infection will progress to the secondary stage.Secondary syphilis:-In the secondary stage, the patient can have a wide variety of signs and symptoms. General constitutional symptoms are common; however, it is characterized by a body-wide rash, prominent in palms and soles. This rash can be macular, papular, or pustular; patients can also develop patches in oral mucosa and tongue, as well as wart-like sores called condylomata lata. Tertiary syphilis:-In the pre-antibiotic era, 15 to 30 years after the initial infection, patients could develop any of the three forms of tertiary syphilis. -Cardiovascular syphilis involves the ascending thoracic aorta. Patients may present with aorticaneurysm or left heart failure. -Gummatous syphilis is uncommon, but it is especially important in patients coinfected with HIV. Gummas can appear in the skin, bones, or internal organs. -Central Nervous System syphilis presents with general paresis, tabes dorsalis, meningitis, hearing and vision loss, and dementia.Latent syphilis:-It occurs when the patient has positive serology for T. pallidum, but the patient is asymptomatic. -Latent syphilis can also be divided into early latent (when the primary infection occurred within the previous 12 months); and late latent syphilis (when the primary stage happened more than 12 months ago.)-Differentiating early and late latent syphilis is vital because the treatment will differ.Congenital syphilis:-The infection occurs during pregnancy.-It can cause miscarriage, stillbirth, or birth defects like nasal cartilage destruction, and frontalbossing, among others. Screening and Diagnostic Testing:-The USPSTF recommends screening asymptomatic, nonpregnant adults and adolescents at increased risk for syphilis infection (Grade A).-The USPSTF recommends early screening for syphilis infection in all pregnant women. as early as possible when they first present to care. -Repeat screening: The CDC and joint guidelines from the American Academy of Pediatrics (AAP) and the ACOG endorse repeat screening, especially for women at risk, early in the third trimester (at about 28 weeks of gestation) and again at delivery.-High-risk patients include men who have sex with men (MSM) and men and women living with HIV. -Also, people with a history of incarceration, a history of commercial sex work, certain racial/ethnic groups (African Americans and Hispanics), and being a male younger than 29 years.How to screen: -Initial screening should be done with a nontreponemal test (RPR or VDRL); if positive, a treponemal test (TP-PA or FTA-ABS) would be the next step. -Nontreponemal tests can be positive in patients with preexisting conditions, e.g., collagen vascular diseases, pregnancy, malignancy, tuberculosis, etc.-The USPSTF also refers to the reverse sequence screening algorithm, where we perform a treponemal test first in those patients that could be missed after a nontreponemal test, for example, people who are homeless, also in nontraditional and nonclinical settings. -A treponemal test will be followed by a nontreponemal test, however, there is no evidence of the accuracy of this screening algorithm, so it is an open field for researchers.-Remember that most patients will have positive antibodies for life, irrespective of treatment or disease stage.Treatment:-One word: Penicillin is the treatment of choice.-Additionally, every patient diagnosed with primary and secondary syphilis should be tested for HIV and other sexually transmitted diseases at the time of diagnosis. Primary, secondary, and early latent syphilis: Benzathine penicillin G, 2.4-million-unit IM, in a single dose.-Children/Infant age > 1 month of age: Benzathine PCN G, 50,000 units/kg body weight IM up to 2.4 million-unit in a single dose. -Children > 1 month with P&S syphilis should be evaluated for sexual abuse.Arreaza:-Pregnancy: Treatment is still penicillin G, if there is a penicillin allergy, desensitization should be done in a controlled setting.-In non-pregnant with PCN allergy- alternatives are doxycycline 100 mg BID x14 days or Ceftriaxone 1 G daily IM or IV for 10-14 days.-For P&S syphilis: clinical and serological evaluation should be done at 6 to 12 months after treatment. Late latent syphilis and tertiary: Benzathine penicillin G, 7.2-million-unit total, administered as 2.4 million units IM each week x3 doses. (2.4 x3 = 7.2). A good strategy is to assume all latent syphilis are late latent. -Follow up with a quantitative nontreponemal serologic test at 6, 12, and 24 months, and compare thistiter with the initial titer at the time of diagnosis.-Special recommendation: Check RPR titer the same day you give the first dose of penicillin.Neurosyphilis: -CSF examination is recommended if neurologic findings are present.-If neurosyphilis is confirmed, it will require aqueous penicillin G, 3-4 million units IV every 4 hours for 10-14 days. Alternative ceftriaxone 2 G IV daily x14 days. Get guidance from an ID specialist. We will continue talking about syphilis in another episode, which was an excellent introduction.____________________________Conclusion: Now we conclude episode number 112, “Syphilis Basics.” Dr. Avila raised our awareness of syphilis in our community and the importance of screening all adolescents and adults at risk of infection, and especially ALL pregnant persons, during their first prenatal visit or as early as possible. Timely treatment with penicillin is important to prevent late complications of syphilis and especially to prevent the devastating consequences of congenital syphilis. This week we thank Hector Arreaza, Carol Avila, and Alinor Mezinord. Audio edition by Adrianne Silva.Even without trying, every night, you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you; send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week!References:1. Data on syphilis, The Global Health Observatory, World Health Organization, who.int, https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/data-on-syphilis,  accessed September 14, 2022. 2. Center for Disease Control and Prevention. (2022, April 11). National Overview of STD.  https://www.cdc.gov/std/statistics/2020/overview.htm#CongenitalSyphilis. 3. STDs in Kern County, Kern County Public Health Services Department, STDS in Kern County 2018, https://kernpublichealth.com/wp-content/uploads/STDs-in-Kern-County-2018-slide-set-comparison.pdf, downloaded on Sep 12, 2022. 4. Center for Disease Control and Prevention. (2022, April 4). Reported Cases and Rates of Reported Cases by State, Ranked by Rates, United States, 2020. https://www.cdc.gov/std/statistics/2020/tables/13.htm 5. Morgen, Sam, Reported cases of STDs in Kern County dropped in 2020, but decrease could be misleading, The Bakersfield Californian, Apr 17, 2022, bakersfield.com, https://www.bakersfield.com/news/reported-cases-of-stds-in-kern-county-dropped-in-2020-but-decrease-could-be-misleading/article_6e7d8d36-bd18-11ec-a98f-7f247bc2517e.html. 6. U.S. Preventive Services Task Force. (2016, June 7). Syphilis Infection in Nonpregnant Adults and Adolescents: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/syphilis-infection-in-nonpregnant-adults-and-adolescents. 7. Center For Disease Control And Prevention. (2022, July 21). Sexually Transmitted Infections Treatment Guidelines. https://www.cdc.gov/std/treatment-guidelines/syphilis.htm. 8. Calonge N; U.S. Preventive Services Task Force. Screening for syphilis infection: recommendation statement. Ann Fam Med. 2004 Jul-Aug;2(4):362-5. doi: 10.1370/afm.215. Erratum in: Ann Fam Med. 2004 Sep-Oct;2(5):517. PMID: 15335137; PMCID: PMC1466700. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466700/. 9. Royalty-free music used for this episode: Good Vibes Alt Mix by Videvo, downloaded on May 06, 2022 from https://www.videvo.net/royalty-free-music-track/good-vibes-alt-mix/1017292/ 

Last week, a panel of medical experts recommended for the first time that doctors screen all adult patients under 65 for anxiety disorders. The advisory group, called the U.S. Preventive Services Task Force, said the guidance was intended to help prevent mental health disorders from going undetected and untreated for years or even decades. It made a similar recommendation for children and teenagers earlier this year.Appointed by an arm of the federal Department of Health and Human Services, the panel has been preparing the guidance since before the pandemic. Its recommendation highlights the extraordinary stress levels that have plagued the United States in recent years. Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan Medical School, who serves on the task force, calls mental health disorders “a crisis in this country.”What's the answer to this extraordinary rise in stress, anxiety, and depression?Some say we need more psychiatrists, psychologists, and therapists. America is “short on mental health resources on all levels,” says Dr. Jeffrey Staab, a psychiatrist and chair of the department of psychiatry and psychology at Mayo Clinic in Rochester, Minnesota. But … wait. Maybe what people feel are valid descriptions of personal experience rather than symptoms of mental illness. Maybe we need to stop thinking about anxiety and depression as “disorders” and start regarding them as rational responses to a society that's become ever more gruesomely disordered.Who has not feared illness and loss of loved ones from Covid-19? Who isn't concerned by the soaring costs of living and the growing insecurity of jobs and incomes? Who isn't terrified by Trump's and his followers' attacks on democracy? Who doesn't worry about mass shootings at their children's or grandchildren's schools? Who isn't affected by the climate crisis? Add in increasingly brutal racism; attacks on Asian-Americans, Hispanic-Americans, and Jews; mounting misogyny and anti-abortion laws; homophobia and transphobia; and the growing coarseness and ugliness of what we see and read in social media — and you'd be nuts if you weren't stressed.Studies show that women have nearly double the risk of depression as men. Black people also have higher stress levels — from 2014 to 2019, the suicide rate among Black Americans increased by 30 percent. Are women and Black people suffering from a “disorder,” or are they responding to reality? Or both? White men without college degrees are particularly vulnerable to “deaths of despair” from suicide, overdoses, and alcoholic liver diseases, with contributions from the cardiovascular effects of rising obesity, according to the American Council on Science and Health. Are they suffering from a “disorder,” or are they responding to a fundamental change in American society? Or both?In their book, Deaths of Despair and the Future of Capitalism, economists Anne Case and Angus Deaton argue that “the deaths of despair among whites would not have happened, or would not have been so severe, without the destruction of the white working class….” Part of the problem, they say, is that the less educated are often underpaid and disrespected, “and may feel that the system is rigged against them.”Even if we had far more mental health professionals, what would they do against these formidable foes? Prescribe more pills? If anything, Americans are already overprescribed. I'm not arguing against better access to mental health care. In fact, quite the opposite. Increased staffing and improved access to care are very much needed. (Right now over 2,000 mental health therapists, psychologists, and social workers in California are entering their second month of an open-ended strike to make Kaiser Permanente, the nation's largest nonprofit HMO, to improve access to care for its patients. The outcome will have nationwide ramifications for determining whether laws that guarantee parity for mental health care will, in practice, help patients access care that meet their needs.)But in addition to providing more and better access to mental health care, we must also try to make our society healthier… … So that the next pandemic doesn't kill a larger percentage of Americans than in any other advanced nation.… So that Americans have more job security and stronger safety nets, rather than the least economic security of any advanced nation.… So income and wealth aren't the most unequal of any other advanced nation.… So our democracy survives Trumpism and big money.… So guns and assault weapons are difficult to buy, rather than easier to get than in any other advanced nation.… So we take a leading role in ending the climate crisis.… And we do everything possible to overcome racism, homophobia, and misogyny. These goals are terribly difficult to achieve, of course. But without seeking to achieve them — without making their achievement central to what we must do as a people — no number of psychiatrists, psychologists, and therapists, and no amount of medications, will be enough to substantially reduce the stress, anxiety, and depression so many Americans are now experiencing. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit robertreich.substack.com/subscribe

This week the U.S. Preventive Services Task Force announced recommendations that doctors screen all patients under 65 for anxiety. Since the beginning of the pandemic, we've heard about sharp increases in the number of people suffering from mental health problems. With a health care system already overburdened and seemingly unable to deal with the rise in mental health issues, America is facing what is being called a mental health crisis.But are we losing sight of another crisis - the issues causing increased anxiety and depression in Americans?Host Michel Martin speaks with Dr. Danielle Carr about her recent essay in the New York Times, Mental Health Is Political.

În cadrul ediției de pe 20 septembrie 2022 a emisiunii #știința360 de pe Radio România Cultural, Dr. Marius Geantă, Președintele Centrului pentru Inovație în Medicină #inomed, a comentat avansurile științifice ale momentului. Așteptăm datele anul viitor, dar o primă comunicare a avut ieri loc la Congresul European de Oncologie Medicală: testul Galleri are potențialul real de a transforma, folosind principiile medicinei personalizate, depistarea precoce și screening-ul cancerului. Testul se bazează pe analiza informației genomice conținute în sângele persoanelor sănătoase, cu vârsta mai mare de 50 de ani, alături de utilizarea inteligenței artificiale, cu scopul de a identifica semnale precoce ale dezvoltării cancerului. Analiza prezentată la ESMO se bazează pe datele dintr-un studiu care a inclus 6.662 de persoane, depistând semnale precoce pentru cancer la 92 dintre cei implicați (la cei mai multi, pentru forme de cancer pentru care nu există alte modalități de depistare precoce și screening). Pornind de la semnalele precoce, au fost 35 de participanți diagnosticați cu cancer în stadii timpurii. Testul Galleri a detectat mai multe tipuri de cancer decât puteau fi depistate prin toate metodele standard combinate de screening aprobate de U.S. Preventive Services Task Force. Mai multe detalii despre testul Galleri: https://raportuldegarda.ro/medicina-personalizata-esmo22-test-galleri-cancer/ Mai multe detalii despre topul Esențial COVID-19 din această săptămână - https://bit.ly/3C0pk29 și https://raportuldegarda.ro/stiri-covid-romania/

This week we chat with Dr. Tracy Gapin, board certified by the American Board of Urology, a Fellow of the American College of Surgeons, and author of the bestselling book Male 2.0: Cracking the Code to Limitless Health and Vitality. Dr. Gapin shares with us his methods of offering a personalized path to help men maximize sexual health, testosterone levels, and prostate health. Text HEALTH to 26786 for a free digital copy of Male 2.0 and a discovery call with Dr. Gapin.  On What The Health?!: Check your heart, check your reflexes, check your mental health. Way to go, U.S. Preventive Services Task Force! Use code FUNC for 20% off at Wildhealth.com! Use code FUNC for $500 off tuition at Functional Medicine Coaching Academy. Follow Dr. Tracy Gapin on IG @drtracygapin Follow us on IG @whatthefunc

Russian lawmakers have toughened punishment for soldiers who breach their duties. Putin's big speech was postponed and some fear that will mean bigger threats from Russia. The U.S. Preventive Services Task Force has recommended anxiety screening in all adults up to age 65, despite evidence of symptoms. A discussion on anxiety and stress. A Georgia woman hit the KFC drive thru for lunch, returned to her office and found over $540 in cash with her chicken sandwich and fries.See omnystudio.com/listener for privacy information.

Russian lawmakers have toughened punishment for soldiers who breach their duties. Putin's big speech was postponed and some fear that will mean bigger threats from Russia. The U.S. Preventive Services Task Force has recommended anxiety screening in all adults up to age 65, despite evidence of symptoms. A discussion on anxiety and stress. A Georgia woman hit the KFC drive thru for lunch, returned to her office and found over $540 in cash with her chicken sandwich and fries.See omnystudio.com/listener for privacy information.

The mental health crisis in the U.S. has now reached the point to where an influential group of medical experts is now recommending all adults under 65 years old get screened for anxiety. The U.S. Preventive Services Task Force made similar recommendations earlier this year to begin anxiety screening in children and teens. We go In Depth into this growing problem.  President Biden apparently won't commit to running for re-election in 2024. If he doesn't, a familiar name to everyone in California probably will.  The Supreme Court may have to decide for good if social media companies can censor political speech.  People in California will have the choice in a few years of becoming compost when they die. We go In Depth into how that works and how it might be better for the environment than cremation.  Aid organizations are now helping people in Puerto Rico after Hurricane Fiona swept through. Many people are still without power.  Your breathing muscles could be key to lowering your blood pressure.  LED lights are being criticized because of the light pollution they cause at night. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

The mental health crisis in the U.S. has now reached the point to where an influential group of medical experts is now recommending all adults under 65 years old get screened for anxiety. The U.S. Preventive Services Task Force made similar recommendations earlier this year to begin anxiety screening in children and teens. We go In Depth into this growing problem. President Biden apparently won't commit to running for re-election in 2024. If he doesn't, a familiar name to everyone in California probably will. The Supreme Court may have to decide for good if social media companies can censor political speech. People in California will have the choice in a few years of becoming compost when they die. We go In Depth into how that works and how it might be better for the environment than cremation. Aid organizations are now helping people in Puerto Rico after Hurricane Fiona swept through. Many people are still without power. Your breathing muscles could be key to lowering your blood pressure. LED lights are being criticized because of the light pollution they cause at night. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Joe Aguiar once again took the helm of "Connecticut Today" and opened with something that's been affecting adults for the last few years: anxiety. After reading a report from U.S. Preventive Services Task Force, Joe spoke on some of anxieties in the time during and after pandemic (0:00). After that, Joe welcomed Jason Garrapy, a business development manager at Endecom Business IT Solutions to talk about cyber security and what we can do to help prevent cyber crimes and hacks (6:38). Image Credit: Getty Images

Russian President Vladimir Putin has ordered a partial mobilization of reservists in Russia. He is risking a deeply unpopular step that follows a string of humiliating setbacks for his troops nearly seven months after invading Ukraine. It's the first mobilization in Russia since World War II. The Russian leader also warned the West on Wednesday he isn't bluffing over using all the means at his disposal to protect Russia's territory, in what appeared to be a veiled reference to Russia's nuclear capability. President Joe Biden is ready to make the case at the U.N. General Assembly that Russia's “naked aggression” in Ukraine is an affront to the heart of what the international body stands. In his address Wednesday morning, the American president is looking to rally allies to continue to back the Ukrainian resistance. The U.S. Federal Reserve is expected to raise its key short-term rate by a substantial three-quarters of a point for the third consecutive time. Many Fed watchers will be paying particular attention to Chairman Jerome Powell's remarks at a news conference afterward. Hurricane Fiona strengthened into a Category 4 storm Wednesday after lashing the Turks and Caicos Islands and was forecast to squeeze past Bermuda later this week. The storm was blamed for causing at least four direct deaths in its march through the Caribbean, where it unleashed torrential rain in Puerto Rico, leaving a majority without power. In sports, Aaron Judge blasted his 60th homer, the Atlanta Braves clinched a playoff spot, the New York Mets rallied for a win, and Nathan MacKinnon is now the NHL's highest paid player. The separatist leaders of four Russian-controlled areas of Ukraine say they are planning to hold referendums this week for the territories to become part of Russia as Moscow loses ground in the war it launched. The votes will be held in the Luhansk, Kherson and partly Russian-controlled Zaporizhzhia and Donetsk regions. There are reports that more migrants are on the move and will land in President Joe Biden's home state of Delaware. A British official says around a quarter of a million people joined the huge queue to see Queen Elizabeth II's coffin lying in state in London's Westminster Hall. The figure was released a day after Britain ended 10 days of national mourning for the late monarch. Jimmy Kimmel is celebrating his 20th anniversary as ABC's late-night host early, signing a three-year contract extension for “Jimmy Kimmel Live!” His show debuted in January 2003, and the new deal means he will remain with it into the 2025-26 season. After a year spent off air, the Golden Globe Awards are returning to NBC in January, when the embattled Hollywood Foreign Press Association will seek a primetime comeback. The 80th Golden Globes will be held January 10, airing both on NBC and Peacock. Federal authorities have charged 47 people in what they're calling the largest fraud scheme yet to take advantage of the COVID-19 pandemic by stealing and defrauding the government of $250 million. Lawyers for former President Donald Trump are resisting independent arbiter Raymond Dearie's request for information about whether the seized records had been declassified, as Trump has maintained. In a letter to Dearie on Monday night, the lawyers said that issue could be part of Trump's defense in the event of an indictment. After bashing the proceedings on his web show, conspiracy theorist Alex Jones has made his first appearance outside a courthouse in Connecticut where a jury will determine how much in damages he should pay for telling his audience the Sandy Hook Elementary School shooting was a hoax. Jones showed up and made comments outside, but left a short time later. An influential health guidelines group says U.S. doctors should regularly screen adults for anxiety. It's the first time the U.S. Preventive Services Task Force has recommended anxiety screening in primary care for adults without symptoms. —The Associated PressSee omnystudio.com/listener for privacy information.

Lung cancer is the leading cause of cancer deaths in the United States and the second most common malignancy in both men and women. Aline Zouk, MD, explains that many of these deaths are preventable via early low-dose CT scan screening among smokers and early-stage treatment. Because survival rates increase dramatically with earlier detection, the U.S. Preventive Services Task Force has updated its guidelines for screening—now, around 14 million Americans are recommended to receive yearly screenings. Dr. Zouk explains how the guidelines account for pack-years and age. The challenge for physicians, notes Zouk, is to encourage screening for patients before they exhibit any symptoms.

Nuvance Health neurologist Dr. Paul Wright discusses the new U.S. Preventive Services Task Force guidance that says people age 60 and older should not start taking daily, low-dose aspirin to prevent stroke.He also helps people understand why a majority of strokes may be prevented through lifestyle modifications.

Nuvance Health neurologist Dr. Paul Wright discusses the new U.S. Preventive Services Task Force guidance that says people age 60 and older should not start taking daily, low-dose aspirin to prevent stroke.He also helps people understand why a majority of strokes may be prevented through lifestyle modifications.

The U.S. Preventive Services Task Force recently issued its sixth set of guidelines on using daily aspirin to prevent cardiovascular disease. The guidelines appeared in JAMA — whose editors asked our guest, Dr. Allan Brett, to write an editorial evaluation. This edition carries Brett's advice on using the new guidelines in daily clinical practice. Brett's JAMA editorial USPSTF […] The post Podcast 290: USPSTF's new take on aspirin and primary prevention of CVD first appeared on Clinical Conversations.

In this episode, we review the high-yield topic of U.S. Preventive Services Task Force Recommendations from the Stats section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

On this episode, we review the management of Crohn's Disease. We go over the newest guidelines and some of the supporting clinical data. We end by discussing the U.S. Preventive Services Task Force's colorectal cancer screening recommendations.  Once again, we're excited to announce that our listeners can claim ACPE-accredited continuing education for listening to our podcasts! We're partnering with freeCE by PharmCon, to provide listeners with the opportunity to claim 1-hour of continuing education credit each month. To earn credit for this episode, visit the following link for more information about earning CE for listening to our podcasts: https://hubs.ly/Q012N29c0 For freeCE members, this CE option is included in your membership benefits at no additional cost! Members can simply follow the link above to take the post-test and evaluation for this activity. Use the password COLON (all caps) to unlock the post-test for this episode. If you are not currently a freeCE member, we invite you to explore all the benefits of their Unlimited Membership on their website. CorConsult Rx listeners can receive 15% off the purchase of an unlimited membership by entering the discount code “PODCAST2022” at checkout, or by clicking the following link https://hubs.ly/Q012N0H60 Thanks for listening! If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. You can find our account at the website below:  www.patreon.com/corconsultrx If you have any questions for Cole or me, reach out to us on any of the following: Text - 415-943-6116 Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com Instagram and other social media platforms - @corconsultrx This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.

Episode 72: Depression in Adolescents.  COVID-19 vaccine updates including booster shots and mix and match options. Depression in adolescents is discussed by Virginia Bustamante, Charizza Besmanos, and Hector Arreaza. Introduction: COVID Vaccines Update October 2021Written by Hector Arreaza, MD. Participation: Lillian Petersen, RN, and Nathan Heathcoat, MS3.  The FDA granted emergency use authorization for a booster shot with the Pfizer/BioNtech COVID-19 vaccine in September 2020.On October 20, 2021, the FDA also granted emergency use authorization for a booster shot with the Moderna AND Johnson & Johnson (also known as Janssen or J&J) COVID-19 vaccines. Pfizer/BioNtech: Brand name Comirnaty®. It has full FDA approval for patients who are 18 years and older for the prevention of COVID-19. The rest of the indications of this vaccine are under the Emergency Use Authorization (EUA). It is authorized for 12 years and older. Total of two doses, 21 days apart. Authorized for 3rd dose in immunocompromised patients (on active cancer treatment, organ transplant recipients, taking immunosuppressive or high dose corticosteroids, have moderate to severe immunodeficiency). 3rd dose is given at least 1 month after the second dose. It is authorized for a single booster shot in special populations (older than 65 years of age OR 18-64 years of age at high risk of severe COVID-19 or with frequent occupational exposure). The booster shot must be given 6 months after the primary series is complete.Moderna: No brand name yet. All uses are under emergency use authorization. It is authorized for 18 years and older for the prevention of COVID-19. Give a total of two doses, 4 weeks apart. A third dose is authorized to be given 1 month after the second dose. Patients who can receive a third dose include patients on active cancer treatment, organ transplant recipients, taking immunosuppressive or high dose corticosteroids, or have an immunodeficiency. It is authorized for a single booster shot 6 months after completing primary series. The booster shot of Moderna should be half dose. People who may receive a booster shot are those who are older than 65 years of age OR 18-64 years of age at high risk of severe COVID-19 or with frequent occupational exposure.Johnson & Johnson (Janssen): No brand name yet. Authorized as a single dose vaccine. Authorized for a single booster shot 2 months after the first dose. Mix and Match Approval: The FDA authorized on October 20, 2021, heterologous booster dose for currently approved or authorized COVID-19 vaccines. You can give a booster shot with a different vaccine than the one you received primarily. For example, a patient who received J&J vaccine may receive a booster shot with Pfizer or Moderna 2 months later. Another example, a patient received primary series of Pfizer vaccine, may receive a booster shot with Moderna, Pfizer or J&J 6 months after completing primary series. Booster shots are authorized, again, for patients who are 65 years and older, 18-64 years of age at high-risk for severe COVID-19 or with frequent occupational exposure.The vaccination of children 5-11 years old is still under discussion, more updates coming soon.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ___________________________Depression in Adolescents. By Virginia Bustamante, MS4; Charizza Besmanos, MS4; and Hector Arreaza, MD.  Vicky: We will talk about adolescence and depression today. I was reading a piece on the Impact of COVID-19 Pandemic on Adolescent Mental Health on Psychiatry Advisor by Tori Rodriguez. She is a licensed professional counselor with a master's in arts in counseling psychology. This article really got me thinking, how prevalent is depression in adolescents? Even before COVID-19. I read the article and I wasn't even aware of the numbers. So, I decided to do some research on the topic. Charizza: When you brought up the topic for discussion, I asked myself how much do I even know? I found that the CDC reported that “more than 1 in 3 high school students had experienced persistent feelings of sadness or hopelessness in 2019.” This was a 40% increase since 2009. It also said that, “in 2019 about 1 in 6 youth reported making a suicide plan in in the past year. That was a 44% increase since 2009.” 44% increase! That is almost unbelievable. Now I'm asking myself what is causing such a drastic increase.Vicky: When I read Rodriguez's piece it really got me thinking. What is or are there even known causes linked to this huge increase?Charizza: Are adolescents more open to talk about mental illness? Or are there other factors affecting their mental illness? For example, increasing social media presence or other home/ social pressures. Vicky: Actually, that may be partially why. The U.S. News and World Report wrote a piece that highlighted the possible contributing factors that have led to this increase. They stated that data hasn't really shown a conclusive answer but there are some common themes that have emerged. And I'd like to spend much of this podcast really going into those themes and discussing them. The U.S. News and World Report listed five common themes. Theme one, what they called “a modern-day diagnosis” - where they reference a John Hopkins Health Review which explained that adolescent depression is somewhat of a new diagnosis. Charizza: Up until about the 1980's mental health professionals were reluctant to diagnose adolescents with a mood disorder. Because their brains were still developing, they thought it was not appropriate to diagnose someone so young with, for example depression. Vicky: Yes exactly, so the current thought is, that perhaps this change of thinking has played a part in the increasing numbers in the form of increased reporting and/or documentation. The second theme they listed was “hyper-connected & overstimulated.” This stems from how our world is today. Where electronic devices and social media are a big part of young people's lives. The idea that they have a life in the real world and the virtual world.  Charizza:  I read a study on Teens, Social Media and Technology, a Pew Research Center study, that more than 95% of teenagers have access to a smartphone and 45% of them described themselves as being online “almost constantly.”  Vicky: To think, how does this affect the way they see themselves? For maybe a lot of us listening right now we've been on social media. That could be Facebook, Instagram, Tik-Tok, and going way back Myspace. We know that social media can be an amazing place to share our lives but can also be filled with a lot of criticism.Arreaza: Have you heard of “FOMO”? It's “Fear of Missing Out”. It's a condition that can cause severe anxiety because others are having fun, or you missed a particular event, memorable experience, or an opportunity to connect with someone famous, or an online investment. People with FOMO need to stay always connected. Vicky: The Journal of Abnormal Psychology explained that the spike in depression and suicidal tendencies may be connected to social media among young people. They went on to describe how it's not uncommon for young people to measure their self-worth based on the likes. I've been there. Questioning myself whether to post or not post a picture based on whether it's “Instagram worthy”? Will it get enough likes to be posted? Rather than sharing moments of my life with friends and family as the platform was intended to. Charizza: It's not something I'm proud of but I've gotten sucked into the fake reality of online. That's why I reduced my social media presence. Vicky: Was there a specific reason or situation that led to that?Charizza: I just felt like that it was taking more energy than it was meant for. And honestly I've felt happier since not really using my Facebook anymore. Vicky: If that makes you happier, I support it. I mean I might consider it myself. Arreaza: Yes, a social media “fasting” may be beneficial for some people. Vicky: For the third theme, the article referred to what they called “uncertain times.”Charizza: What does that even mean?Vicky: Each generation is influenced and shaped, in a positive or negative way, by the events happening at that time in history. And sadly, today's young people have grown up in a post-9-1-1 world, mass terrorist attacks, and shootings whether that be high schools, malls, and even churches. All these events mean that young people may know the fear of terrorism. A sense of security has been taken from them by these awful and cowardly attacks of others. Charizza: I had a friend who was afraid to go to the movies after the 2012 Aurora Colorado shooting. For a long time, every time she went, she couldn't sit there and enjoy the movie. She kept turning around looking at the door every time it opened. Afraid something would happen. So, thinking of that and thinking that others may be going through similar and even more difficult times, I can completely understand this contributing depression among young people. Vicky: This fear and stress appears to be contributing to the increase in depression. The fourth theme was “not enough sleep.” The Nation Sleep Foundations recommends teens get 8.5 to 9.5 hours and instead teens get around 7 hours. When I am well rested, I perform my best. My energy, memory and overall mood is better. But with school, work, and everything else it's hard sometimes to get the hours I need. I mean I don't know about you Charizza, but I can work on getting more sleep. Charizza: Sadly, I struggle with it too. But for adolescents where they're still developing and undergoing different physiological changes those hours are especially important. The Sleep Foundation stressed the importance of sleep for teens. They talk about how it helps with physical development - with all the changes they are undergoing, academic achievement - by promoting attention, improving memory (like you brought up), and definitely helps with emotional health. The website states that mental health disorders for example anxiety, depression, and even bipolar disorder have been linked to poor sleep. They even stated that sleep deprivation in teenagers can increase the risk for suicide.Arreaza: A poor sleep also can lead to obesity in adolescents and adults. Something we should remember is also the timing of sleep for adolescents. The sleep pattern changes over the lifetime of people, and it's not only in duration, but also the time they sleep. Normally, a teenager tends to go to bed late and wake up late. For this reason, high school schedules are being changed in California to start at 8:00 AM. Vicky: It sounds like improving sleep in adolescents can be a great way of preventing mental health disorders or even reducing their symptoms. The last and fifth theme discussed in The U.S. News and World Report as a possible contributing factor to the increase in adolescent depression is a “lack of community.” This goes back to the world we live in today. We live with this - what the article quotes as - “go-go mentality” and the community we would have previously built or created around us have gotten smaller. So as they quoted “our face-to-face connections” have decreased.Charizza: Is there anything they suggest?Vicky: The U.S. Preventive Services Task Force recommends primary caregivers screen adolescents 12-18 for depression. But this doesn't always happen. They suggested that identifying adolescent depression should NOT be something that only falls on the medical provider but something we should ALL be responsible for. We can do this by building healthy and trusting relationships with our young people. Hopefully also rebuild this sense of community. Today we highlighted some themes that are possibly related to the increase in adolescent depression. Those were: the idea of a modern-day diagnosis, second being hyper-connected & overstimulated, third the uncertain times we live in, fourth not enough sleep, and lastly the sense of a lack of community. Charizza: We hope you guys all really enjoyed listening. And remember if you are or know someone struggling with depression and/or suicide thoughts reach out to someone. Let someone know how you are doing. Tell a teacher, adult, someone. Vicky: If you for whatever reason don't feel comfortable doing that or feel you may not have someone to reach out to and are in danger of hurting yourself or others please call 911. Charizza: There are also national suicide prevention hotlines. That is 1-800-SUICIDE and that's 1-800-SUICIDE. There is also 1-800-273-TALK, again that's 1-800-273-TALKVicky: There is also the Mary K Shell Mental Health Center with a walk-in crisis center. They are located here in Bakersfield on College and Mt. Vernon. They are actually in the same parking lot as Kern Medical Center. Their number is 661- 868-8123.________________________________Conclusion: Now we conclude our episode number 72 “Depression in Adolescents.” Our adolescent patients are a special population, so special that you can even do a fellowship after finishing your residency. Our adolescents are under a lot of pressure, especially during this era of social media. Remember to screen for depression and start treatment right away with behavioral therapy and medications as needed or refer your depressed patients to a psychiatrist to start treatment promptly. Do not forget to assess risk of suicide and act fast to prevent suicide in your patients. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Lillian Petersen, Nathan Heathcoat, Virginia Bustamante, and Charizza Besmanos. Audio edition: Suraj Amrutia. See you next week! _____________________References:Mental Health, Adolescent and School Health, Centers for Disease Control and Prevention, CDC.gov,  https://www.cdc.gov/healthyyouth/mental-health/index.htm, accessed on September 20, 2021.  Lohmann, Rachel Cassada, What's Driving the Rise in Teen Depression?, US News, April 22, 2019. https://health.usnews.com/wellness/for-parents/articles/2019-04-22/teen-depression-is-on-the-rise.  Anderson, Monica and Jingjing Jiang, Teens, Social Media and Technology 2018, Pew Research Center, May 31, 2018. https://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/.  Rodriguez, Tori, Impact of the COVID-19 Pandemic on Adolescent Mental Health, Psychiatry Advisor, April 30, 2021, https://www.psychiatryadvisor.com/home/topics/child-adolescent-psychiatry/adolescent-mental-health-issues-are-further-exacerbated-by-the-covid-19-pandemic/. 

Mass vaccination sites are set to make a comeback in Baltimore County. A vaccine mandate went into effect today for Baltimore City employees. Senator Ben Cardin pays tribute to former Secretary of State Colin Powell. We have a conversation on the public health effects of Baltimore's public transportation. And everything you need to know about the U.S. Preventive Services Task Force's new guidelines on using aspirin to prevent heart disease.   See omnystudio.com/listener for privacy information.

Today we give Colorado a Yasss Queen! They are stepping up for the trans healthcare services, and we have Rep. Brianna Titone, to tell us more! Also, why you should not take aspiring, sound baths and how to get past money issues in a relationship. Let's go there!  Special guests:  Colorado State Rep. Brianna Titone - Health and Insurance Committee, Energy and Environment Committee, Vice Chair, Joint Technology Committee.  Dr. Chien-Wen Tseng - Member of the U.S. Preventive Services Task Force, as well as a family physician and research director at the University of Hawaii John A Burns School of Medicine Dr. Helen Lavretsky - Professor of Psychiatry at UCLA, Director of Integrative Psychiatry Program Adam Kol - The Couples Financial Coach. He helps couples who love each other make sure the money conversation doesn't get in the way and also hosts the Couples Financial Coach Podcast. See omnystudio.com/listener for privacy information.

The Teton County coroner announced Gabby Petito's cause of death was strangulation and the manner of death was homicide. Petito was reported missing on September 11. She had been traveling on a road trip with her fiancé, Brian Laundrie, who returned to Florida without her and hasn't been in over a month. Dr. Brent Blue is the Teton County coroner. He tells Anderson Cooper “there is no evidence that this was done by any kind of animal” and “we believe this is strangling by human being.” The U.S. Preventive Services Task Force is considering making changes to its guidance on taking a daily aspirin to prevent heart disease and stroke. CNN's Chief Medical Correspondent Dr. Sanjay Gupta joins AC360 to explain the possible changes and says “they're not saying you should stop” taking an aspirin if you've already been taking one.   Airdate: October 12, 2021   Guests: Dr. Brent Blue Dr. Sanjay Gupta To learn more about how CNN protects listener privacy, visit cnn.com/privacy

Adults 60 or older should not necessarily take a daily aspirin to prevent a first heart attack or stroke, according to a draft recommendation from the U.S. Preventive Services Task Force. The government-backed panel of independent experts is revising several key guidelines and warning that, for some, aspirin's risks may outweigh the benefits. Judy Woodruff talks to Dr. John Wong about the issue. PBS NewsHour is supported by - https://www.pbs.org/newshour/about/funders

Adults 60 or older should not necessarily take a daily aspirin to prevent a first heart attack or stroke, according to a draft recommendation from the U.S. Preventive Services Task Force. The government-backed panel of independent experts is revising several key guidelines and warning that, for some, aspirin's risks may outweigh the benefits. Judy Woodruff talks to Dr. John Wong about the issue. PBS NewsHour is supported by - https://www.pbs.org/newshour/about/funders

ReferencesPrentice RL. Clinical trials and observational studies to assess the chronic disease benefits and risks of multivitamin-multimineral supplements.Am J Clin Nutr 2007, 85:308S-313S.NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements and Chronic Disease Prevention.NIH Consens State Sci Statements 2006, 23:1-30.Fortmann SP, Burda BU, Senger CA, et al. Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force.Ann Intern Med 2013.Allen LH. How common is vitamin B-12 deficiency?Am J Clin Nutr 2009, 89:693S-696S.Hooshmand B, Solomon A, Kareholt I, et al. Homocysteine and holotranscobalamin and the risk of Alzheimer disease: a longitudinal study.Neurology 2010, 75:1408-1414.Morris MC, Evans DA, Tangney CC, et al. Dietary copper and high saturated and trans fat intakes associated with cognitive decline.Arch Neurol 2006, 63:1085-1088.de Bortoli MC, Cozzolino SM. Zinc and selenium nutritional status in vegetarians.Biol Trace Elem Res 2009, 127:228-233.Burnett-Hartman AN, Fitzpatrick AL, Gao K, et al. Supplement use contributes to meeting recommended dietary intakes for calcium, magnesium, and vitamin C in four ethnicities of middle-aged and older Americans: the Multi-Ethnic Study of Atherosclerosis.J Am Diet Assoc 2009, 109:422-429.Yang Q, Cogswell ME, Hamner HC, et al. Folic acid source, usual intake, and folate and vitamin B-12 status in US adults: National Health and Nutrition Examination Survey (NHANES) 2003-2006.Am J Clin Nutr 2010, 91:64-72.Troesch B, Hoeft B, McBurney M, et al. Dietary surveys indicate vitamin intakes below recommendations are common in representative Western countries.Br J Nutr 2012, 108:692-698.Bitterman KJ, Anderson RM, Cohen HY, et al. Inhibition of silencing and accelerated aging by nicotinamide, a putative negative regulator of yeast sir2 and human SIRT1.J Biol Chem 2002, 277:45099-45107.Baggott JE, Oster RA, Tamura T. Meta-analysis of cancer risk in folic acid supplementation trials.Cancer Epidemiol 2011.Stranges S, Navas-Acien A, Rayman MP, Guallar E. Selenium status and cardiometabolic health: state of the evidence.Nutrition, metabolism, and cardiovascular diseases : NMCD 2010, 20:754-760.

For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources:  ·PrevMed's website·PrevMed's YouTube channel·PrevMed's Facebook page

Episode 66: Meth Abuse. By Ikenna Nwosu, MD, and Hector Arreaza, MD.  Discussion about screening, epidemiology, clinical presentation, diagnosis, and treatment of meth abuse. Association between intranasal corticosteroids and lower risk of COVID-19 complications is mentioned.Introduction: Intranasal corticosteroids associated with better outcomes in COVID-19By Bahar Hamidi, MS3, American University of the Caribbean When I first heard of the news of a pandemic occurring, I never thought it would last more than a couple weeks. Of course, as a medical student the first thing I wanted to know was what bug is causing all this commotion in the news. When I discovered “Coronavirus” my first reaction was a chuckle and blurting out “no way.” Why did I respond this way you may ask? As a student when we studied that coronavirus would cause nothing more than a regular cold, thus a mere pesky virus causing a whole pandemic seemed odd to me at the time. Little did I know almost two years later we are still talking about it! “Don't touch your face before washing your hands.” These are the words that run through my mind anywhere I am nowadays. Why? Well, SARS-CoV-2 spike (S) protein is why. This protein engages ACE2 (angiotensin-converting enzyme 2) as the entry receptor. This virus's receptor is found to be highly expressed in our nasal mucosa. How much of this ACE2 we have interestingly can correlate with your age; lower in children compared with adults. Other things that can affect a person's susceptibility is the level of eosinophils in your body. High absolute eosinophil count showed to have a lower hospitalization risk in a group of individuals with asthma and COVID, but we must keep in mind that the study can be confounded by the use of inhaled corticosteroids (iCS). This was taken into account during a study.The study was done by Ronald Strauss and collaborators, it's titled, Intranasal Corticosteroids Are Associated with Better Outcomes in Coronavirus Disease 2019, and it was published on The Journal of Allergy and Clinical Immunology: In Practice, September 2021.So how may inhaled corticosteroids prevent significant illness from COVID? The answer is lower expression of ACE2 and its cellular serine protease TMPRSS2. Theoretically, it makes sense because the less entry gates the virus has the less sick someone may possibly get. Therefore, the study hypothesizes that by suppressing receptor expression, intranasal corticosteroid use is protective against complicated outcomes like hospitalizations, admission to ICU and mortality.Interestingly in addition, two types of corticosteroids [ciclesonide (Alvesco®) and mometasone (Asmanex® for asthma and Nasonex for allergic rhinitis)] were discovered to suppress replication of coronavirus. This overall study has pertinent findings for the treatment of this everlasting pandemic and proves there is yet much left to discover and continue to research.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ___________________________Meth Abuse. By Ikenna Nwosu, MD, and Hector Arreaza, MD IntroductionDrug use is a growing problem with serious consequences to individuals, families, and whole nations. Today we will discuss one of the most common drugs abused by our patients: Methamphetamine. Definition   Methamphetamine (street name chalk, crank, crystal, glass, ice, meth) is a stimulant commonly abused in many parts of the United States. It is a psychostimulant that causes the release and blocks the reuptake of monoamine neurotransmitters, including dopamine, norepinephrine, and serotonin. Methamphetamine is most often smoked or snorted and is less commonly injected or ingested orally.  Arreaza: Phentermine (appetite suppressant) is not meth. Phentermine is less potent because it acts mostly on norepinephrine, very little on dopamine, and minimally on serotonin.  Epidemiology  Amphetamine-type stimulants, which include methamphetamine, are the fastest rising drug of abuse worldwide. An estimated 2.1% of the United States population have been reported to have tried methamphetamine at some time in their lives with its rate of use found to be similar among men and women. Data indicates that methamphetamine is a significant public health problem. Mortality has increased by about 40 percent from 2015 to 2016 and drug overdose deaths involving methamphetamine have tripled since 2011. Arreaza: The mortality is high but also the morbidity. I can imagine how costly it is for health systems to take care of the complications of meth use, from dental work to cardiovascular disease, i.e., heart failure. It is a serious problem in Bakersfield, California. As an interesting fact, meth is the most common drug identified in urine drug screenings, then follows marijuana, cocaine, heroin, and fentanyl. Clinical manifestations  When someone uses meth, they have increased energy and alertness, pupillary dilation, tachycardia, euphoria, decreased need for sleep, grinding teeth, dry mouth, loss of appetite, and other symptoms of sympathetic nervous system activation.  Repeated use causes weight loss, dental decay, chronic adverse mood, and cognitive changes, including irritability, aggression, panic, suspiciousness, and/or paranoia, hallucinations, and memory impairment.  Chronic use also can exacerbate depression and anxiety, and those changes can interfere tremendously in patient care. The risk of suicide is also higher. It can also cause complications in other systems:-Cardiovascular (cardiomyopathy, myocardial infarction, and stroke)-Skin (abscesses, aged appearance, and skin lesions)-Neurologic (confusion, memory loss, slowed learning)-Oral (dental decay or “meth mouth”) Acute intoxicationComplications of severe acute intoxication: hypovolemia, metabolic acidosis, hyperthermia, disseminated intravascular coagulation (DIC), rhabdomyolysis, tachydysrhythmia, hypertension, and seizures.  Methamphetamine as a psychostimulant, has a half-life of 12 hours, so its effects last longer than those of cocaine. It is metabolized by the liver through the cytochrome P2D6 system. After the acute intoxication you can see the opposite: sedation, slurred speech, hypersomnia.  Screening  No specific guidelines regarding screening for methamphetamine use are available.  In 2008, The U.S. Preventive Services Task Force concluded that evidence available at that time was insufficient to assess the balance of benefits and harms of screening adolescents, adults, and pregnant women for illicit drug use.  This guideline was updated in June 2020. The USPSTF now gives a grade of recommendation “B” to screening for unhealthy drug use. How do you screen? By asking questions about unhealthy drug use in all adults older than 18 years old. This recommendation does not include testing biological specimens. Screening should be implemented when diagnosis, effective treatment and care can be offered at your clinic or you can refer to other providers for treatment. The American Academy of Pediatrics, the American Medical Association's Guidelines for Adolescent Preventive Services, and the Bright Futures initiative endorse screening adolescents for illicit substance use. On the other hand, the USPSTF concluded in June 2020 that the current evidence is insufficient to recommend screening for unhealthy drug use in adolescents. So, it gives a grade of recommendation “I”. Remember, “I” does not mean “Do not screen”, “I” means “Insufficient or I don't know”. The American College of Obstetricians and Gynecologists recommends direct questioning of all patients about their use of drugs as part of periodic assessments. Screening for methamphetamine use by history should be considered for pregnant women, teenagers and young adults, persons with criminal histories, men who have sex with men, and persons in high-risk ethnic groups. Diagnostic testing with informed consent can be useful in patients with stimulant-associated symptoms and signs, but this is not screening, this is a diagnostic test. Diagnosis  DSM-5 criteria — A problematic pattern of methamphetamine use leading to clinically significant impairment or distress, as manifested by two or more of the following within a 12-month period:• Methamphetamine is often taken in larger amounts or over a longer period than was intended (patient wants more and more meth)• There is a persistent desire or unsuccessful efforts to cut down or control methamphetamine use (patients want to quit but they can't)• A great deal of time is spent in activities necessary to obtain methamphetamine, use methamphetamine, or recover from its effects (patient spends a long time using meth and recovering)• Craving, or a strong desire or urge to use methamphetamine (patient crave)• Recurrent methamphetamine use resulting in a failure to fulfill major role obligations at work, school, or home• Continued methamphetamine use despite having persistent or recurrent social problems caused or exacerbated by the effects of methamphetamine• Important social, occupational, or recreational activities are given up or reduced because of methamphetamine use• Recurrent methamphetamine use in situations in which it is physically hazardous• Continued methamphetamine use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by methamphetamine Subtypes of severity of methamphetamine use disorder ●Mild: Two to three symptoms●Moderate: Four to five symptoms●Severe: Six or more symptoms Urine drug testMethamphetamine can be detected in urine for approximately 48 hours after use. It can be detected in meconium in newborns,indicating maternal use in the second half of pregnancy. Pseudoephedrine can cause a false positive test result for amphetamines.The amphetamine portion of the "tox screen" is susceptible to both false positive and false negative results and must be interpreted in clinical context.  Drugs of abuse, such as benzphetamine and bupropion (a synthetic cathinone), may give positive results. Medications such as selegiline and nonprescription nasal inhalers (decongestants) containing the active ingredient l-methamphetamine (l-desoxyephedrine) may yield positive results for amphetamine. Phentermine can give a false positive result in Utox for meth or MDMA (ecstasy). If a patient states he/she is taking phentermine, you can order a confirmatory test, which will then show that it was phentermine and not amphetamine or methamphetamine. If you are taking phentermine for weight loss, you should stop taking it a week before the drug test. Treatment of acute intoxicationThe treatment of acute methamphetamine intoxication is largely supportive. -Activated charcoal (after oral ingestion) when there are severe symptoms of intoxication and absorption needs to be reduced-Benzodiazepines may be indicated for seizures or agitation-Antipsychotics may be needed for paranoia or psychosis. -Cooling measures may be required if there is hyperthermia. -If elevated blood pressure is dangerously high, it should be lowered, but there are no data regarding blood pressure goals or which medications to use. -Abuse of multiple substances is possible. Patients may have used a combination of marijuana, alcohol, and cocaine, for example. You should also consider testing for several STIs in meth users since high risk sexual behaviors are possible. Treatment of abuseOutpatient behavioral therapies are the standard treatment for methamphetamine abuse and dependence. Inpatient treatment may be needed in some cases. -Cognitive behavior therapy and contingency management programs are successful in treating cocaine addiction and may be effective in treating methamphetamine addiction as well. -Contingency programs consists of rewarding patients who provide a drug-free urine sample.-The Matrix Model is an individualized outpatient regimen that has been used successfully to treat patients who abuse stimulants. It is based on cognitive principles, incorporating individual, group, and family therapies, as well as drug testing and a 12-step program.  Medications to treat meth abuseThere are no medications approved by the U.S. Food and Drug Administration to treat methamphetamine dependence. Some studies on this topic include:-A Cochrane review showed that fluoxetine (Prozac, 40 mg per day) may have modest benefit in reducing cravings for a short time but does not reduce use of meth, and that imipramine (Tofranil) may improve adherence to therapy in methamphetamine users. -One small RCT showing that bupropion (Wellbutrin) decreased subjective methamphetamine-induced effects and craving in a laboratory setting. -A randomized controlled trial enrolled 60 men who have sex with men; participants had methamphetamine use disorder and were actively using the drug. All the men received weekly counseling plus mirtazapine (Remeron), 30 mg per day, or placebo. Men in the mirtazapine group had decreased methamphetamine use and sexual risk, despite low adherence.In Episode 47, Kafiya Arte mentioned the Accelerated Development of Additive Treatment for Methamphetamine Disorder (ADAPT-2), which assessed the efficacy of combined bupropion and naltrexone for the treatment of meth use disorder. 403 participants were enrolled. The efficacy of extended-release injectable naltrexone (380 mg every 3 weeks) combined with once-daily oral extended-release bupropion (450 mg) was evaluated, as compared to placebo.  Results: 13.6% response rate in the naltrexone-bupropion group and only 2.5% response with placebo. The response rate among participants that received naltrexone and bupropion was low, but it was higher than those who received placebo. Withdrawal-Stimulant withdrawal is less dangerous than withdrawal from alcohol, opioids, or sedatives, but seizures are possible.-Stimulant withdrawal symptoms include depression, somnolence, anxiety, irritability, inability to concentrate, psychomotor slowing, increased appetite, and paranoia. -There are no known effective treatments. -Methamphetamine withdrawal is associated with more severe and prolonged depression than is cocaine withdrawal, so patients with withdrawal should be monitored closely for suicidal ideation. How is methamphetamine made?Most methamphetamine used in the United States comes from small illegal laboratories in Mexico and within the US. It is unexpensive, potent, and highly pure. Pseudoephedrine is a common component used in the production of meth, along with many other dangerous ingredients. These chemicals can cause deadly lab explosions and house fires and they may remain in the air of the houses used as laboratories.   Can you get high if you breath second-hand methamphetamine smoke?Researchers have not proven that people who inhale secondhand methamphetamine smoke get high or have other health consequences but breathing these fumes can cause a positive urine test for methamphetamine. More research is needed in this field. Methamphetamine use is a big problem. Prevention of use is key in fighting this devastating addiction. In patients who are addicted, treatment includes behavioral health strategies. No medications have been approved for treatment of dependence, but we hope new research finds an effective medication to treat it.  Conclusion: Now we conclude our episode number 66 “Meth Abuse.” This topic is very extensive, but Dr Nwosu presented a good summary. Meth will continue to be a significant problem as long as we do not find a cure for this devastating addiction. Remember to screen your patients for drug use by asking direct and simple questions, then offer the addiction services available in your area. Even without trying, every night you go to bed being a little wiser. Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Ikenna Nwosu, and Bahar Hamidi. Audio edition: Suraj Amrutia. See you next week! ___________________________  References: Ronald Strauss, Nesreen Jawhari, Amy H. Attaway, Bo Hu, Lara Jehi, Alex Milinovich, Victor E. Ortega, Joe G. Zein, Intranasal Corticosteroids Are Associated with Better Outcomes in Coronavirus Disease 2019, The Journal of Allergy and Clinical Immunology: In Practice, September 2021, ISSN 2213-2198, https://doi.org/10.1016/j.jaip.2021.08.007. Winslow BT, Voorhees KI, Pehl KA. Methamphetamine abuse. Am Fam Physician. 2007 Oct 15;76(8):1169-74. PMID: 17990840. https://www.aafp.org/afp/2007/1015/p1169.html Klega AE, Keehbauch JT. Stimulant and Designer Drug Use: Primary Care Management. Am Fam Physician. 2018 Jul 15;98(2):85-92. PMID: 30215997. https://www.aafp.org/afp/2018/0715/p85.html Paulus, Martin, Methamphetamine use disorder: Epidemiology, clinical manifestations, course, assessment, and diagnosis, Up ToDate, last updated: July 20, 2021. https://www.uptodate.com/contents/methamphetamine-use-disorder-epidemiology-clinical-manifestations-course-assessment-and-diagnosis?search=methamphetamine%20use%20disorder&source=search_result&selectedTitle=2~128&usage_type=default&display_rank=2 Boyer, Edward W and Steven A Seifert, et. al, Methamphetamine: Acute intoxication, Up To Date, last updated: December 24, 2019. https://www.uptodate.com/contents/methamphetamine-acute-intoxication?search=Methamphetamine:%20Acute%20intoxication&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Methamphetamine, Drug Facts, National Institute on Drug Abuse (NIDA), accessed on July 28. 2021. https://www.drugabuse.gov/publications/drugfacts/methamphetamine.  

It's "In the News..." the top diabetes headlines of the past seven days. This week: Why is COVID more dangerous with diabetes? A new study says technology (like pumps and CGMs) doesn't help "Diabetes Distress," more screening recommended for "social risk" of type 2, bioartificial pancreas research and there's a T1D Superhero movie in the works! -- Links and transcript below Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android   Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines of the past seven days.  As always, I'm going to link up my sources in the Facebook comments – where we are live – and in the show notes at d-c dot com when this airs as a podcast.. so you can read more if you want, on your own schedule. XX In the News is brought to you by Real Good Foods! Find their Entrée Bowls and all of their great products in your local grocery store, Target or Costco. XX Our top story this week.. type 2 diabetes has been identified for a while now as one of the main risk factors for severe COVID-19. New research from the University of Michigan says the culprit appears to be an enzyme called SETDB2, which is part of the reason why wounds don't heal well in some people with diabetes. Put very simply, as levels of this enzyme went down, inflammation during COVID went up. There is already a protein – Interferon – that is known to increase levels of this enzyme.. These researchers hope their findings will help in clinical trials of interferon or other treatments. They also say it's important to go through a patient's medical history to better target treatment for COVID. https://medicalxpress.com/news/2021-09-people-diabetes-severe-covid-.html XX Interesting study about young adults and what these researchers call Diabetes Distress. The study shows Distress – which they don't really define, but what sounds like depression or burnout or other mental health struggles – is associated with higher A1Cs. Not too much of a surprise, but they also found it doesn't matter if these young adults using insulin pumps or CGMs or just multiple daily injections. This Yale study was done by looking at past surveys of more than 400 people aged 18-29 in NY. They found that while users of insulin pumps and CGMs have overall lower A1Cs, the benefit of device use diminishes when high diabetes distress is present. https://www.healio.com/news/endocrinology/20210908/diabetes-distress-associated-with-higher-hba1c-for-young-adults-regardless-of-device-use XX Certain racial and ethnic minorities develop type 2 diabetes at a younger age than white Americans. That means , current diabetes screening and prevention practices for them may be inadequate and inequitable This Northwestern Medicine study says American adults are diagnosed with type 2 at an average age of 50, but for Black and Mexican American adults it's 4 to 7 years earlier. And more than 25% of that group report a diagnosis before turning 40. Recommended screening time is important not just for better health but because screenings are almost always only covered by insurance when the U.S. Preventive Services Task Force recommends them. If that sounds familiar, that's the group that recently announced new guidelines that lowered the recommended age from 40 to 35 to start screening adults who are overweight or obese for type 2 diabetes. Future research should consider whether even earlier screening is indicated among individuals with exposure to social risks, the study authors said. https://medicalxpress.com/news/2021-09-black-mexican-american-adults-diabetes.html XX Very early on but promising results for what's being called a bio- artificial pancreas. This is a tiny implantable device that holds insulin-secreting cells in a compartment protecting them from the body's autoimmune response. The micro-encapsulation device has the potential to be an autonomous system that would not require constant refilling and replacement of insulin cartridges, according to these researchers. The prototype has two separate chambers — one that collects nutrients from the device's surroundings, and one that houses the protected cells. Lots of work before this one's ready for clinical trials https://interestingengineering.com/a-bioartificial-pancreas-could-substantially-enhance-type-1-diabetes-treatment XX More to come, including news about a T1D superhero movie, but first, I want to tell you about one of our great sponsors who helps make Diabetes Connections possible. Real Good Foods. Where the mission is Be Real Good They make nutritious foods— grain free, high in protein, never added sugar and from real ingredients— I was in Target this week and I saw the new Entrée bowls, I bought the Lemon Chicken and the Lasagna. The Lemon chicken was great! It uses hearts of palm pasta instead of regular noodles which I thought sounded odd but really tasted good. They keep adding to the menu line! You can buy online or find a store near you with their locator right on the website. I'll put a link in the FB comments and as always at d-c dot com. Back to the news… And a Big boost for diabetes camps. Lilly Diabetes will commit nearly $1 million over the next three years in a joint effort with the Helmsley Charitable Trust to the Type 1 Diabetes Camps Initiative. The money is going specifically to non-profit diabetes camping organizations nationwide serving low-income youth living with T1D. and help diabetes camps adapt to the physical requirements of COVID-19 and better serve youth living with T1D via capital improvements. https://www.prnewswire.com/news-releases/lilly-diabetes-joins-the-leona-m-and-harry-b-helmsley-charitable-trust-to-pledge-significant-funding-to-type-1-diabetes-camps-initiative-301368797.html XX A new movie with a superhero who lives with type 1 is coming to theaters next summer. Called “Gum-she: The Type 1 Protector,” it's created by Jermaine Hargrove, diagnosed with type one 15 years ago as an adult. The main character Justice Johnson has diabetes but it's not the cause of her superpower. That comes from the bubble gum she's always chewing and she's able to shoot gum from her palms to help her save the world. The American Diabetes Association is partnering on the film and  promoting it.. one of the big themes is health equity.. There is a great article in diabetes mine all about this, I'll link that up. In it, Hargrove says Bubble gum brings everyone together. Like music: it's everywhere.” I'm excited about this – but I have to say – if this had come out when my kids were little – I would be hiding all of the bubble gum. If you watch the teaser trailer – she is shooting bubble gum everywhere! Using it to create bridges and running around like spider man. So.. it looks really cute but knowing my kids? Again.. I'd have to hide the gum. Watch for the trailer on world diabetes day – nov 14. The full film will be released next summer. https://www.healthline.com/diabetesmine/a-new-diabetes-superhero-movie-you-wont-want-to-miss https://gumshe.com/ XX Please join me wherever you get podcasts for our next episode - The episode out right now is with Ethan Orr – the Colorado high school swimmer removed from his meet because of his the medical tape over his CGM. And send me your Dear Dr. Banting audio! What would you say to the man credited with the discovery of insulin? All the details and how to send it to me is in the show notes. That's In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon.  

It's "In the News..." the only LIVE diabetes newscast! -- Top stories this week: T2D screening guidelines to change New Gvoke Kit approved Gestational Diabetes cases up in younger women Are magnets & radio waves coming to T1D care? Update on #DiversityInDiabetes -- Links and sources in the transcript Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android Episode Transcript below:   Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines of the past seven days.  As always, I'm going to link up my sources in the Facebook comments – where we are live on Wednesday August 25th 2021 – and in the show notes at d-c dot com when this airs as a podcast.. so you can read more if you want, whenever you want. XX In the News is brought to you by Real Good Foods! Find them in your local grocery store, Target or Costco. Real Food You Feel Good About Eating. XX Top story this week.. the number of young people with type 2 nearly doubled in the United States from 2001 to 2017. These researchers found significant increases in all types of diabetes among both sexes and across racial and ethnic groups. Type 1 diabetes remains more common among white youth. The highest rates of type 2 diabetes were seen in youth who are Black or Native American. It's interesting that these CDC and NIH researchers say they don't know the cause of the huge increase in type 2. They talk about rising obesity, but wonder what's behind that? They also wonder if it's because of increased screenings, environment or something else. https://www.reuters.com/business/healthcare-pharmaceuticals/diabetes-surges-among-american-youth-study-shows-2021-08-24/ XX Big change recommended in screening for adults with type 2. The U.S. Preventive Services Task Force now recommends screening for people who are overweight starting at age 35… five years earlier than recommended right now. That would include 40% of the US adult population. This task force recommends screenings that insurance companies must completely cover, without out of pocket costs to the insured, under the Affordable Care Act. XX FDA approval for Gvoke Kit to treat severe hypoglycemia. Xeris pharmaceuticals already provides Gvoke glucagon as an autoinjector and a prefilled syringe.. this Kit is for patients who prefer to draw up their own doses of glucagon using a vial and syringe. You don't have to mix anything, it's still a ready-to-use liquid glucagon. Could be helpful to those who prefer mini-glucagon doses – which are NOT FDA approved – but are sometimes used during illness. Note that's my comment, Xeris and the FDA is not talking about mini glucagon dosing at all.   https://www.fiercepharma.com/drug-delivery/xeris-a-rival-to-lilly-and-novo-gets-fda-nod-for-glucagon-kit   XX Growing numbers of pregnant women are developing gestational diabetes. Between 2011 and 2019, rates of gestational diabetes in the United States jumped 30%, according to a large nationwide study of first-time mothers. The cause? Not clear. Every age group saw an increase – from 15 to 44 – so it's not just moms getting older, which is happening. These researchers want to look at non -traditional risk factors like stress. This was a huge study – 13 million moms in the US. https://www.upi.com/Health_News/2021/08/18/diabetes-pregnancy/7401629306285/ XX In the – no thank you – department – researchers say they've got an implanted pump you'd refill just by swallowing a capsule. The catch? First, they have to implant the pump – which is described as the size of flip phone - along the abdominal wall, interfaced with the small intestine.   That refill capsule is magnetic, so the implant draws the capsule toward it. It then punches the capsule with a retractable needle and pumps the insulin into its reservoir. The needle must also punch through a thin layer of intestinal tissue to reach the capsule. These Italian developers testing it all out in pigs – they say it controlled blood glucose successfully… for several hours. https://spectrum.ieee.org/implantable-medical-devices https://www.newscientist.com/article/2287225-diabetes-implant-is-restocked-by-swallowing-magnetic-insulin-capsules/ XX Another maybe it'll work item… Israeli startup Hagar has something called G-Wave technology that measures blood sugar levels using noninvasive radio waves. The prototype puts the tech into a ceramic bracelet. Uses Bluetooth to transmit readings to an a mobile app with display and alert functions. A proof-of-concept study found the company's radio frequency technology was able to continuously measure glucose levels with at least 90% accuracy, compared to the estimated 70% rate for traditional continuous glucose monitors. They claim that's because it measures glucose in real time. Hagar now plans to launch clinical trials to pursue FDA approval https://www.fiercebiotech.com/medtech/hagar-brews-up-11m-after-a-serendipitous-spill-led-to-creation-new-cgm-tech XX More to come, but first, I want to tell you about one of our great sponsors who helps make Diabetes Connections possible. Real Good Foods. Where the mission is Be Real Good They make nutritious foods— grain free, high in protein, never added sugar and from real ingredients— I was in Target this week and I saw the new Entrée bowls, I bought the Lemon Chicken and the Lasagna. The Lemon chicken was great! It uses hearts of palm pasta instead of regular noodles which I thought sounded odd but really tasted good. They keep adding to the menu line! You can buy online or find a store near you with their locator right on the website. I'll put a link in the FB comments and as always at d-c dot com. Back to the news… XX Big grant goes to Scripps Whittier Diabetes Institute to study the use of CGMs in hospitalized patients with type 2. This is a $3.1 million dollar grant from The National Institutes of Health. It's to build on research going on now – during the COVID-19 pandemic. CGM devices have been approved for outpatient use since 1999, but their use in the hospital setting remains limited to research efforts and the special conditions allowed during the pandemic. https://timesofsandiego.com/tech/2021/08/10/scripps-whittier-diabetes-institute-gets-3-1m-for-glucose-device-study/-- XX Congrats to Diversity in Diabetes for their newly minted 501c3 status. The group was founded last summer and is dedicated to creating awareness and providing solutions to end health disparities and the lack of representation in the diabetes space. Their big event – People of Color Living with Diabetes Virtual Summit kicks off Sept 16 – more info and how to register in the show notes. XX Please join me wherever you get podcasts for our next episode -Tuesday –  we're talking to the folks from MannKind, makers of Afrezza inhalable insulin. You had a lot of questions for them.. looking forward to that episode! The episode out right now is with Kyle Banks – a Broadway performer diagnosed with type 1 while acting in the Lion King. That's In the News for this week.. if you like it, please share it! If you're watching this replay on YouTube please subscribe, if you're listening via the audio podcast please follow. Whatever it's called – I appreciate you being here. Thanks for joining me!  

It's "In the News..." the only LIVE diabetes newscast! Top stories this week: lots of interesting news in the latest Tandem Diabetes investor call including timeline and country updates. Researchers see whether a closed loop system can help people with type 2, new recommendations for gestational diabetes screening, camels milk for diabetes?! and the The Association of Diabetes Care & Education Specialists Annual Conference starts this week. Join Stacey on Facebook every Wednesday at 4:30pm EDT to watch "In the News..." Live. Learn more about the Book to Clinic Program here Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android Episode Transcription below: Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines of the past seven days.  As always, I'm going to link up my sources in the Facebook comments – where we are live – and in the show notes at d-c dot com when this airs as a podcast.. so you can read more if you want, whenever you want. XX In the News is brought to you by Real Good Foods! Excited to have them back as a sponsor! Real Food You Feel Good About Eating. XX Our top story this week.. couple of interesting nuggets in Tandem Diabetes' recent investor call. The company has grown at least 40% in nearly every quarter since late 2017 when the first major update came through on the Tslim X2.  They're getting ready to launch Control IQ in Germany and France.. and they're moving ahead with studies of this hybrid closed loop system down to age 2. Timing of NEW features is still a bit up in the air.. the company says they answered more FDA questions about bolus by phone and feel on track for approval by the end of the year – iOS and Android. T-sport submission will now likely happen in 2022. Like a lot of diabetes tech, COVID pushed these timelines out. One other little tidbit.. looks like there won't be a big user manual with the mobile improvements  – the training will be part of the app itself. Seems like common sense, but that's a big change that apparently the FDA asked for.     https://seekingalpha.com/article/4445137-tandem-diabetes-cares-tndm-ceo-john-sheridan-on-q2-2021-results-earnings-call-transcript XX How about a closed loop for type 2? New research from the University of Cambridge shows it works just fine. This was interesting because the idea here was to look at people who require dialysis or a kidney transplant. This was a different system, a fully closed loop – no meal announcements needed. People using the artificial pancreas system spent more time in range and less time with hypos. This system has an adaptive algorithm and got better as it went, the average time in range on day one was 36% and by the third week it was 60%. They didn't list much about the technology here – but I'm going to follow up.  It's not clear why these researchers aren't also studying this completely closed loop for people with type 1. They are moving ahead with a new study in people with type 2 who do not need dialysis. https://www.healtheuropa.eu/artificial-pancreas-trialled-in-type-2-diabetes-patients/110399/ XX New recommendations for gestational diabetes – screening should continue into the second trimester says the U.S. Preventive Services Task Force. They say screening for gestational diabetes improves both  maternal and infant health, and treatment. Gestational diabetes is estimated to occur in up to 9-percent of all pregnant women but might be up to three times as high depending on the diagnostic criteria used, say these researchers. The task force recommends clinicians screen for gestational diabetes between 24 and 28 weeks', using a two-step approach of both a screening tool (oral glucose challenge test) and diagnostic (oral glucose tolerance test), just the tolerance test, or fasting plasma glucose tests.   https://www.medpagetoday.com/endocrinology/diabetes/93984 XX A new way of looking at glucagon.. these researchers say they want to administer it as a preventive.. writing in the journal of the American Chemical Society these researchers say they have developed hydrogels that remain intact in the presence of glucose but slowly destabilize as levels drop, releasing glucagon into the system, safely raising blood sugar. This is very early on and hasn't yet been tested in people.. the early challenges so far have been keeping the hydrogel stable and keeping the glucagon from leaking out of the water like structure. But they say they've got it and are moving on to further studies. https://www.news-medical.net/news/20210720/Novel-method-for-glucagon-delivery-to-help-individuals-living-with-Type-1-diabetes.aspx   XX More to come, but first, I want to tell you about one of our great sponsors who helps make Diabetes Connections possible. Real Good Foods. Where the mission is Be Real Good They make nutritious foods— grain free, high in protein, never added sugar and from real ingredients— we are big fans of the pizza – Benny puts his in a frying pan, I prefer the air fryer. They keep adding to the menu line with breakfasts like waffles & breakfast sandwiches and great meals made with cauliflower & stuffed chicken. You can buy online or find a store near you with their locator right on the website. I'll put a link in the FB comments and as always at d-c dot com. Back to the news… Is this the new okra or something that might actually work? Looking at camel's milk to help lower blood glucose. camel milk has many of the sought-after bioactive properties of so-called "superfoods." And is said to help with insulin resistance and glycemic control. There's a clinical trial going on right now in Abu Dhabi looking to see if that's folk lore or the real deal. One study they point to is in a camel breeding community in North India which found that those who regularly consumed camel milk had a 0% rate of diabetes. Quick warning here.. camel milk if you can get it is very expensive and you're warned to avoid it in raw form..     https://www.medscape.com/viewarticle/956261 XX The Association of Diabetes Care & Education Specialists Annual Conference starts this week. The theme is “Changing Forward,” was designed to highlight patient care that moves away from what organizers call an institutional, task-oriented approach. They want to push for more individualized care that reflects the diversity of people with diabetes. It's a virtual conference and of course we'll have an update next week from any sessions or reports that are of interest. XX That's In the News for this week.. if you like it, please share it! Quick housekeeping note and a thank you… I have something called the book to clinic program where I'm able to supply pediatric endocrinology offices and clinics with my book – The World's Worst Diabetes Mom. I'm thrilled and flattered that educators and endos think this is of value to families. Big thanks to our newest book to clinic sponsor, Dia Be Tees - their mission is to raise Diabetes Awareness through modern, cute, humorous and fun tees! 10% of their profits go to JDRF. It's very reasonable to become a book to clinic sponsor! if you're interested please let me know. And if you're a clinic who wants books, reach out and I'll put you on the list. Please join me wherever you get podcasts for our next episode -Tuesday –  you'll hear from my son and get his thoughts on what it was like to spend one month overseas with a youth program not focused on type 1. He's 16 and you bet I'm happy he's home, but we both learned a lot. Thanks and I'll see you soon

Rhythm & News interview with Dr. Rachel Issaka, an assistant professor with UW Medicine and a health services researcher with the Fred Hutchinson Cancer Research Center, about new recommendations from the U.S. Preventive Services Task Force that calls for colorectal cancer screenings for adults to now begin at age 45, instead of the previous standard of screenings beginning at age 50. Interview by Chris B. Bennett.

Review the 2021 USPSTF Guidelines on Colorectal Cancer (CRC) screening with our guest, Dr. Michael Barry (vice-chair of the U.S. Preventive Services Task Force). Topics include a breakdown of testing modalities (stool tests versus direct visualization), screening ages, what to do for patients older than 75, and more!         Claim CE credit at curbsiders.vcuhealth.org. It's free for all healthcare professionals! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written and Produced by: Elena Gibson MD  Cover Art and Infographic: Elena Gibson MD Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP  Reviewer: Matthew Watto MD  Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Michael Barry MD  Sponsor: Indeed indeed.com/internalmedicine CME Partner: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.  Show Segments Intro, disclaimer, guest bio Guest one-liner Benefits of CRC screening How to choose a testing modality Testing in adults over 75 years old Health disparities in CRC screening Outro

Returning guest, Dr. Kathryn Lang, VP of Outcomes and Evidence at Guardant Health discusses the recent data shared at the 2021 American Society of Clinical Oncology (ASCO) on the investigational blood-based LUNAR-2 assay. This data shows that it offers a high sensitivity in detecting colorectal cancer (CRC) in asymptomatic patients. This is particularly important now that the U.S. Preventive Services Task Force announced it has lowered the age for CRC screening from 50 to 45. Dr. Kathryn Lang is a board certified hemato-oncologist, who completed clinical training in London, UK. With a strong focus on outcomes research throughout her career and over 50 publications, Dr. Lang moved to an industry role with Pfizer in 2016 where she led the global data science initiatives and developed regulatory grade observational research within Pfizer Oncology. She moved to her current role with Guardant Health in 2018 where she is VP of Outcomes and Evidence focusing on early detection of cancer and applied health economics and outcomes research. She is the principal investigator of ECLIPSE, the prospective, multi-site, observational study which is currently enrolling and aims to recruit 10,000 subjects to provide the clinical validation cohort for the LUNAR-2 colorectal cancer screening assay developed by Guardant Health. #ASCO2021 #GuadrantHealth #LUNAR2Assay

This week, we're discussing the recent U.S. Preventive Services Task Force, or USPSTF, recommendation on colorectal cancer screening beginning at 45. Then, we'll hear about a doublet regimen that produced durable responses in patients with advanced head and neck cancer. Lastly, we'll hear about a study being presented during the ASCO Annual Meeting about a novel immunotherapy combination for advanced melanoma.Coverage of stories discussed this week on ascopost.com:USPSTF Issues New Recommendation Statement on Colorectal Cancer ScreeningPembrolizumab Plus Cetuximab in Recurrent or Metastatic Head and Neck CancerTo listen to more podcasts from ASCO, visit asco.org/podcasts.

João, Kaue e Rapha com a participação do psiquiatra Rodolfo discutem sobre rastreio, impacto e tratamentos do transtorno associado ao uso do álcool. Minutagem em breve. 1. Kriston L, Hölzel L,Weiser A-K, Berner MM, Härter M. Meta-analysis: are 3 questions enough to detect unhealthy alcohol use? Ann Intern Med. 2008;149(12):879-888. doi:10.7326 2. Weisner C, Matzger H, Kaskutas LA. How important is treatment? one-year outcomes of treated and untreated alcohol-dependent individuals. Addiction. 2003;98(7):901-911. doi:10 .1046/j.1360-0443.2003.00438.x 3. Barata IA, Shandro JR, Montgomery M, et al. Effectiveness of SBIRT for Alcohol Use Disorders in the Emergency Department: A Systematic Review. West J Emerg Med. 2017;18(6):1143-1152. doi:10.5811/westjem.2017.7.34373 4. Falk D,Wang XQ, Liu L, et al. Percentage of subjects with no heavy drinking days: evaluation as an efficacy endpoint for alcohol clinical trials. Alcohol Clin Exp Res. 2010;34(12):2022-2034. doi:10.1111/j.1530-0277.2010.01290.x 5. Anton RF, O’Malley SS, Ciraulo DA, et al; COMBINE Study Research Group. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006;295(17): 2003-2017. doi:10.1001/jama.295.17.2003 WEERAKOON, Sitara M.; JETELINA, Katelyn K.; KNELL, Gregory. Longer time spent at home during COVID-19 pandemic is associated with binge drinking among US adults. The American Journal of Drug and Alcohol Abuse, 2020. POLLARD, Michael S.; TUCKER, Joan S.; GREEN, Harold D. Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA network open, v. 3, n. 9, p. e2022942-e2022942, 2020 BASTOS, Francisco Inácio Pinkusfeld Monteiro et al. III levantamento nacional sobre o uso de drogas pela população brasileira. 2017. O’Connor EA, Perdue LA, Senger CA, et al. Screening and Behavioral Counseling Interventions in Primary Care to Reduce Unhealthy Alcohol Use in Adolescents and Adults: Updated Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 171. AHRQ Publication No. 18-05242-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2018. 3 NATIONAL INSTITUTE ON ALCOHOL ABUSE; ALCOHOLISM (US). Helping Patients who Drink Too Much: A Clinician's Guide: Updated 2005 Edition. US Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 2007. 2 CURRY, Susan J. et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. Jama, v. 320, n. 18, p. 1899-1909, 2018. MILLSTEIN, Susan G.; MARCELL, Arik V. Screening and counseling for adolescent alcohol use among primary care physicians in the United States. Pediatrics, v. 111, n. 1, p. 114-122, 2003. Committee on Substance Use and Prevention. Substance use screening, brief intervention, and referral to treatment [published online June 20, 2016]. Pediatrics. doi:10.1542/peds.2016-1211 PEREIRA, Bruna Antunes de Aguiar Ximenes; SCHRAM, Patricia Franco Cintra; AZEVEDO, Renata Cruz Soares de. Avaliação da versão brasileira da escala CRAFFT/CESARE para uso de drogas por adolescentes. Ciência & Saúde Coletiva, v. 21, p. 91-99, 2016. MÉNDEZ, Eduardo Brod et al. Uma versão brasileira do AUDIT-Alcohol Use Disorders Identification Test. Pelotas: Universidade Federal de Pelotas, p. 69, 1999. Richard Saitz, Murray B Stein, Michael Friedman. Psychosocial treatment of alcohol use disorder. Uptodate Abril 2021. Approach to treating alcohol use disorder. Richard Saitz, Andrew J Saxon, Michael Friedman. Uptodate Abril 2021. [26/5 20:26] Raphael Coelho Cm Epm: KELLY, John F.; HUMPHREYS, Keith; FERRI, Marica. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews, n. 3, 2020. [26/5 20:26] Raphael Coelho Cm Epm: Brief intervention for unhealthy alcohol and oth

The U.S. Preventive Services Task Force has lowered the recommended age of colorectal cancer screenings from 50 to 45. Colorectal cancer cases have risen among the younger population over the past few decades.For more information about this story, visit https://michmed.org/v1NXk. See acast.com/privacy for privacy and opt-out information.

Colorectal cancer screening update, COVID-19 vaccine update, and abnormal uterine bleeding basics.Today is May 24, 2021.Colorectal cancer screening update Written by Hector Arreaza, MD. Participation: Ikenna Nwosu, MD, and Daniela Viamontes, MD.Today is May 24, 2021.On august 29, 2020, we were in the midst of a pandemic and we woke up with the sad news about the death of Chadwick Aaron Boseman (also known as Black Panther). An interesting fact: The tweet in which his family announced his death on Twitter became the most-liked tweet in history. But why are we talking about Chadwick’s death? Because he died of colon cancer. I do not know if this recommendation came because of Chadwick, but it’s a good way to open this episode: remembering Black Panther.We heard the rumors, but now it’s official. On May 18, 2021, the USPSTF released their final recommendation statement about colorectal cancer screening. The age to start screening has been changed from 50 to 45 years old. This is a grade B recommendation. Grade B means that this recommendation has moderate to substantial net benefit, so offer this service to your patients. Screening adults between 76 and 85 years old who have been previously screened has a small net benefit (grade C recommendation). So, select patients may be screened for colorectal cancer in this age group (76-85), especially those who have never been screened.Do you remember this recommendation from medical school for high risk patients? Start screening at age 40 or 10 years before a patient’s direct-relative was diagnosed with colon cancer. This was a recommendation given by the US Multi-Society Task Force (which includes the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy). This same organization already recommended in 2017 to start screening at age 45 in African American patients, and the American Cancer Society recommended screening all patients at age 45 in 2018. The ACS does not have a guideline to screen high risk patients for colon cancer. Most organizations agreed on not screening after age 85.Strategies for screening:High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every yearDani: Stool DNA-FIT every 1 to 3 years (Cologuard®)  CT colonography every 5 years Flexible sigmoidoscopy every 5 years OR Flexible sigmoidoscopy every 10 years + annual FIT Colonoscopy screening every 10 yearsDiscuss different options with your patients, choose your favorite and do it!  Introduction: Update on COVID 19 vaccines  By Hector Arreaza, MD, and Lillian Petersen, RN. COVID-19 vaccines now can be co-administered with other vaccines according to the ACIP. COVID-19 vaccines and other vaccines may now be administered without regard to timing. They can be given on the same day or within the 14 days previously recommended between vaccines.  It is not known if reactogenicity of COVID-19 vaccine is increased with co-administration with other reactogenic vaccines (such as vaccines with live attenuated viruses).  How do you decide if you want to co-administer a vaccine? 1. Consider whether the patient is behind or at risk of becoming behind on recommended vaccines.2. Consider their risk of vaccine-preventable disease.3. Consider the reactogenicity profile of the vaccines. If multiple vaccines are administered at a single visit, administer each injection in a different injection site, at least one inch apart or in different limbs. Current or previous SARS-CoV-2 infection: Everyone should be offered COVID-19 vaccination regardless of their history of COVID-19 infection. Viral testing or serologic test is not recommended for the purposes of vaccine decision-making. People with current SARS-CoV-2 infection should be deferred until the person has recovered from the acute illness (if the person had symptoms) and they have met criteria to discontinue isolation. This applies to patients who got the disease before receiving any vaccine or after receiving the first dose.  A minimum interval between infection and vaccination has not been established, but evidence suggests that the risk of reinfection is low in the months after initial infection but may increase with time due to waning immunity. People with a history of multisystem inflammatory syndrome in children (MIS-C) or adults (MIS-A):It is unclear if people with a history of MIS-C or MIS-A are at risk of recurrence of the same dysregulated immune response following reinfection with SARS-CoV-2 or in response to vaccination. People with a history of MIS-C or MIS-A may choose to be vaccinated but they should consider delaying vaccination until they have recovered from their illness and for 90 days after the date of diagnosis. Find more information at the CDC.gov website. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ___________________________Abnormal Uterine Bleeding. By Sherika Adams, MS3, P. Eresha Perera, MS3, and Hector Arreaza, MD.  Definition. AUB is a symptom, not a diagnosis. It is equivalent to say: “This patient’s periods are abnormal.” Anything that falls out of what is considered “normal periods” is classified as abnormal uterine bleeding.These 4 elements are assessed when determining if a patient has AUB: Regularity, frequency, duration, and volume.  What is considered normal? Frequency = Every 24-38 days, regularity +/- 2-20 days over 12 months, duration = 4.5 to 8 days, volume = 5-80 mL. 10-30% of women of reproductive age may have AUB. According to the American College of Obstetricians and Gynecologists (ACOG), abnormal uterine bleeding is characterized by bleeding or spotting following sexual intercourse or menopause, between menstrual cycles, menstrual cycles lasting more than 38 days or shorter than 24 days, heavy bleeding during menstruation, and “irregular” menstrual cycles that have 7-9 days of variation.Terms no longer used: menorrhagia, metrorrhagia, and dysfunctional uterine bleeding (DUB). Not all symptoms reported as “vaginal bleeding” are coming from the vagina. For example, bleeding from anus, urethra, bladder, and perineum should be ruled out before establishing the diagnosis of AUB. Classification of Abnormal Uterine Bleeding (AUB). Abnormal uterine bleeding (AUB) in nonpregnant premenopausal women can be classified by the acronym PALM-COEIN, which was established by the International Federation of Gynecology and Obstetrics (FIGO) in 2011.  PALM-COEIN: Palm: Structural etiologies, Coein: Non-structural etiologies P is for polyps: Polyps are epithelial tumors in the endometrium or cervix and can be identified by hysterosonography or hysteroscopic imaging. A is for adenomyosis: Adenomyosis is endometrial stroma and glands in the myometrium and can be identified by histopathology, and now MRI and transvaginal ultrasound. L is for leiomyomas: Leiomyomas also known as uterine fibroids are benign smooth muscle tumors that are diagnosed by pelvic examination and pelvic imaging such as ultrasound with contrast or MRI. M is for malignancy and hyperplasia: Malignancy and hyperplasia are often abnormal epithelial tissue that is benign or cancerous that can be seen with transcervical endometrial sampling. C is for coagulopathy: Coagulopathy is bleeding disorders such as Von Willebrand disease is identified by laboratory testing. O is ovulatory dysfunctions: Ovulatory dysfunction occurs when there is a variation of more than seven days of the menstrual cycle in the past 12 months and ovulation is dysfunctional. In a woman without ovulation, there is no corpus luteum, and there is no progesterone, so estrogen goes unopposed, causing a buildup of endometrium and irregular bleeding.   E is endometrial causes: Endometrial causes can occur when there is normal ovulation, no other identifiable cause of AUB, and there is heavy menstrual bleeding, which includes intermenstrual bleeding. Primary disorders of endometrial hemostasis are likely due to vasoconstriction disorders, inflammation, or infection. Endometrial dysfunction is poorly understood; there are no reliable diagnostic methods, and it should be considered only after other causes are excluded. I is for iatrogenic cause: Iatrogenic causes include gonadal steroids (estrogen, androgens), anticoagulants, intrauterine devices, antipsychotics, antidepressants, and anti-hypertensives. N is for not otherwise classified: Example of an etiology under not otherwise classified might be AV malformations. This classification does not include pregnancy. Postmenopausal bleeding: Abnormal uterine bleeding can also occur in post-menopausal women and is an indication of potentially lethal endometrial cancer. Post-menopausal women should be worked up for cancer when they present with bleeding. However, most common cause of bleeding in this population is atrophy of the vaginal mucosa or endometrium. If younger than 45 patients but history of unopposed estrogen exposure (PCOS, obesity, estrogen therapy) should also undergo endometrial biopsy to rule out possibility of endometrial cancer.  Management of AUB. Management of the AUB can be initiated only after the etiology of the bleeding has been established. Firs of all, rule out pregnancy related bleeding by performing a pregnancy test. Also, rule out other sources of bleeding. The first question to answer would be: Does this patient need an emergent treatment for her AUB or can she be treated as outpatient? Determine that by checking the history, vitals, orthostatic vitals, physical exam, and labs.  If patient requires admission, the options for treatment include: uterine tamponade, intravenous estrogen, dilation and curettage, and uterine artery embolization. In case of severe bleeding without hemodynamic instability, patients can be treated initially with oral estrogen, high-dose estrogen-progestin oral contraceptives, oral progestins, or intravenous tranexamic acid.For chronic AUB, once etiology has been established, the goal is to treat the underlying condition. The goal of treatment is to control the bleeding since AUB can persists until menopause.  Initial outpatient treatment is usually pharmacological. For those not wanting to conceive soon, consider IUD placement. “Among medical therapies, the 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena) is most effective for decreasing heavy menstrual bleeding (71% to 95% reduction in blood loss) and performs similarly to hysterectomy when quality-adjusted life years are considered.”[8] Other long-term medical treatment options include estrogen-progestin oral contraceptives, oral progestins, oral tranexamic acid, NSAIDs (nonsteroidal anti-inflammatory drugs), and depot medroxyprogesterone. Surgical treatment is often considered for patients on long term medical therapy with no response, or for severe cases of bleeding with recurrent need for emergent treatment. Some surgical options are endometrial ablation, which performs as well as the levonorgestrel-releasing intrauterine system. Some structural lesions can be resected via hysteroscopy (polyps). Myomectomy and uterine artery embolization are options for patients with severe AUB who want to preserve fertility. Uterine leiomyomas or adenomyosis can be medically managed with OCPs but can also be treated with surgery as well, depending on the physician-patient discussion of options. Hysterectomy is the definitive treatment of severe AUB. Remember, PALM COEIN stands for: Polyps, Adenomyosis, Leiomyomas, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial causes, Iatrogenic cause, Not otherwise classified. ____________________________Conclusion. Written by Hector Arreaza, MDNow we conclude our episode number 53 “Abnormal Uterine Bleeding”. Eresha and Sherika did a great job explaining the Palm-Coein classification, and gave us a good overview of the management of AUB. Remember to start screening for colorectal cancer at age 45 now, what strategy for screening will you use? And for those patients who were hesitant about getting the COVID-19 vaccine with other vaccines, well, the ACIP said we can co-administer it with other vaccines. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Daniela Viamontes, Ikenna Nwosu, Lillian Petersen, Sherika Adams, and P. Eresha Perera. Audio edition: Suraj Amrutia. See you next week! _____________________References:U.S. National Library of Medicine, Clinical Trials.Gov, https://clinicaltrials.gov/ct2/show/study/NCT02026869. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States, Centers for Disease Control and Prevention, https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#Coadministration, accessed on May 20, 2021.  Colorectal Cancer: Screening, Final Recommendation Statement, U.S. Preventive Services Task Force, May 18, 2021, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening. Abnormal Uterine Bleeding FAQ, The American College of Obstetricians and Gynecologists (ACOG), https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding, accessed on May 17, 2021.  Fraser, Ian, et al. Abnormal uterine bleeding in reproductive-age women: Terminology and PALM-COEIN etiology classification, Up to Date, last updated: Dec 16, 2019. https://www.uptodate.com/contents/abnormal-uterine-bleeding-in-reproductive-age-women-terminology-and-palm-coein-etiology-classification?search=palm%20coein&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Goodman Annekathryn, et al, Postmenopausal uterine bleeding, Up to Date, last updated: Feb 02, 2021. https://www.uptodate.com/contents/postmenopausal-uterine-bleeding?search=abnormal%20uterine%20bleeding%20postmenopausal&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Kaunitz, Andre M, Abnormal uterine bleeding: Management in premenopausal patients, Up to Date, last updated: Aug 25, 2020. https://www.uptodate.com/contents/abnormal-uterine-bleeding-management-in-premenopausal-patients?search=abnormal%20uterine%20bleeding%20management&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Wouk N, Helton M. Abnormal Uterine Bleeding in Premenopausal Women. Am Fam Physician. 2019 Apr 1;99(7):435-443. PMID: 30932448. https://pubmed.ncbi.nlm.nih.gov/30932448/ 

Jaime Perales, PhD, presents statistics, screening tools and useful resources for primary care providers for Alzheimer’s disease. The KIDs list is presented. Question of the month: Fever and Cough.Introduction: KIDs List and Cognitive Impairment in the ElderlyBy Hector Arreaza, MDToday is May 3, 2021.  In family medicine, we believe in caring for patients “from the cradle to the grave.” During this introduction, we want to inform first of the KIDs list[1] and then some updates on cognitive impairment screening in older adults[2].First, KIDs stand for Key Potentially Inappropriate Drugs in Pediatrics. It is a list of medications that are potentially inappropriate in children. It contains 67 drugs with their risks, recommendations, strength of recommendation and quality of evidence. Common meds include anti-infectives, antipsychotics, dopamine antagonists and GI agents. 85% of these meds require a prescription, and are taken by mouth, or used by parenteral route or even for external use. For example: Mineral oil, oral, carries the risk of lipid pneumonitis, recommended to avoid in patients younger than 1 year old, this recommendation is strong with low quality of evidence. For all the “abuelas” (Spanish for grandmothers) out there, listen to this: Camphor carries a risk of seizures, the recommendation is “use with caution in children.” However, the recommendation is weak and quality of evidence is low, but the concern is enough to include it on the list, in other words, use “vi-vah-pore-oo” with caution in children. I recommend you look up the KIDs list and use your clinical judgment to incorporate it into your practice. From childhood, now we go to the elderly. On February 25, 2020, the USPSTF posted their final recommendation statement regarding screening for cognitive impairment in older adults. This is a Grade I recommendation (Insufficient Evidence). It means that more research is needed to recommend for or against it. This is the same recommendation given in 2014. An article published in JAMA on the same date, Feb 25, 2020, reports that screening instruments can adequately detect cognitive impairment, however there is no evidence that this screening improves patient or caregiver outcomes or causes harm. It is still uncertain if early detection of cognitive impairment is important to provide interventions for patients or caregivers with significant clinical benefits.Jaime Perales, PhD, will present some statistics on Alzheimer’s disease, he will explain some useful tools to screen for cognitive impairment and address the issue of Alzheimer’s disease at the primary care level. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.  Question of the Month: Fever and CoughWritten by Hector Arreaza, MD, read by Claudia Carranza, MD, and Valerie Civelli, MDThis is a 69-yo male patient, who has history of controlled hypertension. He comes to an urgent care clinic for acute onset of fever (102 F), cough, and shortness of breath which has progressively worsened over the last 3 days. He does NOT smoke tobacco, but uses recreational marijuana once a month, and drinks 1-2 beers a week. He goes to the doctor once a year for check-ups. He takes benazepril 10 mg daily for his hypertension. He does not believe in vaccines and his last shot was a tetanus shot 5 years ago. He has no surgical history. He retired as an accountant 5 years ago. Vital signs are normal except for tachycardia of 110 (his baseline is 85) and temperature of 101.5 F (38.6 C). He has bibasilar crackles on auscultation. You perform labs in clinic and he has a white count of 13.5, and a chest x-ray shows a right lower lobe consolidation. He has a negative rapid COVID-19 test. What are your top 3 differential diagnoses and what is the acute management of this patient’s condition? Let’s repeat the question: What are your top 3 differential diagnoses and what is the acute management of a 69-year-old male, non-smoker, who has fever, cough, shortness of breath, tachycardia, bibasilar crackles, elevated WBCs, a right lower lobe consolidation, and a negative rapid COVID-19 test?Send us your answer before May 7, 2021, to rbresidency@clinicasierravista.org and the best answer will win a prize!____________________________Screening for Alzheimer’s. With Jaime Perales Puchalt, PhD, and Hector Arreaza, MD Jaime Perales Puchalt is an Assistant Professor in the Department of Neurology. His main areas of interest include dementia among minorities and populations of Latin American origin in the Americas. He currently spearheads the Latino Alzheimer's education efforts at the University of Kansas Alzheimer’s Disease Center (KU ADC) and the Latino Cohort in which he recruits and conducts clinical dementia assessments of English and Spanish speaking Latinos. He has also led the integration of the Spanish National Alzheimer's Coordinating Center Unified Data Set 3.0 into REDCap. Together with Dr. Vidoni, Dr. Perales developed Envejecimiento Digno, a curriculum to increase Alzheimer's disease awareness among individual Latino community with different literacy levels.  Dr. Perales completed his MS in Psychology at the University of València, and his MPH in Public Health and PhD in Biomedicine at the University Pompeu Fabra, Barcelona. He started his research career at the University of València, where he collaborated in several stress-related projects among breast cancer patients, Latin American immigrants and caregivers of schizophrenia patients. Dr. Perales co-managed a four-year European Commission-funded multi-country study on healthy aging (COURAGE in Europe) at the Parc Sanitari Sant Joan de Déu. He also spent one year as a visiting researcher at the Institute of Public Health, University of Cambridge conducting dementia-related epidemiological research and collaborating in successful aging literature reviews. At Juntos: Center for Advancing Latino Health (KU), he contributed to the cultural and linguistic adaptation of several smoking cessation interventions for Latinos[3].Questions discussed during this episode:  Incidence and prevalence of dementia in the US: under-diagnosis, death risk, caregiver, Recommendations on screening for dementia by national organizations: American Academy of Neurology, examining models of dementia care (page 22), USPSTF, grade I, no evidence, screening early improves outcomes; ARDADBest evidence-based tools for screening for dementia: MMSE, MoCA (better for MCI), AD8, MiniCog. Useful resources for primary care providers: Alzheimer’s Association: Unidos Podemos (soap opera), NIH Caring for a person with Alzheimer’s Disease, Course: USDHHS,  Any other information you would like to provide us: The course, Jul 23, 2021, and Sep 3, 2021. Conclusion.Now we conclude our episode number 50 “Screening for Alzheimer’s Disease”. You heard from our experts the importance of assessing and treating your patients with Alzheimer’s Disease. We hope you can find all the resources mentioned during our interview with Jaime Perales, make sure you check our episode notes to find the links or just Google them, they are readily available online. Do not forget to send us your answer to the question of the month: What are your top 3 differential diagnosis and acute management of a 69-year-old male with new onset of fever, cough, shortness of breath, and right lower lobe consolidation. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Ariana Lundquist, Jaime Perales, Claudia Carranza, and Valerie Civelli. Audio edition: Suraj Amrutia. See you next week! References and resources mentioned during this episode:Meyers RS, Hellinga RC, Hoff DS. The KIDs List: Medications That Are Potentially Inappropriate in Children. Am Fam Physician. 2021 Mar 15;103(6):330. PMID: 33719376. https://www.aafp.org/afp/2021/0315/p330.html Cognitive Impairment in Older Adults: Screening, February 25, 2020. U.S. Preventive Services Task Force.  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cognitive-impairment-in-older-adults-screening Patnode CD, Perdue LA, Rossom RC, et al. Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323(8):764–785. doi:10.1001/jama.2019.22258.  https://jamanetwork.com/journals/jama/article-abstract/2761650 KU Medical Center, The Univeristy of Kansas, Core Faculty, https://www.kumc.edu/ku-adc/core-faculty/jaime-perales-puchalt-phd.html 2021 Alzheimer’s Disease Facts and Figures, Special Report on Race, Ethnicity and Alzheimer's in America, published by the Alzheimer’s Association, Chicago, Illinois, USA.  https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf Examining Models of Dementia Care: Final Report, U.S. Department of Health & Human Services, September 1, 2016, https://aspe.hhs.gov/pdf-report/examining-models-dementia-care-final-report ¡Unidos Podemos! (Fotonovela, Spanish), Alzheimer’s Association, http://www.alz.org/espanol/downloads/Novella_spanish_081213.pdf Together We Can! (Picture Novel, English), Alzheimer’s Association, http://www.alz.org/espanol/downloads/Novella_english_081213.pdf Alzheimer’s Disease, Caring for a Person with Alzheimer's Disease: Your Easy-to-Use Guide, U.S. Department of Health & Human Services, National Institute on Aging, https://order.nia.nih.gov/sites/default/files/2019-03/Caring_for_a_person_with_AD_508_0.pdf