Jan Dyer

The consensus is in: Undetectable is Untransmittable (U = U).  That is, scientific experts are finally willing to say that the concept of “Undetectable is Untransmittable” for HIV treatment is now “firmly established.” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), writing in JAMA, says an “overwhelming” body of clinical evidence provides a firm basis for accepting the concept as scientifically sound.

In the JAMA commentary, Fauci and colleagues review the results of clinical trials validating U = U. One landmark study, for instance, showed that no linked HIV transmissions occurred among HIV serodifferent heterosexual couples when the partner living with HIV had a durably suppressed viral load. Subsequent studies confirmed the findings and extended them to male-male couples.

The key, the researchers all agree, is to be absolutely adherent to antiretroviral therapy (ART). Viral suppression measured at 6 months after starting therapy is required for U = U. Stopping ART represents a “significant challenge” to successful implementation of U = U. According to the clinical trials, when ART is stopped, viral rebound usually occurs within 2 to 3 weeks. In 2 studies, stopping ART caused viral rebound to levels that would have been associated with increased risk of HIV transmission.

The NIH experts say this consensus has a variety of implications. It gives incentive to people living with HIV to start and adhere to treatment, removes the sense of fear and guilt they may have about harming others, and reduces the risk of legal penalties arising from putting virus-free partners at risk. And because “prevention as control” is a critical tool, the U = U concept can support worldwide efforts to control—or even eliminate—the pandemic.

Source:

Eisinger RW, Dieffenbach CW, Fauci AS. JAMA. 2019.

doi: 10.1001/jama.2018.21167. [Epub ahead of print.]

The consensus is in: Undetectable is Untransmittable (U = U).  That is, scientific experts are finally willing to say that the concept of “Undetectable is Untransmittable” for HIV treatment is now “firmly established.” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), writing in JAMA, says an “overwhelming” body of clinical evidence provides a firm basis for accepting the concept as scientifically sound.

In the JAMA commentary, Fauci and colleagues review the results of clinical trials validating U = U. One landmark study, for instance, showed that no linked HIV transmissions occurred among HIV serodifferent heterosexual couples when the partner living with HIV had a durably suppressed viral load. Subsequent studies confirmed the findings and extended them to male-male couples.

The key, the researchers all agree, is to be absolutely adherent to antiretroviral therapy (ART). Viral suppression measured at 6 months after starting therapy is required for U = U. Stopping ART represents a “significant challenge” to successful implementation of U = U. According to the clinical trials, when ART is stopped, viral rebound usually occurs within 2 to 3 weeks. In 2 studies, stopping ART caused viral rebound to levels that would have been associated with increased risk of HIV transmission.

The NIH experts say this consensus has a variety of implications. It gives incentive to people living with HIV to start and adhere to treatment, removes the sense of fear and guilt they may have about harming others, and reduces the risk of legal penalties arising from putting virus-free partners at risk. And because “prevention as control” is a critical tool, the U = U concept can support worldwide efforts to control—or even eliminate—the pandemic.

Source:

Eisinger RW, Dieffenbach CW, Fauci AS. JAMA. 2019.

doi: 10.1001/jama.2018.21167. [Epub ahead of print.]

The consensus is in: Undetectable is Untransmittable (U = U).  That is, scientific experts are finally willing to say that the concept of “Undetectable is Untransmittable” for HIV treatment is now “firmly established.” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), writing in JAMA, says an “overwhelming” body of clinical evidence provides a firm basis for accepting the concept as scientifically sound.

In the JAMA commentary, Fauci and colleagues review the results of clinical trials validating U = U. One landmark study, for instance, showed that no linked HIV transmissions occurred among HIV serodifferent heterosexual couples when the partner living with HIV had a durably suppressed viral load. Subsequent studies confirmed the findings and extended them to male-male couples.

The key, the researchers all agree, is to be absolutely adherent to antiretroviral therapy (ART). Viral suppression measured at 6 months after starting therapy is required for U = U. Stopping ART represents a “significant challenge” to successful implementation of U = U. According to the clinical trials, when ART is stopped, viral rebound usually occurs within 2 to 3 weeks. In 2 studies, stopping ART caused viral rebound to levels that would have been associated with increased risk of HIV transmission.

The NIH experts say this consensus has a variety of implications. It gives incentive to people living with HIV to start and adhere to treatment, removes the sense of fear and guilt they may have about harming others, and reduces the risk of legal penalties arising from putting virus-free partners at risk. And because “prevention as control” is a critical tool, the U = U concept can support worldwide efforts to control—or even eliminate—the pandemic.

Source:

Eisinger RW, Dieffenbach CW, Fauci AS. JAMA. 2019.

doi: 10.1001/jama.2018.21167. [Epub ahead of print.]

Many adults spend a large part of their time at work—making the workplace an important but underused location for suicide prevention, say CDC researchers who analyzed data on 22,053 suicides in 17 states. The US suicide rate among working adults (aged 16-64 years) rose 34% between 2000 and 2016, from 12.9 to 17.3 per 100,000.

Suicide rates rose in many occupational groups between 2012 and 2015, but identifying the specific role that occupational factors might play in suicide risk is complicated, the researchers say: Both work (eg, little job control and job insecurity) and nonwork (eg, relationship conflict) factors are associated with psychological distress and suicide. And factors such as access to lethal means while on the job play a part as well.

The major occupational group with the highest male suicide rate was Construction and Extraction (from 43.6% in 2012 to 53.2% in 2015. The Arts, Design, Entertainment, Sports, and Media groups had the highest female suicide rate (15.6%, up from 11.7%).

Health Care Support, which ranked twelfth on the 2015 list, actually saw a drop in the numbers of male suicides (19.5/100,000 in 2015, vs 22.1 in 2012). But among women, the numbers rose 31%: from 8.4 per 100,000 to 11.0, making that category third among females. 

With a 13% drop (from 10.3 to 9.0), Health Care Practitioners and Technical (female) moved from fourth to sixth place. For men, the category ranked eighth, with a rate change of 23%, from 20.8 to 25.6 suicide deaths per 100,000.

The researchers say better understanding of how suicides are distributed by occupational group might help inform prevention programs and policies. The CDC recommends a comprehensive approach, including strategies such as:

• Enhancing social connectedness;
• Strengthening state or local economic supports;
• Implementing practices that encourage help-seeking and reduce stigma;
• Providing referrals to mental health and other services; and
• Reducing access to lethal means among people at risk

The CDC also encourages decision makers, such as employers, to create a response plan, should someone in their organization commit suicide.

Many adults spend a large part of their time at work—making the workplace an important but underused location for suicide prevention, say CDC researchers who analyzed data on 22,053 suicides in 17 states. The US suicide rate among working adults (aged 16-64 years) rose 34% between 2000 and 2016, from 12.9 to 17.3 per 100,000.

Suicide rates rose in many occupational groups between 2012 and 2015, but identifying the specific role that occupational factors might play in suicide risk is complicated, the researchers say: Both work (eg, little job control and job insecurity) and nonwork (eg, relationship conflict) factors are associated with psychological distress and suicide. And factors such as access to lethal means while on the job play a part as well.

The major occupational group with the highest male suicide rate was Construction and Extraction (from 43.6% in 2012 to 53.2% in 2015. The Arts, Design, Entertainment, Sports, and Media groups had the highest female suicide rate (15.6%, up from 11.7%).

Health Care Support, which ranked twelfth on the 2015 list, actually saw a drop in the numbers of male suicides (19.5/100,000 in 2015, vs 22.1 in 2012). But among women, the numbers rose 31%: from 8.4 per 100,000 to 11.0, making that category third among females. 

With a 13% drop (from 10.3 to 9.0), Health Care Practitioners and Technical (female) moved from fourth to sixth place. For men, the category ranked eighth, with a rate change of 23%, from 20.8 to 25.6 suicide deaths per 100,000.

The researchers say better understanding of how suicides are distributed by occupational group might help inform prevention programs and policies. The CDC recommends a comprehensive approach, including strategies such as:

• Enhancing social connectedness;
• Strengthening state or local economic supports;
• Implementing practices that encourage help-seeking and reduce stigma;
• Providing referrals to mental health and other services; and
• Reducing access to lethal means among people at risk

The CDC also encourages decision makers, such as employers, to create a response plan, should someone in their organization commit suicide.

Many adults spend a large part of their time at work—making the workplace an important but underused location for suicide prevention, say CDC researchers who analyzed data on 22,053 suicides in 17 states. The US suicide rate among working adults (aged 16-64 years) rose 34% between 2000 and 2016, from 12.9 to 17.3 per 100,000.

Suicide rates rose in many occupational groups between 2012 and 2015, but identifying the specific role that occupational factors might play in suicide risk is complicated, the researchers say: Both work (eg, little job control and job insecurity) and nonwork (eg, relationship conflict) factors are associated with psychological distress and suicide. And factors such as access to lethal means while on the job play a part as well.

The major occupational group with the highest male suicide rate was Construction and Extraction (from 43.6% in 2012 to 53.2% in 2015. The Arts, Design, Entertainment, Sports, and Media groups had the highest female suicide rate (15.6%, up from 11.7%).

Health Care Support, which ranked twelfth on the 2015 list, actually saw a drop in the numbers of male suicides (19.5/100,000 in 2015, vs 22.1 in 2012). But among women, the numbers rose 31%: from 8.4 per 100,000 to 11.0, making that category third among females. 

With a 13% drop (from 10.3 to 9.0), Health Care Practitioners and Technical (female) moved from fourth to sixth place. For men, the category ranked eighth, with a rate change of 23%, from 20.8 to 25.6 suicide deaths per 100,000.

The researchers say better understanding of how suicides are distributed by occupational group might help inform prevention programs and policies. The CDC recommends a comprehensive approach, including strategies such as:

• Enhancing social connectedness;
• Strengthening state or local economic supports;
• Implementing practices that encourage help-seeking and reduce stigma;
• Providing referrals to mental health and other services; and
• Reducing access to lethal means among people at risk

The CDC also encourages decision makers, such as employers, to create a response plan, should someone in their organization commit suicide.

Degarelix was developed as a novel gonadotropin-releasing hormone (GnRH) antagonist, with the aim of counteracting the testosterone surge often experienced with GnRH agonists. Degarelix blocks the GnRH receptors in the pituitary gland, rapidly reducing testosterone production, but the effects last only for a month. It is common practice to switch from degarelix to a GnRH agonist once the testosterone levels are down and stable. Degarelix is safe and effective for the short term, but what about the long term?

Researchers from Osaka City University and Bell Land General Hospital in Japan evaluated 5-year survival and time to castration-resistant prostate cancer (CRPC) in 108 patients with prostate cancer treated with degarelix. In the study, 57 patients were switched from degarelix to a GnRH agonist; 51 continued on degarelix.

Overall 5-year survival was high (89%) but statistically superior in the changed group (97% vs 74%). The 5-year cancer-specific survival also was longer in the changed group (100% vs 85%).  Average time to CRCP was comparable in both groups (43 months in the changed group, 35 months in the continued group). The CRPC conversion did not reach the median at the time of data analysis. The median percentage decrease in prostate-specific antigen level for all patients treated with degarelix was 99.7%. The lowered levels were maintained even after switching to GnRH agonists.

The researchers say theirs is the first report of long-term data on degarelix and the first study to report that changing the treatment from a GnRH antagonist to a GnRH agonist did not affect the oncologic outcomes in patients with hormone-sensitive prostate cancer.

Source:

Asakawa J, Iguchi T, Tamada S, et al. Basic Clin Androl. 2018;28:9.

doi: 10.1186/s12610-018-0074-2.

Degarelix was developed as a novel gonadotropin-releasing hormone (GnRH) antagonist, with the aim of counteracting the testosterone surge often experienced with GnRH agonists. Degarelix blocks the GnRH receptors in the pituitary gland, rapidly reducing testosterone production, but the effects last only for a month. It is common practice to switch from degarelix to a GnRH agonist once the testosterone levels are down and stable. Degarelix is safe and effective for the short term, but what about the long term?

Researchers from Osaka City University and Bell Land General Hospital in Japan evaluated 5-year survival and time to castration-resistant prostate cancer (CRPC) in 108 patients with prostate cancer treated with degarelix. In the study, 57 patients were switched from degarelix to a GnRH agonist; 51 continued on degarelix.

Overall 5-year survival was high (89%) but statistically superior in the changed group (97% vs 74%). The 5-year cancer-specific survival also was longer in the changed group (100% vs 85%).  Average time to CRCP was comparable in both groups (43 months in the changed group, 35 months in the continued group). The CRPC conversion did not reach the median at the time of data analysis. The median percentage decrease in prostate-specific antigen level for all patients treated with degarelix was 99.7%. The lowered levels were maintained even after switching to GnRH agonists.

The researchers say theirs is the first report of long-term data on degarelix and the first study to report that changing the treatment from a GnRH antagonist to a GnRH agonist did not affect the oncologic outcomes in patients with hormone-sensitive prostate cancer.

Source:

Asakawa J, Iguchi T, Tamada S, et al. Basic Clin Androl. 2018;28:9.

doi: 10.1186/s12610-018-0074-2.

Degarelix was developed as a novel gonadotropin-releasing hormone (GnRH) antagonist, with the aim of counteracting the testosterone surge often experienced with GnRH agonists. Degarelix blocks the GnRH receptors in the pituitary gland, rapidly reducing testosterone production, but the effects last only for a month. It is common practice to switch from degarelix to a GnRH agonist once the testosterone levels are down and stable. Degarelix is safe and effective for the short term, but what about the long term?

Researchers from Osaka City University and Bell Land General Hospital in Japan evaluated 5-year survival and time to castration-resistant prostate cancer (CRPC) in 108 patients with prostate cancer treated with degarelix. In the study, 57 patients were switched from degarelix to a GnRH agonist; 51 continued on degarelix.

Overall 5-year survival was high (89%) but statistically superior in the changed group (97% vs 74%). The 5-year cancer-specific survival also was longer in the changed group (100% vs 85%).  Average time to CRCP was comparable in both groups (43 months in the changed group, 35 months in the continued group). The CRPC conversion did not reach the median at the time of data analysis. The median percentage decrease in prostate-specific antigen level for all patients treated with degarelix was 99.7%. The lowered levels were maintained even after switching to GnRH agonists.

The researchers say theirs is the first report of long-term data on degarelix and the first study to report that changing the treatment from a GnRH antagonist to a GnRH agonist did not affect the oncologic outcomes in patients with hormone-sensitive prostate cancer.

Source:

Asakawa J, Iguchi T, Tamada S, et al. Basic Clin Androl. 2018;28:9.

doi: 10.1186/s12610-018-0074-2.

In 2016 > 6,000 young people in the US killed themselves, according to the CDC. Most visited a health care provider or medical setting in the month prior. That means health care settings are not ideal for suicide intervention efforts. Researchers from the National Institute of Mental Health (NIMH) offer advice on how hospitals can address the rising suicide rate in a way that “is flexible and mindful of limited resources”—that is, an easily administered screening survey that provides immediate actionable response.

The NIMH report presents a 3-tiered clinical pathway system, created by a subcommittee of the Pathways in Clinical Care workgroup of the Physically Ill Child committee of the American Academy of Child and Adolescent Psychiatry.

The first step is an initial screen of all patients aged 10 to 24 years (for those with mental health issues, aged > 10 years), using the Ask Suicide-Screening Questions (ASQ) tool.

The first screening tool developed specifically for pediatric patients, the ASQ is free and available in 14 languages. Four questions (for example, “In the past few weeks, have you wished you were dead?”) take about 20 seconds to administer. A “yes” to one or more identified 97% of youth at risk in an NIMH study.

The second step is the most critical, the researchers say: A brief suicide safety assessment, which takes about 10 to 15 minutes to administer. This classifies a patient’s risk of suicide based on survey responses and clinical judgment.

The third step, if deemed necessary, is a full comprehensive safety evaluation by a licensed mental health provider, with the goal of addressing safety issues and establishing an intervention plan.

One of the biggest barriers to screening, NIMH says, is how to effectively and efficiently manage the patients who screen positive. Therefore, NIMH recommends that each health care setting have a plan. The ASQ Toolkit is designed to help with such a plan and to provide tools for managing care. The toolkit is organized according to medical setting: emergency department, inpatient medical/surgical unit, and outpatient primary care and specialty clinics. The kit includes information sheets, the Brief Suicide Safety Assessment Guide, nursing scripts, and information for parents and guardians.

The ASQ Toolkit is available at https://www.nimh.nih.gov/labs-at-nimh/asq-toolkit-materials/index.shtml.

In 2016 > 6,000 young people in the US killed themselves, according to the CDC. Most visited a health care provider or medical setting in the month prior. That means health care settings are not ideal for suicide intervention efforts. Researchers from the National Institute of Mental Health (NIMH) offer advice on how hospitals can address the rising suicide rate in a way that “is flexible and mindful of limited resources”—that is, an easily administered screening survey that provides immediate actionable response.

The NIMH report presents a 3-tiered clinical pathway system, created by a subcommittee of the Pathways in Clinical Care workgroup of the Physically Ill Child committee of the American Academy of Child and Adolescent Psychiatry.

The first step is an initial screen of all patients aged 10 to 24 years (for those with mental health issues, aged > 10 years), using the Ask Suicide-Screening Questions (ASQ) tool.

The first screening tool developed specifically for pediatric patients, the ASQ is free and available in 14 languages. Four questions (for example, “In the past few weeks, have you wished you were dead?”) take about 20 seconds to administer. A “yes” to one or more identified 97% of youth at risk in an NIMH study.

The second step is the most critical, the researchers say: A brief suicide safety assessment, which takes about 10 to 15 minutes to administer. This classifies a patient’s risk of suicide based on survey responses and clinical judgment.

The third step, if deemed necessary, is a full comprehensive safety evaluation by a licensed mental health provider, with the goal of addressing safety issues and establishing an intervention plan.

One of the biggest barriers to screening, NIMH says, is how to effectively and efficiently manage the patients who screen positive. Therefore, NIMH recommends that each health care setting have a plan. The ASQ Toolkit is designed to help with such a plan and to provide tools for managing care. The toolkit is organized according to medical setting: emergency department, inpatient medical/surgical unit, and outpatient primary care and specialty clinics. The kit includes information sheets, the Brief Suicide Safety Assessment Guide, nursing scripts, and information for parents and guardians.

The ASQ Toolkit is available at https://www.nimh.nih.gov/labs-at-nimh/asq-toolkit-materials/index.shtml.

In 2016 > 6,000 young people in the US killed themselves, according to the CDC. Most visited a health care provider or medical setting in the month prior. That means health care settings are not ideal for suicide intervention efforts. Researchers from the National Institute of Mental Health (NIMH) offer advice on how hospitals can address the rising suicide rate in a way that “is flexible and mindful of limited resources”—that is, an easily administered screening survey that provides immediate actionable response.

The NIMH report presents a 3-tiered clinical pathway system, created by a subcommittee of the Pathways in Clinical Care workgroup of the Physically Ill Child committee of the American Academy of Child and Adolescent Psychiatry.

The first step is an initial screen of all patients aged 10 to 24 years (for those with mental health issues, aged > 10 years), using the Ask Suicide-Screening Questions (ASQ) tool.

The first screening tool developed specifically for pediatric patients, the ASQ is free and available in 14 languages. Four questions (for example, “In the past few weeks, have you wished you were dead?”) take about 20 seconds to administer. A “yes” to one or more identified 97% of youth at risk in an NIMH study.

The second step is the most critical, the researchers say: A brief suicide safety assessment, which takes about 10 to 15 minutes to administer. This classifies a patient’s risk of suicide based on survey responses and clinical judgment.

The third step, if deemed necessary, is a full comprehensive safety evaluation by a licensed mental health provider, with the goal of addressing safety issues and establishing an intervention plan.

One of the biggest barriers to screening, NIMH says, is how to effectively and efficiently manage the patients who screen positive. Therefore, NIMH recommends that each health care setting have a plan. The ASQ Toolkit is designed to help with such a plan and to provide tools for managing care. The toolkit is organized according to medical setting: emergency department, inpatient medical/surgical unit, and outpatient primary care and specialty clinics. The kit includes information sheets, the Brief Suicide Safety Assessment Guide, nursing scripts, and information for parents and guardians.

The ASQ Toolkit is available at https://www.nimh.nih.gov/labs-at-nimh/asq-toolkit-materials/index.shtml.

More Native Americans have died of a drug overdose than members of any other racial or ethnic group in the US—which as a whole has seen drug overdose deaths triple since 1999. But little is known about the regional impact of opioids in tribal and urban American Indian/Alaska Native (AI/AN) communities, according to Indian Health Service (IHS) researchers from Portland, Oregon. They examined death records from the Washington State Center for Health Statistics to identify trends and disparities in drug, opioid-involved, and heroin-involved overdose deaths for AI/AN and non-Hispanic whites in Washington.

AI/AN and whites had similar overdose-related death rates during 1999 and 2001, but then the deaths began to multiply faster among Native Americans: Between 2013 and 2015, Native Americans were dying at nearly 3 times the rate of drug and opioid-related overdose. Heroin-related deaths were 4 times higher.

During 2013-2015, 184 AI/AN people died of a drug overdose in Washington; 126 from opioids. Most of the deaths were in urban communities (both Native American and white). Men were nearly twice as likely as women to die of overdose. Adults aged 25 to 54 years had the highest rates. Age-specific drug overdose mortality rates among AI/AN were almost twice those among whites.

The death rates are disturbing enough, but the researchers also found that death certificates that were not corrected for misclassification of AI/AN race underestimated the mortality rates among AI/AN by about 40%. For example, the uncorrected data showed 28.7 drug-overdose deaths in Washington. The corrected number was 40.9. In contrast, the uncorrected number for whites was 15.7, vs 15.1.

Even before correction for misclassification, AI/AN in Washington had higher drug-opioid-involved, and heroin-involved overdose mortality rates than did whites in Washington and AI/AN in the US.

The researchers note that misclassification of AI/AN in public health data can obscure the prevalence of disease and result in suppression of health statistics because of small numbers. That, in turn, can affect the ability of state and federal programs to direct resources needed for a “robust public health response to this epidemic.”

More Native Americans have died of a drug overdose than members of any other racial or ethnic group in the US—which as a whole has seen drug overdose deaths triple since 1999. But little is known about the regional impact of opioids in tribal and urban American Indian/Alaska Native (AI/AN) communities, according to Indian Health Service (IHS) researchers from Portland, Oregon. They examined death records from the Washington State Center for Health Statistics to identify trends and disparities in drug, opioid-involved, and heroin-involved overdose deaths for AI/AN and non-Hispanic whites in Washington.

AI/AN and whites had similar overdose-related death rates during 1999 and 2001, but then the deaths began to multiply faster among Native Americans: Between 2013 and 2015, Native Americans were dying at nearly 3 times the rate of drug and opioid-related overdose. Heroin-related deaths were 4 times higher.

During 2013-2015, 184 AI/AN people died of a drug overdose in Washington; 126 from opioids. Most of the deaths were in urban communities (both Native American and white). Men were nearly twice as likely as women to die of overdose. Adults aged 25 to 54 years had the highest rates. Age-specific drug overdose mortality rates among AI/AN were almost twice those among whites.

The death rates are disturbing enough, but the researchers also found that death certificates that were not corrected for misclassification of AI/AN race underestimated the mortality rates among AI/AN by about 40%. For example, the uncorrected data showed 28.7 drug-overdose deaths in Washington. The corrected number was 40.9. In contrast, the uncorrected number for whites was 15.7, vs 15.1.

Even before correction for misclassification, AI/AN in Washington had higher drug-opioid-involved, and heroin-involved overdose mortality rates than did whites in Washington and AI/AN in the US.

The researchers note that misclassification of AI/AN in public health data can obscure the prevalence of disease and result in suppression of health statistics because of small numbers. That, in turn, can affect the ability of state and federal programs to direct resources needed for a “robust public health response to this epidemic.”

More Native Americans have died of a drug overdose than members of any other racial or ethnic group in the US—which as a whole has seen drug overdose deaths triple since 1999. But little is known about the regional impact of opioids in tribal and urban American Indian/Alaska Native (AI/AN) communities, according to Indian Health Service (IHS) researchers from Portland, Oregon. They examined death records from the Washington State Center for Health Statistics to identify trends and disparities in drug, opioid-involved, and heroin-involved overdose deaths for AI/AN and non-Hispanic whites in Washington.

AI/AN and whites had similar overdose-related death rates during 1999 and 2001, but then the deaths began to multiply faster among Native Americans: Between 2013 and 2015, Native Americans were dying at nearly 3 times the rate of drug and opioid-related overdose. Heroin-related deaths were 4 times higher.

During 2013-2015, 184 AI/AN people died of a drug overdose in Washington; 126 from opioids. Most of the deaths were in urban communities (both Native American and white). Men were nearly twice as likely as women to die of overdose. Adults aged 25 to 54 years had the highest rates. Age-specific drug overdose mortality rates among AI/AN were almost twice those among whites.

The death rates are disturbing enough, but the researchers also found that death certificates that were not corrected for misclassification of AI/AN race underestimated the mortality rates among AI/AN by about 40%. For example, the uncorrected data showed 28.7 drug-overdose deaths in Washington. The corrected number was 40.9. In contrast, the uncorrected number for whites was 15.7, vs 15.1.

Even before correction for misclassification, AI/AN in Washington had higher drug-opioid-involved, and heroin-involved overdose mortality rates than did whites in Washington and AI/AN in the US.

The researchers note that misclassification of AI/AN in public health data can obscure the prevalence of disease and result in suppression of health statistics because of small numbers. That, in turn, can affect the ability of state and federal programs to direct resources needed for a “robust public health response to this epidemic.”

Patients with HIV/AIDs are vulnerable to Talaromyces marneffei (T marneffei) infection, formerly penicilliosis. But in recent years more cases have been seen in patients not infected with HIV, too. Most cases originate in Southeast Asia: 10% of patients with AIDS in Hong Kong and 30% of patients in North Thailand, for example, have T marneffei infections. But patients with AIDS and penicilliosis travel, as do other immunocompromised patients. Thus, the first reported case of a patient with long-standing pulmonary sarcoidosis who developed T marneffei infection may have significance for clinicians caring for people with, or without, HIV.

Most patients with T marneffei infection have fever, weight loss, and malaise. Subcutaneous abscesses and papulelike ulcers are common (sometimes the lesions are very small). Anemia, hepatosplenomegaly, lymphadenopathy, and diarrhea also are relatively common. However, while cough is a notable symptom, pneumonia is rare—even though the organism is inhaled.

The patient in this report, a native of Cangnan County (an endemic fungal area) in Southeast China, was admitted to the hospital with a 3-week history of daily hyperpyrexia and coughing sputum. When antibiotics did not help, a fungal culture revealed why: He had T marneffei infection. The clinicians say the preexisting pulmonary sarcoidosis covered the clinical features of T marneffei and initially misled them.

After 3 months of antifungal treatment, the patient’s physical condition improved. And the lung lesions were “markedly absorbed” after 3 months. The respiratory signs and skin lesions disappeared gradually after 8 days of treatment.

T marneffei infection is fatal if untreated. Early diagnosis and treatment with antifungals can be life saving.

Source:
Yu X, Miao K, Zhou C, et al. BMC Infect Dis. 2018;18(1):390.

Patients with HIV/AIDs are vulnerable to Talaromyces marneffei (T marneffei) infection, formerly penicilliosis. But in recent years more cases have been seen in patients not infected with HIV, too. Most cases originate in Southeast Asia: 10% of patients with AIDS in Hong Kong and 30% of patients in North Thailand, for example, have T marneffei infections. But patients with AIDS and penicilliosis travel, as do other immunocompromised patients. Thus, the first reported case of a patient with long-standing pulmonary sarcoidosis who developed T marneffei infection may have significance for clinicians caring for people with, or without, HIV.

Most patients with T marneffei infection have fever, weight loss, and malaise. Subcutaneous abscesses and papulelike ulcers are common (sometimes the lesions are very small). Anemia, hepatosplenomegaly, lymphadenopathy, and diarrhea also are relatively common. However, while cough is a notable symptom, pneumonia is rare—even though the organism is inhaled.

The patient in this report, a native of Cangnan County (an endemic fungal area) in Southeast China, was admitted to the hospital with a 3-week history of daily hyperpyrexia and coughing sputum. When antibiotics did not help, a fungal culture revealed why: He had T marneffei infection. The clinicians say the preexisting pulmonary sarcoidosis covered the clinical features of T marneffei and initially misled them.

After 3 months of antifungal treatment, the patient’s physical condition improved. And the lung lesions were “markedly absorbed” after 3 months. The respiratory signs and skin lesions disappeared gradually after 8 days of treatment.

T marneffei infection is fatal if untreated. Early diagnosis and treatment with antifungals can be life saving.

Source:
Yu X, Miao K, Zhou C, et al. BMC Infect Dis. 2018;18(1):390.

Patients with HIV/AIDs are vulnerable to Talaromyces marneffei (T marneffei) infection, formerly penicilliosis. But in recent years more cases have been seen in patients not infected with HIV, too. Most cases originate in Southeast Asia: 10% of patients with AIDS in Hong Kong and 30% of patients in North Thailand, for example, have T marneffei infections. But patients with AIDS and penicilliosis travel, as do other immunocompromised patients. Thus, the first reported case of a patient with long-standing pulmonary sarcoidosis who developed T marneffei infection may have significance for clinicians caring for people with, or without, HIV.

Most patients with T marneffei infection have fever, weight loss, and malaise. Subcutaneous abscesses and papulelike ulcers are common (sometimes the lesions are very small). Anemia, hepatosplenomegaly, lymphadenopathy, and diarrhea also are relatively common. However, while cough is a notable symptom, pneumonia is rare—even though the organism is inhaled.

The patient in this report, a native of Cangnan County (an endemic fungal area) in Southeast China, was admitted to the hospital with a 3-week history of daily hyperpyrexia and coughing sputum. When antibiotics did not help, a fungal culture revealed why: He had T marneffei infection. The clinicians say the preexisting pulmonary sarcoidosis covered the clinical features of T marneffei and initially misled them.

After 3 months of antifungal treatment, the patient’s physical condition improved. And the lung lesions were “markedly absorbed” after 3 months. The respiratory signs and skin lesions disappeared gradually after 8 days of treatment.

T marneffei infection is fatal if untreated. Early diagnosis and treatment with antifungals can be life saving.

Source:
Yu X, Miao K, Zhou C, et al. BMC Infect Dis. 2018;18(1):390.

The NIH and DoD are working on a new database that aims to establish the number of people in the US living with limb loss and to provide insight on their challenges and needs.

The Limb Loss and Preservation Registry, expected to be operational in 2020, will address a “significant public health knowledge gap,” said Dr. Alison Cernich, director of the National Center for Medical Rehabilitation Research. She says the information housed in the database will be vital to preventing limb loss, improving amputation surgeries, refining rehabilitation approaches, and guiding the development of devices for people who have lost limbs. Researchers will be able to sort the data by age, gender, and type of limb loss.

The National Institute of Child Health and Human Development has awarded a 5-year contract, capped at $5 million, to the Mayo Clinic to develop and launch the registry.

The NIH and DoD chose to join resources because there are not enough amputations within the DoD alone to provide a suitable sample for statistically valid conclusions, Dr. Cernich said. Moreover, data available from the DoD and the VA do not include service members who leave the military and seek care in the private sector. Cernich says the partnership between federal agencies will allow them to collect data that will “inform research and improve the lives of all citizens coping with limb loss.”

The NIH and DoD are working on a new database that aims to establish the number of people in the US living with limb loss and to provide insight on their challenges and needs.

The Limb Loss and Preservation Registry, expected to be operational in 2020, will address a “significant public health knowledge gap,” said Dr. Alison Cernich, director of the National Center for Medical Rehabilitation Research. She says the information housed in the database will be vital to preventing limb loss, improving amputation surgeries, refining rehabilitation approaches, and guiding the development of devices for people who have lost limbs. Researchers will be able to sort the data by age, gender, and type of limb loss.

The National Institute of Child Health and Human Development has awarded a 5-year contract, capped at $5 million, to the Mayo Clinic to develop and launch the registry.

The NIH and DoD chose to join resources because there are not enough amputations within the DoD alone to provide a suitable sample for statistically valid conclusions, Dr. Cernich said. Moreover, data available from the DoD and the VA do not include service members who leave the military and seek care in the private sector. Cernich says the partnership between federal agencies will allow them to collect data that will “inform research and improve the lives of all citizens coping with limb loss.”

The NIH and DoD are working on a new database that aims to establish the number of people in the US living with limb loss and to provide insight on their challenges and needs.

The Limb Loss and Preservation Registry, expected to be operational in 2020, will address a “significant public health knowledge gap,” said Dr. Alison Cernich, director of the National Center for Medical Rehabilitation Research. She says the information housed in the database will be vital to preventing limb loss, improving amputation surgeries, refining rehabilitation approaches, and guiding the development of devices for people who have lost limbs. Researchers will be able to sort the data by age, gender, and type of limb loss.

The National Institute of Child Health and Human Development has awarded a 5-year contract, capped at $5 million, to the Mayo Clinic to develop and launch the registry.

The NIH and DoD chose to join resources because there are not enough amputations within the DoD alone to provide a suitable sample for statistically valid conclusions, Dr. Cernich said. Moreover, data available from the DoD and the VA do not include service members who leave the military and seek care in the private sector. Cernich says the partnership between federal agencies will allow them to collect data that will “inform research and improve the lives of all citizens coping with limb loss.”

Using data from the Million Veteran Program (MVP), researchers found people with mutations for PDE3B, PCSK9, and ANGPTL4 had better cholesterol and triglyceride levels than did those without the mutations.

The PDE3B mutation seems to protect against heart disease. A PCSK9 mutation may reduce the risk not only of heart disease, but also abdominal aortic aneurysm. The ANGPTL4 mutation was linked to lower risk of type 2 DM.

MVP, 1 of the world’s largest databases of health and genomic information, partners with veterans receiving care in the VHA to study how genes affect health. It has enrolled > 700,000 veterans to date.

Using data from the Million Veteran Program (MVP), researchers found people with mutations for PDE3B, PCSK9, and ANGPTL4 had better cholesterol and triglyceride levels than did those without the mutations.

The PDE3B mutation seems to protect against heart disease. A PCSK9 mutation may reduce the risk not only of heart disease, but also abdominal aortic aneurysm. The ANGPTL4 mutation was linked to lower risk of type 2 DM.

MVP, 1 of the world’s largest databases of health and genomic information, partners with veterans receiving care in the VHA to study how genes affect health. It has enrolled > 700,000 veterans to date.

Using data from the Million Veteran Program (MVP), researchers found people with mutations for PDE3B, PCSK9, and ANGPTL4 had better cholesterol and triglyceride levels than did those without the mutations.

The PDE3B mutation seems to protect against heart disease. A PCSK9 mutation may reduce the risk not only of heart disease, but also abdominal aortic aneurysm. The ANGPTL4 mutation was linked to lower risk of type 2 DM.

MVP, 1 of the world’s largest databases of health and genomic information, partners with veterans receiving care in the VHA to study how genes affect health. It has enrolled > 700,000 veterans to date.

Health care is more effective when patients understand what they can do to be healthier. But many patients cannot read routine preventive information. To help busy clinicians learn more about what they can do to support patient wellness, the Indian Health Service (IHs) Health Literacy workgroup has developed a 20-minute health literacy and plain-language training module.

The IHS also is:

• Pretesting printed educational materials through focus groups and in-depth interviews to ensure messages are clear;
• Revising the IHS website;
• Hosting webinars on health literacy; and
•  Planning to refresh and promote “As Me 3” campaign, which encourages patients to ask 3 specific questions of their providers to better understand their conditions.

In addition to taking the training module, available at the Learning Management System, the IHS suggests clinicians participate in ongoing training in health literacy, plain language and culturally and linguistically appropriate services; use the “health factor” tab in the electronic health record to assess and document the patient’s level of understanding; and learn about the teach-back technique to enhance patients’ understanding.

Health care is more effective when patients understand what they can do to be healthier. But many patients cannot read routine preventive information. To help busy clinicians learn more about what they can do to support patient wellness, the Indian Health Service (IHs) Health Literacy workgroup has developed a 20-minute health literacy and plain-language training module.

The IHS also is:

• Pretesting printed educational materials through focus groups and in-depth interviews to ensure messages are clear;
• Revising the IHS website;
• Hosting webinars on health literacy; and
•  Planning to refresh and promote “As Me 3” campaign, which encourages patients to ask 3 specific questions of their providers to better understand their conditions.

In addition to taking the training module, available at the Learning Management System, the IHS suggests clinicians participate in ongoing training in health literacy, plain language and culturally and linguistically appropriate services; use the “health factor” tab in the electronic health record to assess and document the patient’s level of understanding; and learn about the teach-back technique to enhance patients’ understanding.

Health care is more effective when patients understand what they can do to be healthier. But many patients cannot read routine preventive information. To help busy clinicians learn more about what they can do to support patient wellness, the Indian Health Service (IHs) Health Literacy workgroup has developed a 20-minute health literacy and plain-language training module.

The IHS also is:

• Pretesting printed educational materials through focus groups and in-depth interviews to ensure messages are clear;
• Revising the IHS website;
• Hosting webinars on health literacy; and
•  Planning to refresh and promote “As Me 3” campaign, which encourages patients to ask 3 specific questions of their providers to better understand their conditions.

In addition to taking the training module, available at the Learning Management System, the IHS suggests clinicians participate in ongoing training in health literacy, plain language and culturally and linguistically appropriate services; use the “health factor” tab in the electronic health record to assess and document the patient’s level of understanding; and learn about the teach-back technique to enhance patients’ understanding.

Researchers from Harvard and Brigham and Women’s Hospital say their study is the first to fully evaluate the link between mutations in sodium glucose co-transporter-1 (SGLT-1)—the gene responsible for absorbing glucose in the gut—and cardiometabolic disease.

The researchers used genetic data from 8,478 participants in the 25-year Atherosclerosis Risk In Communities (ARIC) study. The participants who carried the mutation (6%) had a lower risk of type 2 diabetes, were less obese, had a lower incidence of heart failure, and a lower mortality rate than did those without the mutation, regardless of dietary intake.

The researchers suggest that their findings “open the door to improved therapies” for cardiometabolic diseases.

Researchers from Harvard and Brigham and Women’s Hospital say their study is the first to fully evaluate the link between mutations in sodium glucose co-transporter-1 (SGLT-1)—the gene responsible for absorbing glucose in the gut—and cardiometabolic disease.

The researchers used genetic data from 8,478 participants in the 25-year Atherosclerosis Risk In Communities (ARIC) study. The participants who carried the mutation (6%) had a lower risk of type 2 diabetes, were less obese, had a lower incidence of heart failure, and a lower mortality rate than did those without the mutation, regardless of dietary intake.

The researchers suggest that their findings “open the door to improved therapies” for cardiometabolic diseases.

Researchers from Harvard and Brigham and Women’s Hospital say their study is the first to fully evaluate the link between mutations in sodium glucose co-transporter-1 (SGLT-1)—the gene responsible for absorbing glucose in the gut—and cardiometabolic disease.

The researchers used genetic data from 8,478 participants in the 25-year Atherosclerosis Risk In Communities (ARIC) study. The participants who carried the mutation (6%) had a lower risk of type 2 diabetes, were less obese, had a lower incidence of heart failure, and a lower mortality rate than did those without the mutation, regardless of dietary intake.

The researchers suggest that their findings “open the door to improved therapies” for cardiometabolic diseases.