Jan Dyer

Coffee drinking has been linked to the reduced risk of fibrosis progression, liver cirrhosis, and hepatocellular carcinoma in some patients, including those with hepatitis C virus (HCV) infection, but the results of studies in patients with hepatitis B virus (HBV) infection have been inconsistent. Given the “global impact of HBV infection and the wide consumption of coffee,” researchers from Tzu Chi University in Taiwan, wanted to find out more.

They analyzed data from 328 patients with chronic HBV infection who were enrolled in a population-based gastroesophageal reflux disease study. Of those, 155 patients also entered into a 5-year follow-up study. 

Among the patients with chronic HBV, 137 did not drink coffee. Of the 191 who did, 61 drank it on < 4 days a week, and 130 drank it ≥ 4 days.

Initially, the researchers observed an inverse association between coffee drinking and serum aspartate aminotransferase (AST) levels, as well as predicting indices of liver fibrosis in patients with HBV infection. Patients who drank ≥ 4 cups of coffee per day had a 70% decrease of serum AST, a 70% decrease of the AST to platelet ratio index, and a 70% decrease of fibrosis-4 index values. 

Those findings indicated that coffee might have a “generally beneficial” effect on liver inflammation and fibrosis progression in patients with chronic liver disease, the researchers say. However, at the end of the 5-year follow-up, the incidences of liver cirrhosis complications and changes of serum predicting indices of liver fibrosis were comparable between HBV coffee drinkers and nondrinkers. That indicated, the researchers believe, that the beneficial effect “seems to be outweighed” in patients with chronic HBV infection.

The researchers suggest that the protective effects of coffee consumption on liver inflammation and insulin resistance may not be able to surpass the direct carcinogenic effect of HBV, and even the HBV virus replication.

Coffee drinking has been linked to the reduced risk of fibrosis progression, liver cirrhosis, and hepatocellular carcinoma in some patients, including those with hepatitis C virus (HCV) infection, but the results of studies in patients with hepatitis B virus (HBV) infection have been inconsistent. Given the “global impact of HBV infection and the wide consumption of coffee,” researchers from Tzu Chi University in Taiwan, wanted to find out more.

They analyzed data from 328 patients with chronic HBV infection who were enrolled in a population-based gastroesophageal reflux disease study. Of those, 155 patients also entered into a 5-year follow-up study. 

Among the patients with chronic HBV, 137 did not drink coffee. Of the 191 who did, 61 drank it on < 4 days a week, and 130 drank it ≥ 4 days.

Initially, the researchers observed an inverse association between coffee drinking and serum aspartate aminotransferase (AST) levels, as well as predicting indices of liver fibrosis in patients with HBV infection. Patients who drank ≥ 4 cups of coffee per day had a 70% decrease of serum AST, a 70% decrease of the AST to platelet ratio index, and a 70% decrease of fibrosis-4 index values. 

Those findings indicated that coffee might have a “generally beneficial” effect on liver inflammation and fibrosis progression in patients with chronic liver disease, the researchers say. However, at the end of the 5-year follow-up, the incidences of liver cirrhosis complications and changes of serum predicting indices of liver fibrosis were comparable between HBV coffee drinkers and nondrinkers. That indicated, the researchers believe, that the beneficial effect “seems to be outweighed” in patients with chronic HBV infection.

The researchers suggest that the protective effects of coffee consumption on liver inflammation and insulin resistance may not be able to surpass the direct carcinogenic effect of HBV, and even the HBV virus replication.

Coffee drinking has been linked to the reduced risk of fibrosis progression, liver cirrhosis, and hepatocellular carcinoma in some patients, including those with hepatitis C virus (HCV) infection, but the results of studies in patients with hepatitis B virus (HBV) infection have been inconsistent. Given the “global impact of HBV infection and the wide consumption of coffee,” researchers from Tzu Chi University in Taiwan, wanted to find out more.

They analyzed data from 328 patients with chronic HBV infection who were enrolled in a population-based gastroesophageal reflux disease study. Of those, 155 patients also entered into a 5-year follow-up study. 

Among the patients with chronic HBV, 137 did not drink coffee. Of the 191 who did, 61 drank it on < 4 days a week, and 130 drank it ≥ 4 days.

Initially, the researchers observed an inverse association between coffee drinking and serum aspartate aminotransferase (AST) levels, as well as predicting indices of liver fibrosis in patients with HBV infection. Patients who drank ≥ 4 cups of coffee per day had a 70% decrease of serum AST, a 70% decrease of the AST to platelet ratio index, and a 70% decrease of fibrosis-4 index values. 

Those findings indicated that coffee might have a “generally beneficial” effect on liver inflammation and fibrosis progression in patients with chronic liver disease, the researchers say. However, at the end of the 5-year follow-up, the incidences of liver cirrhosis complications and changes of serum predicting indices of liver fibrosis were comparable between HBV coffee drinkers and nondrinkers. That indicated, the researchers believe, that the beneficial effect “seems to be outweighed” in patients with chronic HBV infection.

The researchers suggest that the protective effects of coffee consumption on liver inflammation and insulin resistance may not be able to surpass the direct carcinogenic effect of HBV, and even the HBV virus replication.

A group of teenage 4-H members take part in a state agricultural fair, after which one of the boys comes sick. But luckily they have also attended the CDC’s Disease Detective Camp in Atlanta and use their newly acquired detective skills to find out why their friend got sick.

That is the story in “The Junior Disease Detectives: Operation Outbreak,” the new graphic novel the CDC has developed with the Department of Agriculture and 4-H.

Spoiler alert: it was the flu. The novel is designed to help young people understand the potential health risks of human influenza viruses that normally circulate in swine, known as variant flu infections.

Four new variant virus infections have been associated with attendance at agricultural fairs in 2 US states, the CDC reports. Most are connected to infected pigs or their environments in fair settings. While variant flu infections in people are rare, the CDC says, they can lead to hospitalization and death. In 2017, 67 variant virus infections were reported in the US; 6 resulted in hospitalization, including 2 ICU admissions.

The novel is intended for use in middle and high school science, technology, engineering, and mathematics (STEM) classrooms. It is the first of a planned series of educational activities being rolled out throughout the 2018-2019 school year.

The novel is available as a free mobile app, and can be downloaded at https://www.cdc.gov/flu/resource-center/freeresources/graphic-novel/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fgraphicnovel%2Findex.html.

A group of teenage 4-H members take part in a state agricultural fair, after which one of the boys comes sick. But luckily they have also attended the CDC’s Disease Detective Camp in Atlanta and use their newly acquired detective skills to find out why their friend got sick.

That is the story in “The Junior Disease Detectives: Operation Outbreak,” the new graphic novel the CDC has developed with the Department of Agriculture and 4-H.

Spoiler alert: it was the flu. The novel is designed to help young people understand the potential health risks of human influenza viruses that normally circulate in swine, known as variant flu infections.

Four new variant virus infections have been associated with attendance at agricultural fairs in 2 US states, the CDC reports. Most are connected to infected pigs or their environments in fair settings. While variant flu infections in people are rare, the CDC says, they can lead to hospitalization and death. In 2017, 67 variant virus infections were reported in the US; 6 resulted in hospitalization, including 2 ICU admissions.

The novel is intended for use in middle and high school science, technology, engineering, and mathematics (STEM) classrooms. It is the first of a planned series of educational activities being rolled out throughout the 2018-2019 school year.

The novel is available as a free mobile app, and can be downloaded at https://www.cdc.gov/flu/resource-center/freeresources/graphic-novel/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fgraphicnovel%2Findex.html.

A group of teenage 4-H members take part in a state agricultural fair, after which one of the boys comes sick. But luckily they have also attended the CDC’s Disease Detective Camp in Atlanta and use their newly acquired detective skills to find out why their friend got sick.

That is the story in “The Junior Disease Detectives: Operation Outbreak,” the new graphic novel the CDC has developed with the Department of Agriculture and 4-H.

Spoiler alert: it was the flu. The novel is designed to help young people understand the potential health risks of human influenza viruses that normally circulate in swine, known as variant flu infections.

Four new variant virus infections have been associated with attendance at agricultural fairs in 2 US states, the CDC reports. Most are connected to infected pigs or their environments in fair settings. While variant flu infections in people are rare, the CDC says, they can lead to hospitalization and death. In 2017, 67 variant virus infections were reported in the US; 6 resulted in hospitalization, including 2 ICU admissions.

The novel is intended for use in middle and high school science, technology, engineering, and mathematics (STEM) classrooms. It is the first of a planned series of educational activities being rolled out throughout the 2018-2019 school year.

The novel is available as a free mobile app, and can be downloaded at https://www.cdc.gov/flu/resource-center/freeresources/graphic-novel/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fgraphicnovel%2Findex.html.

In 2015, researchers showed that polioviruses could travel in groups—or “packets”—that is, membrane-bound vesicles containing multiple virus particles. The researchers used the Trojan horse analogy to describe it. But they could not say whether the system applied to animals and humans, or how effective the “horses” were in infecting host cells.

To find out, the researchers focused on rotaviruses and noroviruses, which are mainly spread through stool-contaminated food or liquids. And they found that the viruses were indeed shed as packet-enclosed clusters in the stool. Moreover, the virus clusters were significantly more infectious than the free, unbound viruses in the fecal samples tested.

The researchers say the high level of infectiousness is likely due to the vesicles delivering many viruses at once to the target tissue. The vesicles also protect their “viral cargo” from being destroyed by prolonged exposure to enzymes and may even make it invisible to the antibodies in the stool or gut.

The virus packets are not only extremely potent, but aggressive. More studies are needed, and more antivirals, the researchers say, but in the meantime, soap and water can help keep them down.

In 2015, researchers showed that polioviruses could travel in groups—or “packets”—that is, membrane-bound vesicles containing multiple virus particles. The researchers used the Trojan horse analogy to describe it. But they could not say whether the system applied to animals and humans, or how effective the “horses” were in infecting host cells.

To find out, the researchers focused on rotaviruses and noroviruses, which are mainly spread through stool-contaminated food or liquids. And they found that the viruses were indeed shed as packet-enclosed clusters in the stool. Moreover, the virus clusters were significantly more infectious than the free, unbound viruses in the fecal samples tested.

The researchers say the high level of infectiousness is likely due to the vesicles delivering many viruses at once to the target tissue. The vesicles also protect their “viral cargo” from being destroyed by prolonged exposure to enzymes and may even make it invisible to the antibodies in the stool or gut.

The virus packets are not only extremely potent, but aggressive. More studies are needed, and more antivirals, the researchers say, but in the meantime, soap and water can help keep them down.

In 2015, researchers showed that polioviruses could travel in groups—or “packets”—that is, membrane-bound vesicles containing multiple virus particles. The researchers used the Trojan horse analogy to describe it. But they could not say whether the system applied to animals and humans, or how effective the “horses” were in infecting host cells.

To find out, the researchers focused on rotaviruses and noroviruses, which are mainly spread through stool-contaminated food or liquids. And they found that the viruses were indeed shed as packet-enclosed clusters in the stool. Moreover, the virus clusters were significantly more infectious than the free, unbound viruses in the fecal samples tested.

The researchers say the high level of infectiousness is likely due to the vesicles delivering many viruses at once to the target tissue. The vesicles also protect their “viral cargo” from being destroyed by prolonged exposure to enzymes and may even make it invisible to the antibodies in the stool or gut.

The virus packets are not only extremely potent, but aggressive. More studies are needed, and more antivirals, the researchers say, but in the meantime, soap and water can help keep them down.

“Diabetes in America was written to serve as the go-to book for anything you ever wanted to know about diabetes,” says Catherine Cowie, PhD, editor and senior advisor for the National Institute of Diabetes and Digestive and Kidney Diseases’  Diabetes Epidemiology Program. “It’s a resource for everyone, because diabetes affects just about everyone.”

Written by recognized experts who “represent every facet of diabetes,” the book covers relevant research, data and trends, complications and related conditions, and prevention and medical care. It is “rich in data,” says Dr. Cowie, and includes cross-sectional national data, as well as smaller geographic community and longitudinal studies. This edition includes both published and unpublished data that were specifically analyzed for the book.

Clinical trial data are summarized to show the strongest evidence available for the effectiveness of interventions, but the book also emphasizes “points of hope” found through research: For example, people at high risk can prevent or delay type 2 diabetes by losing a modest amount of weight, and rates of some complications, such as lower extremity amputations, are on the decline.

Cowie says Diabetes in America is designed to be useful to a variety of readers. Patients can use it to better understand their condition or risk factors; practitioners can use it to assess patients’ risk of diabetes and associated complications; health policy makers who need “sound quantitative knowledge” can use it to guide decision making; scientists can use it to help identify areas of needed research.

To download, visit: https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/diabetes-in-america-3rd-edition.

“Diabetes in America was written to serve as the go-to book for anything you ever wanted to know about diabetes,” says Catherine Cowie, PhD, editor and senior advisor for the National Institute of Diabetes and Digestive and Kidney Diseases’  Diabetes Epidemiology Program. “It’s a resource for everyone, because diabetes affects just about everyone.”

Written by recognized experts who “represent every facet of diabetes,” the book covers relevant research, data and trends, complications and related conditions, and prevention and medical care. It is “rich in data,” says Dr. Cowie, and includes cross-sectional national data, as well as smaller geographic community and longitudinal studies. This edition includes both published and unpublished data that were specifically analyzed for the book.

Clinical trial data are summarized to show the strongest evidence available for the effectiveness of interventions, but the book also emphasizes “points of hope” found through research: For example, people at high risk can prevent or delay type 2 diabetes by losing a modest amount of weight, and rates of some complications, such as lower extremity amputations, are on the decline.

Cowie says Diabetes in America is designed to be useful to a variety of readers. Patients can use it to better understand their condition or risk factors; practitioners can use it to assess patients’ risk of diabetes and associated complications; health policy makers who need “sound quantitative knowledge” can use it to guide decision making; scientists can use it to help identify areas of needed research.

To download, visit: https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/diabetes-in-america-3rd-edition.

“Diabetes in America was written to serve as the go-to book for anything you ever wanted to know about diabetes,” says Catherine Cowie, PhD, editor and senior advisor for the National Institute of Diabetes and Digestive and Kidney Diseases’  Diabetes Epidemiology Program. “It’s a resource for everyone, because diabetes affects just about everyone.”

Written by recognized experts who “represent every facet of diabetes,” the book covers relevant research, data and trends, complications and related conditions, and prevention and medical care. It is “rich in data,” says Dr. Cowie, and includes cross-sectional national data, as well as smaller geographic community and longitudinal studies. This edition includes both published and unpublished data that were specifically analyzed for the book.

Clinical trial data are summarized to show the strongest evidence available for the effectiveness of interventions, but the book also emphasizes “points of hope” found through research: For example, people at high risk can prevent or delay type 2 diabetes by losing a modest amount of weight, and rates of some complications, such as lower extremity amputations, are on the decline.

Cowie says Diabetes in America is designed to be useful to a variety of readers. Patients can use it to better understand their condition or risk factors; practitioners can use it to assess patients’ risk of diabetes and associated complications; health policy makers who need “sound quantitative knowledge” can use it to guide decision making; scientists can use it to help identify areas of needed research.

To download, visit: https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/diabetes-in-america-3rd-edition.

Cetuximab plus radiation therapy has worse outcomes than the current standard of radiation and cisplatin for patients with human papillomavirus-positive (HPV+) oropharyngeal cancer. In fact, the researchers, who reported preliminary findings from a phase 3 study funded by the National Cancer Institute (NCI), were “surprised by the loss of tumor control with cetuximab.”

Cetuximab with radiation is an accepted standard of care, especially for patients who cannot tolerate cisplatin, and it is approved for patients with head and neck cancer, including oropharyngeal cancer. Researchers and the NCI are looking for more ways to “de-escalate” therapies for cancers that have a good prognosis, such as HPV+ cancer of the oropharynx. The goal of this trial was to find an alternative to cisplatin that would control the cancer as effectively but with fewer side effects.

The researchers enrolled 849 patients to randomly receive either cetuximab or cisplatin with radiation. The third, final interim analysis, after a median follow-up of 4.5 years, found that overall survival on the cetuximab arm was significantly inferior to the cisplatin arm. Moreover, serious adverse events were similar in both groups, although toxic side effects were more common in the cisplatin arm.

The study is the first randomized clinical trial specifically designed for patients with HPV+ oropharyngeal cancer, and “it establishes cisplatin with radiation as the standard of care.”

Cetuximab plus radiation therapy has worse outcomes than the current standard of radiation and cisplatin for patients with human papillomavirus-positive (HPV+) oropharyngeal cancer. In fact, the researchers, who reported preliminary findings from a phase 3 study funded by the National Cancer Institute (NCI), were “surprised by the loss of tumor control with cetuximab.”

Cetuximab with radiation is an accepted standard of care, especially for patients who cannot tolerate cisplatin, and it is approved for patients with head and neck cancer, including oropharyngeal cancer. Researchers and the NCI are looking for more ways to “de-escalate” therapies for cancers that have a good prognosis, such as HPV+ cancer of the oropharynx. The goal of this trial was to find an alternative to cisplatin that would control the cancer as effectively but with fewer side effects.

The researchers enrolled 849 patients to randomly receive either cetuximab or cisplatin with radiation. The third, final interim analysis, after a median follow-up of 4.5 years, found that overall survival on the cetuximab arm was significantly inferior to the cisplatin arm. Moreover, serious adverse events were similar in both groups, although toxic side effects were more common in the cisplatin arm.

The study is the first randomized clinical trial specifically designed for patients with HPV+ oropharyngeal cancer, and “it establishes cisplatin with radiation as the standard of care.”

Cetuximab plus radiation therapy has worse outcomes than the current standard of radiation and cisplatin for patients with human papillomavirus-positive (HPV+) oropharyngeal cancer. In fact, the researchers, who reported preliminary findings from a phase 3 study funded by the National Cancer Institute (NCI), were “surprised by the loss of tumor control with cetuximab.”

Cetuximab with radiation is an accepted standard of care, especially for patients who cannot tolerate cisplatin, and it is approved for patients with head and neck cancer, including oropharyngeal cancer. Researchers and the NCI are looking for more ways to “de-escalate” therapies for cancers that have a good prognosis, such as HPV+ cancer of the oropharynx. The goal of this trial was to find an alternative to cisplatin that would control the cancer as effectively but with fewer side effects.

The researchers enrolled 849 patients to randomly receive either cetuximab or cisplatin with radiation. The third, final interim analysis, after a median follow-up of 4.5 years, found that overall survival on the cetuximab arm was significantly inferior to the cisplatin arm. Moreover, serious adverse events were similar in both groups, although toxic side effects were more common in the cisplatin arm.

The study is the first randomized clinical trial specifically designed for patients with HPV+ oropharyngeal cancer, and “it establishes cisplatin with radiation as the standard of care.”

Millions of VA health care appointments are missed each year. But VEText aims to change that by sending reminders to veterans via their cell phones.

Five months after the automated interactive text-message system was introduced, > 3 million patients have received reminder texts—and have then canceled 319,504 appointments, freeing up time slots for other veterans to use.

More than 100 VA facilities are using VEText. Veterans who have used the health care system and have a cell phone number listed in their electronic health records (EHR) are automatically enrolled in VEText. The first text message reminder is sent 7 days before the appointment, and a second reminder is sent 2 days before the appointment. (The timing and frequency may vary by facility.) Veterans with multiple appointments on the same day receive multiple remainders. Veterans can also opt out of the text-messaging reminders.

Because it is integrated with the VA’s EHR system, VEText does not require manual action by VA staff, which can mean staff have more time to provide more personalized care, the VA says.

For more information about VEText, visit https://www.va.gov/HEALTH/VEText.asp.

Millions of VA health care appointments are missed each year. But VEText aims to change that by sending reminders to veterans via their cell phones.

Five months after the automated interactive text-message system was introduced, > 3 million patients have received reminder texts—and have then canceled 319,504 appointments, freeing up time slots for other veterans to use.

More than 100 VA facilities are using VEText. Veterans who have used the health care system and have a cell phone number listed in their electronic health records (EHR) are automatically enrolled in VEText. The first text message reminder is sent 7 days before the appointment, and a second reminder is sent 2 days before the appointment. (The timing and frequency may vary by facility.) Veterans with multiple appointments on the same day receive multiple remainders. Veterans can also opt out of the text-messaging reminders.

Because it is integrated with the VA’s EHR system, VEText does not require manual action by VA staff, which can mean staff have more time to provide more personalized care, the VA says.

For more information about VEText, visit https://www.va.gov/HEALTH/VEText.asp.

Millions of VA health care appointments are missed each year. But VEText aims to change that by sending reminders to veterans via their cell phones.

Five months after the automated interactive text-message system was introduced, > 3 million patients have received reminder texts—and have then canceled 319,504 appointments, freeing up time slots for other veterans to use.

More than 100 VA facilities are using VEText. Veterans who have used the health care system and have a cell phone number listed in their electronic health records (EHR) are automatically enrolled in VEText. The first text message reminder is sent 7 days before the appointment, and a second reminder is sent 2 days before the appointment. (The timing and frequency may vary by facility.) Veterans with multiple appointments on the same day receive multiple remainders. Veterans can also opt out of the text-messaging reminders.

Because it is integrated with the VA’s EHR system, VEText does not require manual action by VA staff, which can mean staff have more time to provide more personalized care, the VA says.

For more information about VEText, visit https://www.va.gov/HEALTH/VEText.asp.

Nearly 1.5 million veterans and more than 500,000 already enrolled in the VA health care system identify as being Hispanic or Latino. “Our veteran population is made up of an increasingly diverse group of people,” said VA Secretary Robert Wilkie. “It’s our duty to expand the ways we communicate with all veterans, so they’re properly informed about the benefits they’ve earned.”

To that end, the VA has released a Spanish version of the application for health benefits, “to simplify and improve the health care enrollment process.” The new language version follows on the VA Advisory Committee on Minority Veterans’ recommendation.

The form is available at VA medical facilities and online at https://www.va.gov/vaforms/medical/pdf/10-10EZ_Spanish.pdf.

Nearly 1.5 million veterans and more than 500,000 already enrolled in the VA health care system identify as being Hispanic or Latino. “Our veteran population is made up of an increasingly diverse group of people,” said VA Secretary Robert Wilkie. “It’s our duty to expand the ways we communicate with all veterans, so they’re properly informed about the benefits they’ve earned.”

To that end, the VA has released a Spanish version of the application for health benefits, “to simplify and improve the health care enrollment process.” The new language version follows on the VA Advisory Committee on Minority Veterans’ recommendation.

The form is available at VA medical facilities and online at https://www.va.gov/vaforms/medical/pdf/10-10EZ_Spanish.pdf.

Nearly 1.5 million veterans and more than 500,000 already enrolled in the VA health care system identify as being Hispanic or Latino. “Our veteran population is made up of an increasingly diverse group of people,” said VA Secretary Robert Wilkie. “It’s our duty to expand the ways we communicate with all veterans, so they’re properly informed about the benefits they’ve earned.”

To that end, the VA has released a Spanish version of the application for health benefits, “to simplify and improve the health care enrollment process.” The new language version follows on the VA Advisory Committee on Minority Veterans’ recommendation.

The form is available at VA medical facilities and online at https://www.va.gov/vaforms/medical/pdf/10-10EZ_Spanish.pdf.

The number of women with opioid use disorder (OUD) at labor and delivery more than quadrupled between 1999 and 2014, according to a first-ever multistate analysis of trends by the CDC.

Researchers found that the national prevalence rate of OUD rose from 1.5 per 1,000 delivery hospitalizations in 1999 to 6.5 in 2014. On average, the national prevalence rate grew by 0.39 cases per 1,000 each year.
 

The increases were significant and seen in all of the 28 states with at least 3 years of data available for analysis. The average increases were lowest in California and Hawaii and highest in Maine, New Mexico, Vermont, and West Virginia.

Opioid use disorder during pregnancy has been associated with a range of negative health outcomes, including maternal death, preterm birth, stillbirth, and neonatal abstinence syndrome (NAS).

The CDC’s recommended strategies include:

• Implementing universal substance use screening at the first prenatal visit;
• Ensuring pregnant women with OUD have access to medication-assisted therapy and related addiction services; and
•  Ensuring that mothers with OUD receive adequate patient-centered postpartum care, including mental health and substance use treatment, relapse-prevention programs, and family planning services

The CDC also is supporting state-based perinatal quality cooperatives, networks of teams working to better identify women with OUD during pregnancy and to standardize care for mothers and NAS-affected infants.

The number of women with opioid use disorder (OUD) at labor and delivery more than quadrupled between 1999 and 2014, according to a first-ever multistate analysis of trends by the CDC.

Researchers found that the national prevalence rate of OUD rose from 1.5 per 1,000 delivery hospitalizations in 1999 to 6.5 in 2014. On average, the national prevalence rate grew by 0.39 cases per 1,000 each year.
 

The increases were significant and seen in all of the 28 states with at least 3 years of data available for analysis. The average increases were lowest in California and Hawaii and highest in Maine, New Mexico, Vermont, and West Virginia.

Opioid use disorder during pregnancy has been associated with a range of negative health outcomes, including maternal death, preterm birth, stillbirth, and neonatal abstinence syndrome (NAS).

The CDC’s recommended strategies include:

• Implementing universal substance use screening at the first prenatal visit;
• Ensuring pregnant women with OUD have access to medication-assisted therapy and related addiction services; and
•  Ensuring that mothers with OUD receive adequate patient-centered postpartum care, including mental health and substance use treatment, relapse-prevention programs, and family planning services

The CDC also is supporting state-based perinatal quality cooperatives, networks of teams working to better identify women with OUD during pregnancy and to standardize care for mothers and NAS-affected infants.

The number of women with opioid use disorder (OUD) at labor and delivery more than quadrupled between 1999 and 2014, according to a first-ever multistate analysis of trends by the CDC.

Researchers found that the national prevalence rate of OUD rose from 1.5 per 1,000 delivery hospitalizations in 1999 to 6.5 in 2014. On average, the national prevalence rate grew by 0.39 cases per 1,000 each year.
 

The increases were significant and seen in all of the 28 states with at least 3 years of data available for analysis. The average increases were lowest in California and Hawaii and highest in Maine, New Mexico, Vermont, and West Virginia.

Opioid use disorder during pregnancy has been associated with a range of negative health outcomes, including maternal death, preterm birth, stillbirth, and neonatal abstinence syndrome (NAS).

The CDC’s recommended strategies include:

• Implementing universal substance use screening at the first prenatal visit;
• Ensuring pregnant women with OUD have access to medication-assisted therapy and related addiction services; and
•  Ensuring that mothers with OUD receive adequate patient-centered postpartum care, including mental health and substance use treatment, relapse-prevention programs, and family planning services

The CDC also is supporting state-based perinatal quality cooperatives, networks of teams working to better identify women with OUD during pregnancy and to standardize care for mothers and NAS-affected infants.

The opioid crisis has taken a toll everywhere, but American Indians and Alaska Natives have been hardest hit. That group had the highest drug overdose death rates in 2015, and the largest percentage increase— > 500%—in the number of deaths between 1999 and 2015 compared with that of other racial and ethnic groups.

In February 2018, the IHS released the revised agency policy on chronic pain management. It also has now launched a website (www.ihs.gov/opioids) as another step in addressing the problem.

The website discusses the crisis response, funding opportunities, best practices, and proper pain management. It includes Community Opioid Action Plans, which inform the public about how indigenous planning using traditional practices and holistic, culturally appropriate approaches can help.

The website also provides resources for tribes, such as links to the Office of Tribal Affairs and Policy, the point of contact for tribal governments, tribal organizations and federal agencies on behavioral health issues that affect tribal communities; the Office of Indian Alcohol and Substance Abuse; and SAMHSA Tribal Training and Technical Assistance.

The opioid crisis has taken a toll everywhere, but American Indians and Alaska Natives have been hardest hit. That group had the highest drug overdose death rates in 2015, and the largest percentage increase— > 500%—in the number of deaths between 1999 and 2015 compared with that of other racial and ethnic groups.

In February 2018, the IHS released the revised agency policy on chronic pain management. It also has now launched a website (www.ihs.gov/opioids) as another step in addressing the problem.

The website discusses the crisis response, funding opportunities, best practices, and proper pain management. It includes Community Opioid Action Plans, which inform the public about how indigenous planning using traditional practices and holistic, culturally appropriate approaches can help.

The website also provides resources for tribes, such as links to the Office of Tribal Affairs and Policy, the point of contact for tribal governments, tribal organizations and federal agencies on behavioral health issues that affect tribal communities; the Office of Indian Alcohol and Substance Abuse; and SAMHSA Tribal Training and Technical Assistance.

The opioid crisis has taken a toll everywhere, but American Indians and Alaska Natives have been hardest hit. That group had the highest drug overdose death rates in 2015, and the largest percentage increase— > 500%—in the number of deaths between 1999 and 2015 compared with that of other racial and ethnic groups.

In February 2018, the IHS released the revised agency policy on chronic pain management. It also has now launched a website (www.ihs.gov/opioids) as another step in addressing the problem.

The website discusses the crisis response, funding opportunities, best practices, and proper pain management. It includes Community Opioid Action Plans, which inform the public about how indigenous planning using traditional practices and holistic, culturally appropriate approaches can help.

The website also provides resources for tribes, such as links to the Office of Tribal Affairs and Policy, the point of contact for tribal governments, tribal organizations and federal agencies on behavioral health issues that affect tribal communities; the Office of Indian Alcohol and Substance Abuse; and SAMHSA Tribal Training and Technical Assistance.

The reported prevalence of occult hepatitis B infection (OBI) varies widely: from < 1% to as high as 89.5% in HIV patients. Among patients with chronic hepatitis, the prevalence—again—ranges widely, from 0% to 52% but is highest in patients with chronic hepatitis C (CHC).

The clinical impact of OBI on patients with CHC has been extensively investigated, say researchers from the Institute of Liver and Biliary Sciences in New Delhi, India, but the available data are conflicting. In fact, when they conducted their study to assess the prevalence of OBI and evaluate its impact on clinical outcomes and response to antiviral therapy in CHC, the findings were “largely inconclusive.”

The study included 80 patients, of whom 32 (40%) had seropositive OBI. Hepatitis C virus genotype information was available for 59 patients, revealing that genotype 3 was most common.

However, analysis of clinical, biochemical, histopathologic and treatment response based on seropositivity and semiquantitative estimate of anti-HBc did not yield statistically significant results. Plasma samples of 14 were reactive for anti-HBc, 12 for anti-HBs, and 6 for both antibodies. Hepatitis B virus DNA (34 IU/mL) was detected in the plasma sample of only 1 patient by quantitative polymerase chain reaction.  Therefore, the researchers say, the prevalence of OBI was 1.25%.

Anti-HBc total antibody levels did not influence clinical outcomes and response to directly acting antiviral therapy. Nor did genotype make a significant difference: 90.7% of genotype 3 patients and 92.8% of genotype 1 patients attained sustained virologic response.

More prospective studies should be conducted, the researchers urge, to further explore “this seemingly enigmatic issue.” 

Source:
Bhatia M, Gupta E, Choudhary MC, Jindal A, Sarin SK. J Lab Physicians. 2018;10(3):304-308.
doi:  10.4103/JLP.JLP_12_18.

The reported prevalence of occult hepatitis B infection (OBI) varies widely: from < 1% to as high as 89.5% in HIV patients. Among patients with chronic hepatitis, the prevalence—again—ranges widely, from 0% to 52% but is highest in patients with chronic hepatitis C (CHC).

The clinical impact of OBI on patients with CHC has been extensively investigated, say researchers from the Institute of Liver and Biliary Sciences in New Delhi, India, but the available data are conflicting. In fact, when they conducted their study to assess the prevalence of OBI and evaluate its impact on clinical outcomes and response to antiviral therapy in CHC, the findings were “largely inconclusive.”

The study included 80 patients, of whom 32 (40%) had seropositive OBI. Hepatitis C virus genotype information was available for 59 patients, revealing that genotype 3 was most common.

However, analysis of clinical, biochemical, histopathologic and treatment response based on seropositivity and semiquantitative estimate of anti-HBc did not yield statistically significant results. Plasma samples of 14 were reactive for anti-HBc, 12 for anti-HBs, and 6 for both antibodies. Hepatitis B virus DNA (34 IU/mL) was detected in the plasma sample of only 1 patient by quantitative polymerase chain reaction.  Therefore, the researchers say, the prevalence of OBI was 1.25%.

Anti-HBc total antibody levels did not influence clinical outcomes and response to directly acting antiviral therapy. Nor did genotype make a significant difference: 90.7% of genotype 3 patients and 92.8% of genotype 1 patients attained sustained virologic response.

More prospective studies should be conducted, the researchers urge, to further explore “this seemingly enigmatic issue.” 

Source:
Bhatia M, Gupta E, Choudhary MC, Jindal A, Sarin SK. J Lab Physicians. 2018;10(3):304-308.
doi:  10.4103/JLP.JLP_12_18.

The reported prevalence of occult hepatitis B infection (OBI) varies widely: from < 1% to as high as 89.5% in HIV patients. Among patients with chronic hepatitis, the prevalence—again—ranges widely, from 0% to 52% but is highest in patients with chronic hepatitis C (CHC).

The clinical impact of OBI on patients with CHC has been extensively investigated, say researchers from the Institute of Liver and Biliary Sciences in New Delhi, India, but the available data are conflicting. In fact, when they conducted their study to assess the prevalence of OBI and evaluate its impact on clinical outcomes and response to antiviral therapy in CHC, the findings were “largely inconclusive.”

The study included 80 patients, of whom 32 (40%) had seropositive OBI. Hepatitis C virus genotype information was available for 59 patients, revealing that genotype 3 was most common.

However, analysis of clinical, biochemical, histopathologic and treatment response based on seropositivity and semiquantitative estimate of anti-HBc did not yield statistically significant results. Plasma samples of 14 were reactive for anti-HBc, 12 for anti-HBs, and 6 for both antibodies. Hepatitis B virus DNA (34 IU/mL) was detected in the plasma sample of only 1 patient by quantitative polymerase chain reaction.  Therefore, the researchers say, the prevalence of OBI was 1.25%.

Anti-HBc total antibody levels did not influence clinical outcomes and response to directly acting antiviral therapy. Nor did genotype make a significant difference: 90.7% of genotype 3 patients and 92.8% of genotype 1 patients attained sustained virologic response.

More prospective studies should be conducted, the researchers urge, to further explore “this seemingly enigmatic issue.” 

Source:
Bhatia M, Gupta E, Choudhary MC, Jindal A, Sarin SK. J Lab Physicians. 2018;10(3):304-308.
doi:  10.4103/JLP.JLP_12_18.