StemCell Therapy

The only place people expect and accept radiation is in a medical setting. Outside of thatit is bad, really bad!

What this means is that if you take medical radioactive waste or other radioactive material and combine it with conventional explosives, detonate it, and if it is detectedno one is going to enter that city again for a long, long time.

It is not so much the actual destructive aspect of the explosion, but the spreading of radiation in an area that people fear. The resulting socioeconomic impact is what does the damages.

The above is a low tech way to have maximum impact.

See this NBC News item: How easy is it to get the material to make a dirty bomb? Very, report says

Eric Holdeman is a contributing writer for Emergency Management magazine and is the former director of the King County, Wash., Office of Emergency Management.

Continue reading here:
GAO Found Gap in Dirty Bomb Prevention - Government Technology

Patients who identify as members of the LGBTQ+ community said they receive less information and use fewer preventive care services compared to the overall population, according to a recent study.

A joint report from Phreesia Life Sciences and Klick Health found that gender and sexual identity affects the care received by LGBTQ+ patients.

Nearly half of LGBTQ+ patients over 45 years old said their doctors havent brought up cancer screenings during the last two years. A similar percentage of respondents said that they have received preventive health reminder messages from their doctors offices, which is less than the overall population.

Furthermore, more than 40% said they feel not at all confident that they know which cancer screenings to schedule. Less than 30% reported that preventive care is completely covered by their insurance.

Phreesia associate director of strategy Thea Briggs said the study shows that medical marketers have an opportunity to help close the gap between LGBTQ+ patients knowledge and their use of these services. She added that the pandemic underscored the importance of receiving timely preventive care services and the risks associated with delaying regular visits.

A study conducted by the National Institutes of Health in 2021 found that the pandemic decreased the delivery of preventive care services and contributed to delayed diagnoses, increased mortality and increased health care costs. This phenomenon is especially concerning within marginalized communities and vulnerable patient populations, Briggs noted.

She added that where there have been investments in outreach and communication about health risks to the LGBTQ+ community, like HIV, there are higher levels of understanding and awareness.

Still, there needs to be more focus on encouraging other health protocols, such as routine cancer screenings, Briggs stressed.

One of the important things is to make sure that marketers, for example, when theyre developing information about preventive care, are actively considering these populations and making sure that what theyre developing doesnt exclude people, she explained. They need to make sure that they arent approaching how they disseminate this information in a way that tends towards either the middle of the bell curve or ignores specific communities.

Incorporating more LGBTQ+ voices in the development of educational materials should go a long way toward ensuring that accidental mistakes or unconscious biases dont dissuade patients from receiving timely, necessary care, Briggs said. In addition to imagery in pamphlets or commercials, this could also include listing gender identity on office check-in forms.

These small steps toward a more inclusive patient experience could ultimately reset the baseline for the number of diverse viewpoints involved in such discussions.

Theres a lot that the industry could be doing to better equip both patients and healthcare providers to have these conversations, Briggs continued. At the end of the day, it comes down to two people talking in a room about the most sensitive things in the world. Health is critical and how people identify is a huge part of that.

See more here:
Study: Preventive care scarce in LGBTQ+ community - - Medical Marketing and Media

By Sylvester Carvalho

Lifestyle-related health issues are at their all-time high leading to the early onset of health issues. This, coupled with todays inflated medical prices, makes well-designed, comprehensive health insurance an essential in todays time. The world saw a new wave of disease with the emergence of COVID-19, and it is hence safe to say that the future will see more such illnesses. Adding to this, energy transition, urbanisation, and climate change have bought massive changes in the human health condition.

What is Preventive Health Insurance? As opposed to health insurance that provides financial aid in the event of hospitalisation or treating an illness, preventive health insurance covers the costs of any care received towards preventing the onset of an ailment. While regular general health check-up was standard only for the elderly, the fast-paced way of life is leading to the emergence of health conditions in the late 30s or early 40s among many, leading to the rise in the need for preventive health measures. Some of the most commonly covered preventive health insurance packages include annual check-ups, immunisations, flu shots, fertility tests, screenings, etc.

Lack of awareness and access to preemptive healthcare facilities are the main reasons preventive health care is not prominent in India. As several major health care and insurance agencies invest in preventive health care, the masses will gain access to affordable preventive health insurance.

Many workplaces have also begun considering preventive health insurance as part of their employee health care plan since the rise in the prevalence of chronic and non-communicable diseases. As customer demands and expectations continue to change, insurers are changing ways to adapt their business models to meet new needs and provide relevant products and services. Hence, the insurers are now moving to the approach of Innovate or perish. During the pandemic, the changing consumer behaviour spurred companies to reimagine and build new product strategies to offer relevant preventive insurance products that sustain customer interest, raising the need for preventive insurance.

By Sylvester Carvalho, Lead - Product, Riskcovry

(DISCLAIMER: The views expressed are solely of the author and ETHealthworld does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person / organisation directly or indirectly.)

The rest is here:
The rise of preventive insurance purchases in India - ETHealthWorld

If youve tried all of the cozy socks and slid on the best slippers to try and keep your toes warm, but you still experience cold feet on the regular, it may be time to talk to your doctor. Cold feet can sometimes be totally harmless, but they can also be a symptom of more serious conditions.

Anyone can experience cold feet, but its most common in people with high cholesterol, who carry too much weight, are sedentary, smoke, dont follow a well-balanced diet, or have other circulation or inflammation issues, says Brad Schaeffer, D.P.M., board-certified podiatrist and foot surgeon at SOLE Podiatry NYC and star of TLCs My Feet Are Killing Me.

Cold feet are often related to your arteries, which are the blood vessels that blood flows through, says Barbara Bawer, M.D., a family physician at The Ohio State University Wexner Medical Center. When these vessels narrow, they lead to less blood flow to your extremities, including your feet, she says.

Here, we chat with experts to determine why your feet are always cold and how to treat them.

The most common cause of cold feet is a vascular issue or poor circulation where blood is not circulating efficiently to your legs and feet, Dr. Schaeffer says. Its especially important to make note if youre experiencing cold sensations in just one foot, as this may be a sign of peripheral vascular disease which should be treated ASAP, says Dr. Bawer.

Note: If you smoke, have high blood pressure, or have high cholesterol, these can put you at risk for vascular disease or other issues with your blood vessels, which can cause cold hands and feet, says Meghann Kirk, M.D., board-certified internal medicine doctor and pediatrician with MedStar Health.

Think back and consider how often you experience cold feet. For some people, cold hands and feet are simply a result of how their body metabolism works. Unless you also have lost a considerable amount of weight recently, this may just be how your body operates, Dr. Kirk says.

While cold feet can sometimes be normal, you should never ignore a recurring physiological symptom that bothers you, Dr. Schaeffer notes. But it is completely possible its simply an inherited trait that does no harm.

Peripheral neuropathy is a nerve problem that occurs in your extremities, like your hands and feet, explains Dr. Kirk. Symptoms tend to begin at the furthest part away, so nerve issues are often noticed in the legs and feet. Dr. Schaeffer adds if youre experiencing coldness, but your skin itself is not cold, this could be a symptom of a neurological condition.

Dr. Kirk says if youve lost a lot of weight recently, this can change your circulation and cause cold hands and feet. Weight loss can also change metabolism by slowing it down to preserve calories, leaving you feeling chilly. If youre experiencing unexplained weight loss, be sure to let your doctor know as this can be a symptom of a more serious issue.

Some medications have a common side effect of cold extremities. For example, Dr. Kirk says some blood pressure medications may slow down the circulation which could cause your feet to feel colder than usual. Some migraine medications, stimulants or amphetamines, or cancer drugs can also cause cold feet, Dr. Bawer says.

Additionally, some over-the-counter medications, like decongestants, may constrict or tighten blood vessels, Dr. Kirk adds. Always tell your physician about all medications youre taking, because some over-the-counter drugs can interact with prescription medications, she warns.

Peter Deane, M.D., F.A.C.P., medical director at MVP Health Care explains that diabetes can sometimes cause cold feet because the condition is associated with poor circulation. According to the American Diabetes Association, the condition can lead to nerve damage, called neuropathy, which in turn can cause poor blood flow to the feet. Additionally, this can make the blood vessels in your feet and legs narrow and harden, so its recommended to take precautions to keep blood pressure and cholesterol under control.

Though its not super common, Dr. Kirk says an iron deficiency in the diet may make red blood cell counts low, which means your feet will get little oxygen.

This syndrome typically starts in your teenage years or early 20s when fingers and toes turn colors when exposed to a temperature change, Dr. Kirk explains. It can occur on its own suddenly, or happen along with other autoimmune or connective tissue diseases like lupus, rheumatoid arthritis, or thyroid disorders, according to Hopkins Medicine. Be sure to let your doctor know if you notice color changes in addition to temperature changes in your feet.

Low vitamin B12 levels can lead to nerve damage, Dr. Kirk says. Some people dont have the ability to absorb vitamin B12 properly and may have a B12 deficiency, while others (especially those who follow a plant-based diet) may not have enough B12 in their diet. Foods that are high in vitamin B12 include seafood like salmon, clams, and trout, beef liver, milk, and fortified cereal. If you suspect this may be an issue, speak to your doctor ASAP. This can cause cold hands and feet when sick with an infection, UTI, fever, or other illness.

If you havent changed climate and have a sudden onset change in cold feet, this is likely when there is an underlying issue, Dr. Kirk says. And if your feet hurt, or you experience numbness, tingling, or burning associated with the cold feeling, its something to mention to your healthcare provider.

Additionally, any color changes on the skin or around the feet that pop up along with the temperature change should also send a red flag to go see your doc, she adds. This can look like a darkening, purple color, or even a rash. If you cant stand on your tippy toes or high heels (which requires stretching the muscles and nerves in the foot), she also recommends checking in with your doctor.

Talk with your healthcare provider about cold feet. Dr. Schaeffer says your doctor will likely take a complete medical history because there are many reasons you may be experiencing cold feet. For feet and toes, in particular, podiatrists and foot and ankle surgeons are very familiar with how extremities look and react to touch if blood flow is compromised, he adds.

Your doctor will then determine the best treatment for you based on what the cold feet appear to be related to. If its a circulation issue, for example, your doctor may suggest getting up and moving more often to get the blood flowing, reducing your intake of fatty and sugary foods, drinking more water, elevating your feet, or wearing compression socks.

Additionally, Dr. Deane says cardiovascular exercise can help increase blood flow, medications to treat the underlying problem can offer relief, and in extreme cases, bypass surgery in the legs may be necessary if the arteries are blocked.

Read more:
Why Are My Feet Always Cold? Cold Feet Causes and Treatment - Prevention Magazine

A harm reduction organization in Saint John is preparing to apply to Health Canada for a licence to operate an overdose prevention site, as they grapple with a "poisoned" drug supply on the street.

Julie Dingwell says three clients of Avenue B died last week, and a couple more in the week before that.

Some were experienced drug users, but Dingwell said the addition of fentanyl in street drugs means people no longer know what they're taking.

"We're just in constant grief here with losing people," said Dingwell, who is Avenue B's executive director. "We lost a couple people that we've worked with for 20 years."

Avenue B is planning to build a new facility on Waterloo Street in Saint John's uptown, but in the meantime, Dingwell is looking for another spot to open the overdose preventionsite.

For her, the need is urgent, a matter of life and death.

"We just want to keep people alive," she said.

It would be the second overdose prevention site in the province, after Ensemble Greater Moncton opened a site late last year. The clinic offers people a safe place to test and use their substances, where staff can intervene if they have a negative reaction.

In March, after a spate of opioid overdoses in the community, at least two people were revivedat the Moncton site.

"Their site has gone very well," Dingwell said.

"I'm hoping the province looks at that and says, 'Oh look, it's been so successful in Moncton, we're ready.'"

Saint John Police Chief Robert Bruce said officers used to see a call for an overdose once every three or four days. Now, Bruce said it's not uncommon to see one or two calls per shift.

Overdose calls were up 30 per cent between January and April of this year compared to 2021, which was already up significantly over the same stretch in 2020, according to Bruce.

In some of those cases, people have died and Bruce said testing from the coroner has found "much higher levels of fentanyl."

"Some of the people know what they can handle and what they can'tbecause they've been addicted for some time," he said.

"When they overdose, then you know something isn't right."

All of the police force's supervisors carry Narcan, which can be used to revive someone after an opioid overdose. Sometimes it can take two or three doses, Bruce said, because of the "increasing toxicity" of the drugs.

"We're just about to go to Narcan in every car for our members, just because of the amount of people that we're running into," Bruce said.

"Before it was alright to have a patrol supervisor that had it and could bring it to you fairly quickly, but now we're finding that our officers are going to more of these, so they require it in the vehicle."

Like Dingwell, he too feels there's a sense of urgency when it comes to Avenue B's plan to open an overdose prevention site.

"Avenue B, they're on the ground, they're there every day, they're looking into the eyes of people," Bruce said.

"They know what the issues are. So if they're looking at trying something new, then I'm totally interested in finding out what we can do, how we contribute, how we can work together to try to at least minimize the overdoses that we're seeing."

Bruce has created acommunity action group with "on-the-ground practitioners" ranging from Dingwell with Avenue B, to other social agencies, youth services and provincial correctional staff. It's all part of a belief Bruce hasthat police can't arrest their way out of the problem, that it requires solving deeper social issues.

One committee within that group focuses specifically on substance use, in addition to committees on connected issues like homelessness.

"We're a relatively small city comparatively in this country, but we certainly have big city problems here," the police chief said.

"They're related to mental health, substance use and homelessness."

At Avenue B, Dingwell is assembling a team to "get everything in order" ahead of applying for a licence to operate the overdose prevention site. Once they get a green light, Dingwell believes they'll be ready to move quickly to open.

But first, the non-profit agency needs support from the provincial government to hire staff and outfit the site.

"Implementing overdose prevention sites" is listed as a priority in the province's 2021-25 mental health and addiction plan, but the government hasn't provided a timeline for when it might fund additional overdose prevention sites.

No one from the Department of Health was made available for an interview.

"Overdose Prevention Sites (OPS) provide a much-needed service to people who use various substances, especially for those who are precariously housed or homeless," Department of Health spokesperson Coreen Enos wrote in an emailed statement.

Enos said the department is continuing "to work with community partners to understand the needs and support the community-led plans for more Overdose Prevention Sites across New Brunswick."

"When those details are finalized, the provincial government will have more to share with the public," Enos wrote.

Beyond an overdose prevention site, Dingwellwould like to see a safe supply of opioids. A clinic in the city offers a safe, prescribed supply, but Dingwell said it's not enough for the "hundreds" of clients at Avenue B. She would also like to see the government decriminalize possession of some substances for personal use.

"We just have to be thinking much harder about what we can do to keep people alive," she said.

"It's terrible the amount of ongoing grief that we have to work with."

When asked about the idea of decriminalization, Bruce said nothing should be off the table. He said the New Brunswick Chiefs of Police are studying the effect of decriminalization in British Columbia.

"What we're doing now isn't working that well," he said. "So there must be other ways to do it. We have to do a better job."

The rest is here:
Agency looking to open overdose prevention site in Saint John amid 'poisoned' drug supply - CBC.ca

The Conversation asked Katherine Basbaum, a clinical dietitian at UVA Health who specializes in cardiovascular disease, to explain what this recommendation means for the general public, particularly those who are currently or considering taking dietary supplements in hopes of preventing cancer and cardiovascular disease. In this Q&A with Basbaum, she interprets the data behind the task forces conclusion.

Q. What was the basis of the task forces recommendation?

A. The U.S. Preventive Services Task Force evaluated and averaged the results of multiple studies looking at health outcomes associated with beta carotene and vitamin E supplements. Beta carotene is a phytonutrient or plant chemical with a red-orange pigment; both beta carotene and vitamin E are found in many fruits and vegetables such as carrots, sweet potatoes, kale, spinach, Swiss chard and avocados, to name a few.

The panel of experts concluded that with regard to the prevention of cardiovascular disease or cancer, the harms of beta carotene supplementation outweigh the benefits and that there is no net benefit of supplementation with vitamin E for those purposes. Their recommendation applies to adults who are not pregnant and excludes those who are chronically ill, are hospitalized or have a known nutritional deficiency.

Beta carotene and vitamin E are powerfulantioxidants, substances that may prevent or delay cell damage. They are commonly taken as dietary supplements for their potential health and anti-aging benefits, such as to combat age-related vision loss and the inflammation associated with chronic disease. Vitamin E has also been shown tohelp support the immune system.

Our bodies do requirebeta carotene and various nutrients for a variety of processes, such as cell growth, vision, immune function, reproduction and the normal formation and maintenance of organs. But it is important to point out that more than 95% of the U.S. population receivesadequate levels of vitamin A, vitamin E and beta carotenethrough the foods they consume. Therefore, the average healthy adult likely does not need additional supplementation to support the processes mentioned above.

The task force did not focus on other potential benefits of vitamin supplementation. It noted that there may be other benefits of some supplements that were not covered in this review owing to its focus on cardiovascular disease and cancer prevention.

Q. What risks did the task force point to?

A. Based on its review of the evidence, the expert panel concluded that beta carotene supplementation likely increasesthe risk of lung cancer incidence, particularly in those at high risk for lung cancer, such as people who smoke or who have occupational exposure to asbestos. It also found a statistically significantincreased risk of death from cardiovascular diseaseassociated with beta carotene supplementation.

In one of the clinical trials reviewed by the task force for their recommendation statement, people who smoked or had workplace asbestos exposure were atincreased risk of lung cancer or death from heart diseaseat doses of 20 and 30 milligrams per day of beta carotene. This dosage is higher than the standard recommendation for beta carotene supplementation,which ranges from 6 to 15 milligrams per day.

Continue reading here:
UVA Expert Offers Insight on the Use of Dietary Supplements for Cancer Prevention - UVA Today

A new study published in Molecular Psychiatry demonstrated that replacing the blood of an Alzheimers disease (AD) mouse model with the blood of a wild-type mouse reduced the levels of AD brain markers and improved spatial memory in the mouse model.

Although the mechanisms underlying these findings remain unclear, the results suggest that manipulating certain components in the blood could help treat AD.

Targeting components in the blood for the treatment of AD can help bypass the challenges associated with developing drugs that can cross the blood-brain barrier.

AD is the most common form of dementia, accounting for 60-80% of all dementia cases. More than 6 million individuals in the United States currently have AD and projections indicate that this number is may reach 13 million by 2050. Thus, there is an urgent need for effective treatments for this condition.

A central characteristic of AD is the abnormal accumulation of the beta-amyloid protein into deposits, known as plaques, in the brain.

Single units, or monomers, of the beta-amyloid protein tend to aggregate together to form short chains called oligomers. These soluble oligomers aggregate to form fibrils, which later form insoluble plaques. Experts consider these beta-amyloid aggregates to be responsible for the damage to brain cells in AD.

Beta-amyloidmonomers are produced in the brain and also in other organs. Beta-amyloid monomers and oligomers can cross the blood-brain barrier, passing from the brain to the blood and from the blood to the brain. The beta-amyloid protein is broken down in peripheral organs, including the kidneys and the liver, which explains its presence in blood.

Moreover, research suggests that there is a close association between beta-amyloid levels in the brain and the bloodstream.

In a study conducted using a genetically engineered or transgenic AD mouse model, receiving blood from older, transgenic mice with beta-amyloid deposits accelerated the formation of beta-amyloid deposits in younger transgenic animals.

In contrast, isolating the beta-amyloid protein in the blood using antibodies that cannot cross the blood-brain barrier can reduce the levels of beta-amyloid deposits in the brain.

Similarly, surgically connecting the blood circulation of a wild-type mouse with that of a transgenic AD mouse model can reduce the levels of beta-amyloid deposits in the brain of the rodent.

These data suggest that beta-amyloid protein levels in the blood could impact the levels of beta-amyloid deposits in the brain. Thus, treatments that lower beta-amyloid levels in the blood circulation could be used to slow down the progression of AD.

In the present study, the researchers examined whether the partial replacement of the blood of a transgenic mouse model of AD with the blood of wild-type mice could reduce the levels of beta-amyloid in the brain of the mouse model.

During the blood exchange treatment, the researchers withdrew 40-60% of the blood from the transgenic mice and replaced the withdrawn blood with blood from healthy wild-type mice.

They started this blood exchange treatment when the transgenic mice were 3 months old which means they were mature adults and before the onset of the formation of beta-amyloid plaques.

This blood exchange procedure was performed once a month for the next 10 months until the mice were 13 months old, or middle-aged.

Unlike the untreated transgenic mice that showed beta-amyloid plaques at 13, the transgenic mice receiving the blood exchange treatment showed fewer plaques and a lower plaque burden, which is a measure of the area of the brain covered by plaques.

The researchers also assessed the impact of the blood transfusions from wild-type mice on the memory of the transgenic AD mouse models at 12.5 months of age.

The transgenic mice from the blood exchange group performed better in short-term and long-term spatial memory tests than untreated transgenic mice. Furthermore, the performance of the mice in the blood exchange group was similar to wild-type mice.

In a similar experiment, the researchers continued the monthly blood exchange procedure until 17 months of age. They used the data from the mice sacrificed at 13 and 17 months of age to assess the rate of plaque growth during this period.

The researchers thus found that the blood exchange treatment slowed down the rate of plaque growth.

In the first set of experiments, the researchers started the blood exchange procedure in 3-month-old mice before the development of beta-amyloid plaques.

To examine the potential of this procedure for the treatment of AD, the researchers started the monthly blood exchange treatment at 13 months when transgenic mice tend to show beta-amyloid deposits in the brain and memory deficits.

The researchers found that transgenic mice receiving blood exchange treatment showed fewer beta-amyloid plaques and lower plaque burden at 17 months of age than age-matched untreated transgenic mice.

Moreover, the plaque burden in the 17-month-old transgenic mice receiving the blood exchange treatment was similar to untreated transgenic mice at 13 months. These results suggest that the blood exchange treatment prevented further accumulation of beta-amyloid plaques.

Notably, the performance of the transgenic mice in the blood exchange treatment group in the spatial memory tests was similar to age-matched wild-type mice and better than age-matched untreated transgenic mice.

These experiments show that blood exchange could serve as a disease-modifying treatment, which delays or halts the progression of AD.

The researchers found that beta-amyloid levels in the blood of the transgenic mice increased soon after the blood transfusion from wild-type mice.

Thus, it is possible that the lowering of blood beta-amyloid levels upon the introduction of blood from wild-type mice could enhance the transfer of beta-amyloid from the brain to the bloodstream. This might be a mechanism for the decline in brain beta-amyloid levels due to the blood exchange procedure.

However, the researchers did not directly remove beta-amyloid from the blood of the transgenic AD mouse model and other proteins or factors in the blood could also explain these results.

Thus, more research is needed to characterize the blood components and pinpoint the mechanisms underlying the impact of the blood exchange treatment on memory and beta-amyloid plaques.

The characterization of the blood components underlying these effects of the blood exchange treatment could facilitate the development of treatments for AD patients.

The studys lead author, Dr. Claudio Soto, a neurology professor with McGovern Medical School at UTHealth Houston, told Medical News Today that procedures such as plasmapheresis and blood dialysis could be adapted to remove the beta-amyloid protein from the blood or other blood components and treat individuals with AD.

Dr. Soto noted that [s]tudies in mouse models are necessary as a first step to analyze the efficacy of a therapeutic strategy. Of course, he added, mice are not humans, so we would need to show that our approach works in real life with real patients.'

Whole blood exchange as we did in this study is not feasible in humans [as such], but there are two technologies currently in common medical practice that may work: plasmapheresis and blood dialysis. We are currently adapting these techniques for mice studies and if we obtain positive results, the next step will be to start some clinical trials in humans affected by AD.

Dr. Claudio Soto

We also spoke with Dr. Erik S. Musiek, a professor of neurology at Washington University School of Medicine in St. Louis, who was not involved in this study.

Commenting on the study, Dr. Musiek noted: The authors focus on the idea that there is a pool of beta-amyloid in the periphery that is in equilibrium with that in the brain, and that adding blood with minimal beta-amyloid creates a sink by which beta-amyloid transfers from the brain to the blood, limiting plaque formation. This peripheral sink hypothesis has been around for a long time and has been demonstrated in mice after [the] administration of Abeta antibodies.

However, there are likely many other possible mechanisms at play here, he cautioned. Moreover, according to Dr Musiek, [t]he fact that the blood donors are young, while the AD model mice receiving the blood get quite old (13 months), suggests that there may be factors in the young blood which directly limit beta-amyloid pathology and promote cognition.

It is also possible that the fresh, young blood alters the immune response in the brain of the recipients, facilitating beta-amyloid metabolism Dr. Musiek hypothesized. Finally, it remains unclear if blood exchange in mice that already have [a] significant plaque burden can enhance [the] removal of plaques, as opposed to [preventing] their initial accumulation.

This is very important, as we generally identify people with preclinical AD based on the fact that they already have plaques, and primary prevention therapies to prevent that gradual plaque accumulation are very difficult to implement in humans. However, this study certainly reveals a very interesting phenomenon and should inspire future research, said Dr. Musiek.

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Alzheimer's: Targeting key protein in blood may slow progression - Medical News Today

WASHINGTON Following the notice ofa trade missionto the Philippines, The National Pork Producers Council (NPPC) announced it would work with the Foreign Agricultural Service (FAS) on a project to help the fight against African swine fever (ASF).

Leaders from the Philippine Department of Agriculture and the Minnesota Department of Agriculture will start the project focusing on risk assessment to support safe trade of US pork products in the Philippines.

NPPC is proud to have worked with the Philippine government, US government, and the University of Minnesota to see this grant proposal to the finish line, said Terry Wolters, president of NPPC. Creating international partnerships provides further safeguards to keep American agriculture safe from foreign animal disease so US pork producers can continue to provide consumers in both countries with safe and affordable pork products.

In recent years, the Philippines dealt with ongoing ASF outbreaks and continues to seek better ways to control the virus which ties into food price inflation.

NPPC said it worked with the Philippine embassy to determine the needs of the government and producers ASF outbreak management.

The associations international affairs team partnered with the University of Minnesota to develop a proposal for government assistance which FAS agreed to for both the Philippines and Vietnam.

The knowledge to be gained from the program is a win-win for both countries as it will help us better understand how to prepare, prevent and mitigate a potential ASF outbreak, said Andres M. Perez, DVM, PhD, professor, Department of Veterinary Population Medicine at the University of Minnesota. Assisting other countries to implement control measures that reduce the spread of the disease simultaneously limits the risk to the US pork industry.

Perez also directs the universitys Center for Animal Health and Food Safety (CAHFS).

The new program will also include workshops for provincial officers and intense in-person training of fellows identified by the Philippine Department of Agriculture. Asynchronous training will also be available for participants on material developed and delivered in advance of the workshops.

NPPC wants to thank USDA for funding this program and their broader commitment to prevention and preparedness against ASF and other foreign animal diseases, Wolters added. This program ties in well with the $500 million committed by USDA for ASF preparedness and prevention and the recently launched USDA Borlaug Fellowship Program aimed at developing quick and affordable testing kits for African swine fever and other transboundary animal diseases.

Go here to see the original:
NPPC, FAS focused on ASF prevention in the Philippines - MEAT+POULTRY

Introduction

Successful implementation of healthcare innovations is not an easy-going process. It was shown that only a small fraction of such innovations are ever put into practice.1 Innovation can be an idea, a health intervention, technology, or practice that is perceived as new to an existing system.2 The diffusion or implementation process of an innovation encompasses a complex chain of processes that require non-stop advocacy programs, sensitization workshops, trainings and other systematic approaches to persuade users and facilitators to ensure their acceptability.2,3 Once the innovation is accepted by the implementors and users, it is then easier to ensure its successful implementation. Acceptability is an important outcome measure used to assess implementation success of an innovation.4,5 Healthcare providers acceptability of healthcare interventions is known to be key to success.6 Acceptability is defined as a perception among implementation shareholders that a given treatment, service, practice or innovation is agreeable, palatable, or satisfactory.7

Isoniazid Preventive Therapy (IPT) is one of the healthcare innovations recommended by the World Health Organization (WHO) to reduce the development of active tuberculosis (TB) in people living with HIV (PLHIV).8 As per the recommendation, eligible countries are expected to achieve at least 90% IPT coverage to ensure successful protection. Despite efforts made by member states, the global uptake of IPT in newly enrolled patients at HIV clinics was reported to be very low, ie 46%.9 Different studies conducted in different parts of the world reflect that roll out of IPT have been affected by multifaceted problems such as health system-related factors (inadequate political support, increased workload, stock-outs of IPT, inaccuracy of TB screening tools to exclude active TB, and shortage of isoniazid and tuberculin skin tests); HIV control programs-related factors (limited engagement of healthcare providers during introduction of IPT, poor integration of IPT-related services including TB/HIV collaborative activities, unclear IPT guidelines and standard operating procedures, lack of national consensus on IPT-related services, limited training, and weak monitoring and supervision); provider-related factors (perceived fear of isoniazid resistance, peer influence, negative perception on the benefits/risks of IPT, rumors and misconception about IPT); product-related factors (long duration of IPT, adverse effects); and patient-related factors (non-adherence, pill burden).1015

Eritrea has a TB incidence rate of 67 cases per 100,000 people16 and HIV prevalence of 0.93% in the general population17 and 0.65% of pregnant women attending antenatal care services.18 When the Ministry of Health decided to programmatically introduce IPT, guidelines on its roll out was incorporated in the national Comprehensive HIV/AIDS Care Manual.19 Despite efforts made by the communicable disease control (CDC) program to maximize IPT uptake, the overall average implementation coverage was insufficient, 75% (range: 1285%)20even though it was better than the global average.9 Anecdotal reports show that there was resistance from healthcare professionals on the implementation of IPT which might be among the barriers to implementation. However, no documented information is available on the healthcare providers perception, acceptability and the possible influencing factors on IPT implementation. This qualitative study was, thus, conducted to explore the perspectives of healthcare providers and professionals working in the CDC program on the factors that caused limited implementation of IPT in Eritrea.

This was an exploratory qualitative study that used a framework content analysis to explore the factors limiting the implementation of IPT in Eritrea. An in-depth interview with senior HIV care clinic prescribers were carried out between October 13, 2020 and February 22, 2021. Key informants interview (KII) with senior staff of the CDC division was also conducted on November 1011, 2021.

This study was conducted in HIV care clinics in all Eritreas regional referral hospitals, namely: Hazhaz, Keren, Barentu, Assab, and Mendeferra, and Massawa hospitals and one national referral hospital, ie, Halibet national referral hospital. These clinics serve for about 65% of all PLHIV in Eritrea. All interviews were conducted in a quiet place, and there were no other participants present during the interview.

Purposively selected senior physicians and nurse practitioners working in the HIV care clinics at national and regional referral hospitals were enrolled for in-depth interviews. HIV care clinic prescribers (physicians and registered degree nurses) who had the longest years of working experience were included in the study. Though these were the pre-set criteria for selection, all prescribers working in the HIV care clinics of the regional referral hospitals were included as they were few in number. From Halibet National Referral Hospital, one of the two prescribers was purposively selected and interviewed. Eritrea has two national referral hospitals that have HIV care clinics, Hablibet and Orotta. Prescribers at Orotta National Referral Hospital, which had good uptake of IPT and served both adults and pediatrics, were not interviewed as we had already reached a theoretical data saturation point. Nurse practitioners and counselors who were involved only in counseling and refill of medicines were excluded from the study as they had no decision-making power in prescribing medicines. Anecdotal reports showed that implementation of IPT was poor in the majority of regional referral hospitals and that was later confirmed by a recent study.20 For this reason, priority was given to the prescribers from the regional referral hospitals. The large number of PLHIV served by regional referral hospitals and their prescribers potential influence on other prescribers working in the lower-level health facilities were also additional reasons. The sample size was determined by a theoretical data saturation at which no new information was gathered by additional interviews. Senior staff of the CDC of whom it was expected that they could provide adequate information on the planning and implementation efforts of IPT were also purposively selected as key informants.

MR is a pharmacist, pharmacoepidemiologist and pharmacovigilance specialist and was a PhD student during the data collection period. He works for the National Medicines and Food Administration (NMFA) of Eritrea and is a trained and experienced professional in designing, conducting and reporting qualitative studies. Though the interviewer had no affiliation with the study sites, he had a work-related relationship with some of the participants. The participants were well aware that the researcher and his colleagues were conducting the study to explore how people feel about the value of IPT in Eritrea, and to identify factors limiting implementation of IPT and possible solutions. The other authors had no direct role in the data collection process or interviews. DYBJ is an epidemiologist with experience in mixed-method research, and he is a PhD student at the Erasmus Medical Centre, the Netherlands. ST, a pharmacist working for the NMFA, is an experienced researcher in qualitative studies. BHS and KV, who supervised the research project, are pharmacoepidemiologists working for the Erasmus Medical Centre as professor and associate professor, respectively.

A semi-structured interview guide (S1) adapted to the local context from a similar study conducted previously10 was used for the in-depth interviews. The interview guide aimed to explore the overall impression of prescribers towards the implementation of IPT, multi-level factors that could affect successful implementation of IPT, and areas of improvements.

All interviews were done by one of the researchers (MR), and all except two in-depth interviews were conducted face-to-face by following COVID-19 prevention protocols. Data from the two respondents who were not interviewed face-to-face was collected using telephone interviews as one respondent was not available during the data collection visit and the other was working about 800 kilometers away from the interviewers address. Prior to each interview, the interviewer introduced himself and the objectives of the study, and provided information with regard to a consent. Consent for all the interviewees was taken verbally and was audio-taped for audit trail. Appointments were made in advance with every interviewee at his/her convenience and the timing of the interview was recorded. All interviews were audio-tapped, upon consent, for full documentation and to allow quote verbatim statements or phrases. Probing questions were included in the interviewers guide, but additional follow-up questions were asked as appropriate. Based on the objective of the study, the questions including probes were focused on exploring the factors limiting the IPT implementation. Facial expressions, sense of confusion and reluctance of interviewees, if any, were documented by the interviewer. All interviews were successful at the first attempt and thus, there was no need for repeated interviews. Data coding was performed in parallel to the interviews. All interviews were conducted within the study sites in a local language, Tigrigna. The average time taken for each interview was about 19 minutes long (range: 1026 minutes).

A semi-structured KII guide was self-developed based on the preliminary findings of the in-depth interviews of the prescribers. Key informants were senior professionals working at the CDC division, including HIV and TB control programs. The KII guide was mainly designed in a way to confirm claims made by the prescribers, understand the key informants assumption on possible causes of the problem, assess the extent of planning and efforts made in implementing IPT as well as what they would do differently to avoid problems in the future (S2). Interviews were carried out in their workplace with no other participants. All interviews were successful at the first attempt. Other procedures of data collection such as audio-taping, consent, record of the interview duration, medium of interview [language], and use of probes and follow-up questions were the same as what was followed for the in-depth interview of the prescribers.

All audio records were transcribed verbatim and translated into English by nine research assistants, all pharmacists. Each transcribed and translated interview was again validated by another research assistant. Finally, each transcription and translation was approved by the lead investigator (MR). After repeated reads of the verbatim translation, data was coded and charted by MR and DBYJ. During data familiarization, important phrases or words that were related to the topic of interest were identified and coded by selecting a significant word or phrase from the interviewees statement. No software was used to code or manage the data. Codes were revisited several times, merged, split and modified as appropriate. Codes along with their summary notes were then charted in an Excel spreadsheet to look at patterns and ensure consistencies of data coding. Similar codes were aggregated and classified into meaningful categories. The major categories were labelled as themes and named as appropriate. Sub-categories of every theme were considered as sub-themes. To illustrate the themes and sub-themes, selected quotations are presented and each quotation is accompanied by a coded participant number. Prescribers are coded as HP1, HP2, etc., while key informants are coded as KI1, KI2, and KI3.

To better understand the problem, a conceptual framework model was developed using a problem tree analysis or root cause analysis.21 To do this, the existing problems were first identified from the generated themes and sub-themes. A core or central problem of the overall problem, which is expected to be the trunk of the problem tree, was identified. At the end, causes and effects (consequences) of the central problem were identified. The themes and sub-themes were identified to be the causes and/or effects of the central problem(s). Finally, a conceptual framework model was developed and designed as a problem tree diagram for better visualization (Figure 1).

Figure 1 Conceptual framework model describing the factors that affect or limit the implementation of isoniazid preventive therapy (IPT) in Eritrea, 2021.

Abbreviations: ADRs, Adverse drug reactions; DILI, Drug-induced liver injury; HCPs, Healthcare professionals; INH, Isoniazid; SOPs, Standard Operating Procedures.

The study was reported according to the Standards for Reporting Qualitative Research (SRQR) and Consolidated Criteria for Reporting Qualitative research (COREQ).22,23 The manuscript was shared with study participants to check its appropriateness.

Overall, in-depth interviews with 11 prescribers working in HIV care clinics and three senior key informants working in the CDC Division of the Department of Public Health of the Ministry of Health were conducted. None of the approached prescribers and key informants refused to take part in the study. The demographic details of the study participants are depicted in Table 1. Theoretical data saturation was reached at the 10th prescriber and confirmed after another prescriber was interviewed, and no new information was gathered.

Table 1 Demographic Characteristics of the Study Participants Involved in Interviews on Factors Limiting Implementation of Isoniazid Preventive Therapy in People Living with HIV in Eritrea

In an effort to identify the factors that limit implementation of IPT in PLHIV in Eritrea, five themes and 13 sub-themes emerged from the in-depth interviews and KIIs. The main themes and sub-themes are summarized in a thematic framework analysis (Figure 1). Based on the perspectives of the healthcare professionals and key informants, five multi-level factors that are related to (1) health systems, (2) the National HIV Control Program, (3) healthcare professionals, (4) the product itself, and (5) patients were reported.

This domain captures system-related elements that are mainly associated with the then existing laboratory setup and its challenges.

Unavailability of chemistry laboratory and shortage of laboratory supplies, especially, in the regional hospitals, were among some of the frequently reported challenges for implementation of IPT. Even though the national HIV guideline did not require routine liver function tests for initiating IPT in PLHIV, due to fear of drug-induced liver injury, some of the clinicians reported that unavailability/inadequacy of chemistry laboratory test was one of the major challenges for IPT implementation. Complete dependence on clinical monitoring was also reported to be impractical, as some patients without clinical signs were found to have markedly elevated liver enzymes. Initiating IPT without having baseline information was reported to be challenging. This was reported by one of the HIV care clinic prescribers as follows:

Here we have no chemistry lab and we usually do not dare to start IPT without baseline data. Incidence of hepatitis in our zone is high and thus, it is difficult to start IPT without having baseline data. [HP1]

Another respondent from another health facility also raised the laboratory-related issue as a central problem for the poor uptake of IPT in their setting and stated it as:

There is a need to take baseline [lab] tests. Hepatitis B & C testing and LFT are a must and you cannot put someone on IPT without those tests. But this has been a constant problem for us. I mean, hepatitis B & C testing has been unavailable for several months. The biggest issue therefore is the laboratory. Other constraints are subjective and are not as important. If lab tests were available, there wouldnt have been problems because we would be able to detect and explain scenarios. [HP3]

In situations where chemistry laboratory was available, intermittent stock-outs of laboratory supplies for testing hepatitis B and C, as well as liver function tests, were reported as a challenge. Accordingly, for patients that were suspected or at risk of developing isoniazid-induced liver injury, blood specimens were sent to the National Health Laboratory which was reported as discouraging due to delays in obtaining results.

Few prescribers reported that stock-outs of INH, though infrequent, as a setback in implementing IPT. Although this problem is categorized under the system-related factors, it can also be program-related as the procurement and supply chain management of the CDC have been playing a role in ensuring the availability of INH. One prescriber reported:

Our main reason for not starting IPT was mainly the unavailability of INH. Otherwise, we have no problem to start INH. [HP7]

Using inductive approach, several limiting factors, related to the National HIV Control Program, such as inadequacy of information, lack of collaboration and ownership, inadequate preparation, and lack of outcome evaluation, were identified and labeled as program-related factors.

Implementation of the IPT without adequate planning, advocacy, engagement of healthcare professionals (HCPs), working documents such as registers, guidelines and standard operating procedures (SOPs), awareness raising activities, regular follow-ups, and so on were reported as major challenges for successful implementation of IPT. Inadequate preparation was one of the most often reported problems by prescribers. From their perspectives, all the aforementioned issues should be addressed prior to the introduction of IPT. A key informant acknowledged this as follows:

We should have prepared a good guideline before starting to implement the IPT [six months isoniazid]. We should have collected cohort based-data until patients complete their six-month INH regimen and analyzed it as appropriate. Besides, continuous training should have been given to healthcare professionals and the consumers of IPT. Campaigns targeting consumers on the consequence/risks of TB on PLHIV and the benefits of the IPT should be have been carried out by their [PLHIVs] association. [KI1]

The key informants also disclosed that the program did not take adequate measures in planning and implementation of the intervention. The above KI also reported the inadequate preparation as follows:

I do not believe that adequate measures were taken [by the program]. Advocacy and sensitization were not as it should be. There was not even a register and also no SOPs. The guideline was not in-depth. The program was only following whether it [isoniazid] was started; monitoring tools that can measure final outcomes were not in place. Meaning, there was no follow-up approaches. [KI1]

Deployment of IPT without provision of adequate information to healthcare professionals on benefits/effectiveness of INH, its risks, how a six-month IPT intake could prevent TB for several years, risk of resistance, adverse drug reaction monitoring, etc., were reported among the major factors for hesitancy. The ART clinic physicians asserted that the intervention was introduced without adequate training/sensitization to healthcare professionals.

One of the prescribers disclosed that they had been administering INH to prevent incidents of TB in children having contact with TB patients with full confidence as they had enough information on it. As for the INH preventive therapy in PLHIV, due to limited information on its clinical benefits, potential risks and how the mechanism works, the importance of its implementation was reported as doubtful. The significance of inadequate information in limiting the implementation of IPT was explained by an ART clinic physician, who was not in favor of it, as:

If I could get someone who can tell me all the benefits and risks of implementing IPT in detail and found it convincing, I would definitely initiate it to my patients. [HP5]

The clinician also added:

This has always been in my agenda. We have pressure [from the program] to start implementing it [INH] but with the existing rumors and the limited knowledge we have, we could not dare to start IPT. If the study you have been conducting comes up with concrete answers/information that favors its implementation, we will use it. [HP5]

There were claims that there was lack of coordination, collaboration, and stakeholders engagement and that policy-making decisions related to the introduction of IPT were made behind closed doors. Some of the stakeholders were dissatisfied with communication gaps because they were unable to get involved and did not consider themselves as part of the process. The HIV/TB collaboration was reported to be very weak and the two programs had no sense of collaboration in implementing IPT. This was considered as one of the contributory factors. One prescriber said:

It has been forgotten by all parties. Currently, everyone does not know how to move forward as there is no unified approach. [HP6]

Some of the HIV care clinic prescribers claimed that they were not part of the planning process when IPT was introduced. It was reported that there was a rush from the program and HIV care clinics were simply instructed to implement IPT without clear guidelines and adequate orientation. One of the key informants acknowledged the prescribers claim as follows:

Most of them have no good impression on it [IPT]. Usually, as program managers, we insist on implementing IPT. We tell them that it is important for patients. When I see its acceptability even by the counselors, it seems low. They usually say, if we are instructed to do so we will do. Thus, instead of just ordering to implement the TB preventive therapy, it would be good to involve senior ART clinic physicians prior to introduction. It is not good to simply order or impose without providing adequate information and reaching to consensus. [KI2]

Unavailability of evidence to evaluate the impact of the intervention in Eritrea, despite its use for many years, was also reported as a limiting factor. Some prescribers reported that the unavailability of local data on the benefits and risks of the intervention was discouraging. They had the expectation that the program could regularly evaluate the impact of the intervention so that they could build confidence in it. One of the key informants reported the limitations as follows:

In the past, except the number of people who started isoniazid, we had no information on how many people have completed the preventive therapy, how many of them experienced ADRs, discontinued treatment, experienced hepatotoxicity, and died. The information we have so far is mainly from the studies conducted recently [by the authors]. [KI1]

Fear of ADRs, peer influence/rumors, doubts on duration of protection of IPT and effectiveness of IPT in settings with high latent TB infection, as well as fear of INH resistance and genetic polymorphism were some of the prescriber-related factors that were reported to affect the implementation of IPT.

Some healthcare professionals were not encouraged to administer INH due to fear of potential risks of ADRs. Though they personally had no patients with serious adverse effects, they had the understanding that INH could cause serious hepatic injury especially when there are no laboratory monitoring strategies. Accordingly, several prescribers disclosed that they were sometimes asking their patients if they would like to start IPT, but they had no courage to motivate them. One prescriber said:

We simply ask patients to take IPT, but we dont motivate them because of the risks of ADRs. [HP4]

The interviews indicate that a few fatal experiences of hepatic injury had tremendous impact in creating hesitancy in several prescribers. Two prescribers reported their source of hesitancy as follows:

At this time, we all [our staff] have fear of starting IPT. We had a patient who had good adherence to his medications. One day one of our staff, who had close contact with him, met him in town and she up-front informed him about the new TB preventive therapy being introduced [isoniazid] and encouraged him to come and start it. He completely agreed and came the next day. Within one month following initiation of isoniazid, he developed severe hepatotoxicity and died within a short period of time. As a consequence, the condition was traumatizing, though it was a single experience. [HP2]

One patient died with complications of hepatic injury, yet; other patients begun to question the drug and even healthcare professionals started to have some sort of fear on deciding to whether they should put their patients on INH. This was the biggest problem in patients as well as health workers. It even influenced me. This was a big set-back to be frank. [HP3]

On the other hand, a few prescribers mentioned that INH is tolerable and incidence of hepatic injury was minimal.

A fast-spreading rumor related to a few fatal hepatic injuries was reported to be influential in intensifying healthcare professionals and consumers hesitancy on the IPT. For this reason, some prescribers reported that they had no confidence to initiate IPT with their patients and were waiting for further evidence that would help them to take informed decision. Two prescribers stated the impact of the rumors as follows:

Even recently we have been instructed by the program to start IPT but we are not encouraged with the existing rumors. [HP5]

we heard from the HIV focal persons that there is a controversy surrounding it [INH] that put us in a limbo. So, we had to wait for further data and thus, we havent started with any new patients [HP6]

Another prescriber also reported that the rumor was spreading fast and reached out to patients and the Bdeho (HIV patients) association that triggered discussions with the program.

For some prescribers, it was not clear how a six-month IPT could prevent incident TB for several years. Based on the national guidelines, some prescribers had the assumption that a six-month IPT could protect all their patients from TB for about five years. In clinical practice, observing a short-lived protection of TB in some patients was reported as discouraging/conflicting. Moreover, the fact that different studies show inconsistent lengths of duration of protection of IPT in PLHIV was described as confusing.

Two prescribers argued that administering IPT in settings where latent TB infection is common could not be effective. They had the assumption that it might work in the developed world but not in their settings (Eritrea) as almost every HIV patient could have latent TB due to environmental contamination and poor standard of living. One prescriber stated this as follows:

There are arguments that latent TB is common in all our setting and thus, administering TPT will not be effective; maybe in developed countries. Hence, there are many healthcare professionals who do not accept it. [HP9]

While some of the key informants had the assumption that adverse effects of INH could be the main source of hesitancy, some prescribers voiced that the risk of antibiotic [INH] resistance was a concern. Unavailability of information on INH acetylation profile of the Eritrean population was also reported as a concern by one prescriber.

It was reported that following observation of serious hepatic injuries in some patients, with fast spreading rumors, others started to get concerned of the adverse effects of the intervention. Pill burden was also another issue mentioned as a barrier to implementing IPT. One prescriber mentioned this as follows:

In the beginning, patients had full acceptance over the TB preventive therapy. Later, when some patients start to experience ADRs, they communicated with each other and some of them started to reject it. [HP4]

Serious INH-induced liver injuries, although rarely encountered, were of concern to several prescribers and they were not confident to administer INH without baseline and follow-up liver function tests and tests for hepatitis B and C markers. Some prescribers were administering INH without baseline and follow-up liver function tests, but when they observed a few life-threatening hepatic injuries including death, they were forced to discontinue the treatment in several patients. One prescriber reported:

In the beginning, in the absence of laboratory tests we used to put patients on the regimen but with the occurrence of adverse drug reactions [drug-induced liver injury] we started to worry and we realized that we could not start it without having baseline and follow-up tests. [HP2]

One of the key informants also reported that many of the HIV care clinic physicians were against the tuberculosis preventive therapy as they started to observe many previously stable patients deteriorating following initiation of INH.

Several multi-level - immediate, intermediate, and root - causes/factors related to the healthcare system, HIV control program, healthcare professionals, patients and the product were identified as barriers to the successful implementation of IPT in Eritrea (Figure 1). Information gap on IPT and fear of drug-induced liver injury were found to be the central problems for the limited implementation of IPT in PLHIV. This study revealed that healthcare professionals had lots of information gaps that resulted in rumors and doubts on the benefits and risks of IPT which ultimately caused reluctance on its implementation.

Inadequate advocacy, unavailability of detailed working documents such as registers, guidelines and SOPs, inadequate sensitization and training, lack of regular outcome evaluation of the intervention were among the immediate/intermediate causes/factors for the information gap created which in turn limited the implementation of IPT. Failing to involve key stakeholders including prescribers in the planning and introduction of IPT could also be a source of hesitancies. The thematic analysis reflects that there were program-related problems in convincing the implementors and users to successfully implement the intervention. Taking the multi-level causes into consideration, successful implementation of IPT seems to be a complex process that requires a well-thought-out plan and operationalization. Provision of adequate knowledge on the intervention and persuasion of providers and users to help them decide on the implementation of IPT is important.2 Once an intervention is accepted by the providers and users, it is then easier to ensure its wider diffusion in the healthcare system. Identifying early adopters of the intervention such as senior clinicians/experts and working with them could also facilitate the implementation process. Overall, one of the root causes for the poor acceptability and limited implementation of IPT in Eritrea was found to be inadequate planning and preparation of the National HIV Control Program towards deployment of IPT [Figure 1]. As reported by one of the key informants, one reason for the inadequate planning/preparation was downplaying of the risks of hepatic injury related to IPT in the WHO information note on adverse events of IPT.24 The information note emphasized that INH is generally safe and routine baseline liver function tests are not recommended given the paucity of data on its role, rarity of adverse events and absence of evidence on any real predictor for future toxicity.

A considerably reported cause/factor that forced prescribers to be reluctant on the implementation of IPT was fear of INH-induced liver injuries. This was based on real (rarely encountered but fatal cases of hepatic injuries), perceived risks, and/or rumors. During the early days of introduction, some prescribers reported that they had some level of confidence to prescribe a six-month INH to PLHIV without taking baseline and follow-up laboratory tests. Later, when some clinicians started to experience life-threatening adverse effects that caused death in a few patients, the majority of them became reluctant to administer INH without close laboratory monitoring. Another root cause of hesitancy in administering INH was the inadequacy of laboratory setups, especially in the regional hospitals. This might be the probable reason why about 50% of PLHIV attending regional referral hospitals were not exposed to IPT as compared to the 14.3% in the Central region.20 Acknowledging the existing practicality challenges to carry out regular laboratory monitoring for every patient on IPT, strengthening laboratory setups would help clinicians to at least closely monitor at-risk patients as clinical monitoring only might not be adequate. This could ultimately build confidence on the prescribers to administer IPT and accordingly facilitate its implementation.

Studies, conducted elsewhere, that assessed the general barriers to IPT implementation reported that inaccuracy of TB screening tools to exclude active TB, shortage of isoniazid and tuberculin skin tests, lack of knowledge on the benefits of IPT, pill burden, perceived fear of isoniazid resistance due to poor adherence, poor monitoring and lack of high-level supervision of the IPT implementation, lack of coordination between TB and HIV activities, and heavy workload were among the factors that deter the roll out of IPT.1015 Although the methods of problem analysis differ among studies, the barriers to implementing IPT identified in this study are more or less similar to what has been reported elsewhere. One of the aforementioned factors, lack/inadequate collaboration between TB/HIV activities, needs to be highlighted as it is one of the bottlenecks. Coordinated inputs such as logistical, technical, and operational would create fertile grounds for a successful implementation of IPT in Eritrea as they were doing for forecasting, procurement, and supply chain management of INH.

The findings of the study have the following important programmatic/policy implications: In future, before the introduction of any form of TB preventive therapy, non-stop advocacies, provision of adequate information through regular trainings and campaigns, as well as preparation of adequate working documents should be considered. Also, the involvement of civil societies such as PLHIVs association and other professional societies, HIV care clinic prescribers, the national pharmacovigilance center and National TB Control Program in the planning and operationalization of the intervention would be required for a successful implementation and to ensure ownership of stakeholders. Jointly with stakeholders, setting national and regional indicators, coordination and implementation mechanisms, and a monitoring and evaluation framework are critical factors for success. Another implication is that, once a new intervention is introduced, there should be a requirement to collect cohort-based data for regular evaluation of the benefits and risks of the intervention and elucidate uncertainties by effectively disseminating findings among stakeholders. Moreover, the laboratory setups in HIV care clinics need to be capacitated in order to ensure improved uptake of TB preventive therapy. In Eritrea, the HIV control program is one of the strongest public health programs in the country that has achieved several success stories in planning, advocacy, public campaigns, implementation of new therapeutic agents, program evaluation, and fund acquisition/mobilization. Considering the programs capacity and capability, the afore-mentioned recommendations could be achievable.

Conducting in-depth interviews with programmers and prescribers working in all regional hospitals and a national referral hospital that serve for about 60% of the PLHIV in Eritrea helped us to critically analyze and comprehensively understand the perceived central problems and root causes for the limited implementation of IPT. The study, however, was not without limitations. It was only aimed to identify implementation problems of IPT from perspectives of HCPs as resistance to implementation the TB preventive therapy was mainly reported by prescribers. Considering the perspectives of consumers would, however, be important. Besides, thoughts of the HCPs were collected after things have happened, and we have seen that some people were enthusiastic with IPT before changing their minds and others were, however, already skeptical. Thus, we are not sure of the prescribers perspective on IPT during its first introduction. Another limitation was that the findings of this study would not necessarily represent the situation for other countries. Moreover, the fact that the interviews were conducted by staff of the Ministry of Health of Eritrea might have led to bias in responding to some questions. Further input that could analyze the challenges of the HIV control program in addressing the issue would be important.

The reasons for the limited implementation of IPT in Eritrea were complex multi-level factors/causes and the core problems were mainly related to the HIV control program and the healthcare system. The authors therefore recommend ensuring adequate planning and operationalization on provision of adequate working documents, organizing regular advocacies, strengthening TB/HIV collaborative activities, sensitization and educational programs prior to deployment of a new TB preventive therapy and evaluation of the impact of the intervention. Where it is practical, ensuring the availability of biochemical tests for close laboratory monitoring of at-risk patients would minimize the fear of ADRs that warrants capacitating the laboratory setups. The program is also recommended to take immediate actions to fully understand such problems and strategically restore any confidence gap that may arise during the implementation process as appropriate.

ADRs, adverse drug reactions; ART, antiretroviral therapy; CDC, Communicable Disease Control; HCPs, healthcare professionals; INH, isoniazid; IPT, isoniazid preventive therapy; KI, key informant; KII, key informant interview; LFT, Liver function tests; NMFA, National Medicines and Food Administration; PLHIV, people living with HIV; SOPs, standard operating procedures; TB, tuberculosis; WHO, World Health Organization.

All information gathered is included in the manuscript and the codebook can be requested from the corresponding author ([emailprotected] or [emailprotected]).

Ethical clearance to conduct the study was obtained from the Health Research Ethics and Protocol Review Committee of the Ministry of Health of the State of Eritrea (reference number: 7-18/2020). As obtaining written informed consent might create insecurities on some respondents and some interviews were carried out via telephone, the researchers opted to take verbal informed consent that was approved by the ethics committee. Thus, audiotaped verbal consent was taken, and all ethical and professional considerations were followed, particularly with confidentiality of the reports; only anonymized information is reported.

The authors sincerely thank the study participants for their time and willingness. The authors would also like to acknowledge the staff of the National Medicines and Food Administration of Eritrea, namely: Azania Werede, Feven Ghebreberhan, Liya Abraham, Merhawi Bahta, Merhawi Debesai, Meron Tesfagaber, Michael Habteslassie, Natnael Araya, and Yodit Fitsum who participated in the transcription and translation of the interviews and for their review comments. Finally, the authors sincerely thank the Communicable Disease Control (CDC) division of the Ministry of Health of the State of Eritrea for their immense cooperation, comments and partial funding of the study.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

This work was funded, in part, by the CDC Division of the Ministry of Health of the State of Eritrea (Global Fund HIV Grant activity code: 9.8) and the funding agency had no role in the design, interpretation and write-up of the article.

Katia Verhamme reports grants from Chiesi, GSK, UCB, Amgen, Pfizer-Boehringer Ingelheim, and EMA, outside the submitted work. The authors report no other potential conflicts of interest in relation to this work.

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14. Lester R, Hamilton R, Charalambous S, et al. Barriers to implementation of isoniazid preventive therapy in HIV clinics: a qualitative study. AIDS. 2010;24(Suppl 5):S45S48. doi:10.1097/01.aids.0000391021.18284.12

15. At-Khaled N, Alarcon E, Bissell K, et al. Isoniazid preventive therapy for people living with HIV: public health challenges and implementation issues. Int J Tuberc Lung Dis. 2009;13:927935.

16. World Health Organization. Global tuberculosis report; 2018. Available from: https://apps.who.int/iris/handle/10665/274453. Accessed July 20, 2022.

17. National Statistics Office and Fafo Institute for Applied International Studies. Eritrea Population and Health Survey 2010. Asmara, Eritrea: National Statistics Office and Fafo Institute for AIS; 2013. Available from: https://www.unicef.org/eritrea/ECO_resources_populationhealthsurvey2010.pdf. Accessed July 15, 2022.

18. Internet. HIV/AIDS prevalence rates in Eritrea the lowest in the sub-Saharan Africa: UNAIDS; 2014. Available from: https://www.tesfanews.net/eritrea-lowest-hiv-aids-prevalence-in-sub-saharan-africa/. Accessed July 15, 2022.

19. Ministry of Health of Eritrea. Comprehensive HIV/AIDS Care Manual. Ministry of Health, Department of Public Health; 2017.

20. Russom M, Woldu GH, Berhane A, et al. Effectiveness of a 6-month isoniazid on prevention of incident tuberculosis among people living with HIV in Eritrea: a retrospective cohort study. Infect Dis Ther. 2022;11:559579. doi:10.1007/s40121-022-00589-w

21. Internet. Problem tree analysis. Available from: https://cio-wiki.org/wiki/Problem_Tree_Analysis. Accessed July 15, 2022.

22. OBrien BC, Harris IB, Beckman TJ, et al. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89:12451251. doi:10.1097/ACM.0000000000000388

23. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349357. doi:10.1093/intqhc/mzm042

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Implementation of IPT in people living with HIV | RMHP - Dove Medical Press

For the first time, the Netherlands is vaccinating people preventively against the monkeypox virus. The preventive shots start on Monday in the Amsterdam and The Hague regions because most infections have been detected there. The health authorities will expand it to the rest of the country later. The first group eligible for vaccination consists of approximately 32,000 people.

Over the past weeks, the Dutch health services GGD already vaccinated a small group of people against the monkeypox virus. They were at active risk of becoming infected, for example, because they had close skin-to-skin contact with an infected person.

As of Thursday, there were 712 cases of monkeypox in the Netherlands. The number of infections increased quickly in the past weeks. Most of the people who tested positive are men who have sex with men (MSM). Therefore, the GGDs first invited MSM and transgender people who are HIV positive or taking medicines to prevent them from contracting HIV for the vaccination. Here there is expected to be a large overlap with the highest risk group for monkeypox infection, according to the expert advice on which the health service based the vaccination strategy.

Each person requires two doses of vaccine four weeks apart.

The monkeypox virus spreads through skin-to-skin contact. While the Netherlands current outbreak primarily affects men who have sex with men, anyone can get the virus. At least three women and one child have been infected in the Netherlands.

People tend not to get very sick from the monkeypox virus. It causes symptoms like fever, headaches, muscle aches, and general malaise. A rash with blisters may appear a few days into the infection.

The preventive vaccination campaign is kicking off sooner than the GGDs expected. Last week, a spokesperson for GGD Amsterdam said it would take another few weeks to get ready.

Link:
NL starts preventive vaccination against monkeypox in Amsterdam, The Hague - NL Times

Age and genetics play a vital role when it comes to combating a brain hemorrhage stroke. However, you cant travel back in time and change your travel history but there are many risk causing factors which you can take under your control. Once you get familiar with those risk factors, you can work on them to avert brain hemorrhage.

Deepesh Bhan, an actor of the popular tv serial Bhabiji Ghar Par Hai expired on 23rd July, 2022 during morning hours. The performer died while he was playing cricket, therefore it was believed that he mightve had a heart attack. Asif Sheikh, co-performer of the show told the media that Deepesh Bhan suffered from a brain hemorrhage stroke. His friends expressed their feelings with sorrow and revealed that he was a fit person with no substance abuse habits like alcoholism or smoking.

Artist Neha Pendse also gave her condolences for the actors demise by saying I was in Pune but now I am heading towards Mumbai now and I am hoping to reach his funeral. I had a long journey with Deepesh because we were together in May I Come In Madam and Bhabhi Ji Ghar Hai both. He was the fittest guy around so honestly, I dont know what went wrong. He was a fitness enthusiast and he would talk about nutrition, he lost his mother in November. I am very numb right now and dont know how to react to this".

To stop such grimful events in future, lets go through some ways to put an end to the possibilities of a brain haemorrhage stroke.

Link:
Precautionary measures you can take against brain haemorrhage - Times of India

When you think of acid reflux (heartburn), you usually think of it as being related to issues between your stomach and esophagus. But can there also be a correlation between acid reflux and liver disease?

This article will take a closer look at the possible link between acid reflux and liver disease, as well as the symptoms, treatment options, and prevention strategies for both conditions.

Acid reflux occurs when stomach acid backs up into the esophagus. This is the tube that carries food from your mouth down to your stomach.

Minor cases of acid reflux, which can occur after an especially spicy meal or taking certain medications, generally dont require medical attention.

A more serious type of acid reflux is called gastroesophageal reflux disease (GERD). Its characterized by:

GERD often requires prescription medications or other treatment, as well as dietary and lifestyle adjustments.

There are several types of liver disease, all of which can affect the functions the liver performs, including:

When the liver is damaged by disease or injury, some serious health complications can ensue.

Its not uncommon for people with serious liver conditions, such as cirrhosis or liver failure, to also have GERD.

In a 2021 study of people with liver cirrhosis, researchers found that 83% of them had GERD. Its thought that a condition called ascites may largely explain the prevalence of GERD among these individuals.

Ascites is often a complication of cirrhosis. It causes fluid buildup in the abdomen, and the pressure of fluid in the abdomen may contribute to GERD-like symptoms, as well as abdominal pain and shortness of breath.

A separate 2020 study of people with liver cirrhosis suggested that this liver condition is associated with several factors that can cause abnormal activity of the muscles of the esophagus, which can trigger acid reflux.

A 2017 study suggested that people with GERD may be at a higher risk for nonalcoholic fatty liver disease (NAFLD). While the study didnt demonstrate how GERD may cause NAFLD, the researchers suggest that the two conditions may often coexist because they share similar risk factors, such as obesity.

A more clear-cut example of how GERD may impact liver health was noted in a 2017 study. The researchers found that the use of proton pump inhibitors (PPIs) a common acid reflux treatment may raise the risk of alcoholic liver disease among people who use alcohol.

The study suggested that because PPIs reduce the secretion of gastric acid, the medications may inadvertently facilitate the overgrowth of an intestinal bacterium called Enterococcus, which may raise the risk of liver disease.

Its not always clear when acid reflux symptoms could be related to liver disease or vice versa. However, if youve recently been diagnosed with liver disease and you begin to experience acid reflux more often, it could be a complication of liver disease.

An older study found that the following symptoms are also associated with NAFLD:

Liver diseases dont always show symptoms in their early stages, but when they do, they can include:

Schedule an appointment with your doctor if you experience any of these symptoms or if you start experiencing heartburn frequently without a change in your diet or lifestyle.

Acid reflux is usually treated with medications that either reduce stomach acid production or neutralize stomach acid. Over-the-counter options include:

For GERD, your doctor may suggest prescription-strength H-2 receptor blockers in addition to PPIs. But given the association between PPIs and NAFLD, you may be advised to try other medications first, especially if liver disease has been diagnosed or if youre at high risk for liver issues.

Talk with your doctor about having your liver enzymes tested before starting PPIs to determine whether you already have any liver complications.

There are no formal treatments or cures for certain liver conditions, such as cirrhosis and NAFLD. If cirrhosis becomes severe, a liver transplant may be the only treatment option.

Generally, liver conditions are managed by making significant lifestyle changes that focus on weight management and alcohol avoidance.

Liver disease and acid reflux can sometimes be prevented through changes in diet and lifestyle. Some common strategies to manage liver disease symptoms or prevent the onset of liver disease include:

To help prevent acid reflux, consider the lifestyle strategies outlined above as well as the following:

Acid reflux and liver disease can sometimes accompany each other, especially if you have liver cirrhosis, NAFLD, or liver failure. You may also be at risk of developing liver problems if you take PPIs for acid reflux.

If youre overweight and sedentary, you may face an elevated risk for both acid reflux and liver disease.

While maintaining a moderate weight, exercising regularly, and limiting your intake of alcohol are good tips for overall health, they can be especially helpful in preventing or managing both acid reflux and liver disease.

If you experience any symptoms of these conditions, make an appointment to see your doctor. Early diagnosis of your symptoms may help you avoid complications later on.

View post:
Acid Reflux and Liver Disease: Signs, Symptoms and Prevention - Healthline

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Allergic reactions are a serious condition many Americans face due to an abnormal immune response in the body that, in some cases, can result in death.

An allergic reaction occurs when the immune system responds to a foreign allergen that is not commonly believed to be harmful. A mild reaction may have minor symptoms such as inflammation, or more serious cases can result in anaphylactic shock. Allergies to a certain food, such as peanuts, are common allergic reactions that affect a small portion of the population.

Read below to find out the symptoms and treatments for allergic reactions. You should seek a medical expert during serious or life-threatening cases. Anaphylaxis is the most severe result of an allergic reaction and can lead to respiratory failure while causing the skin to swell.

Type I is an immediate reaction to allergens that may occur after a few seconds to minutes resulting from pollen, insect bites, dust mites, or certain foods. It is associated with the common allergic reaction to food and can, in severe cases, lead to anaphylaxis. Type 2 is when the reaction sets in after a few minutes or hours after the antibodies have a damaging effect on the body's cells.

Vomiting is a common symptom of an allergic reaction. (iStock)

Type III starts showing up after several hours with the antibodies reacting to allergens and is often associated with Lupus, Serum sickness, and Arthus reaction. The final and most delayed stage is type IV which may take hours or days to occur and is present in long-term infectious diseases such as tuberculosis and fungal infections.

MANY FIRST REPORT PEANUT ALLERGY SYMPTOMS IN ADULTHOOD, STUDY FINDS

British immunologists Robert Coombs and Philip Gell established these four types of hypersensitive body reactions in 1963.

Symptoms of an allergic reaction vary based on which type it is and the severity it has on the immune system. Generally, many people experience swelling, redness of the skin, sneezing, rashes, hives, vomiting, bloating, pain, itchy nose, and watery eyes. However, anaphylaxis symptoms are more life-threatening and severe on the individual's body, including painful skin rashes, shortness of breath, chest tightness, lips, tongue or throat swelling, and stomach pain. Immediate medical attention is recommended for those suffering from anaphylaxis.

In severe cases of anaphylaxis it is recommended you seek medical attention immediately or call 9-1-1. (iStock)

Some allergic reactions may be triggered by insect bites, mold, pollen, specific foods, and drugs.

POISON IVY VACCINE MAKING PROGRESS: REPORT

To avoid an allergic reaction, an individual must be aware of the harmful allergens and actively avoid them. Many allergens are airborne, so an individual should wash out their nose daily with a nasal saline rinse to limit the effect it may have on the body.

Various medications are made to treat these reactions, including corticosteroids for nasal allergies, corticosteroid cream for itchiness from rashes, and the auto-injector pen device epinephrine for anaphylaxis.

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What to do if you get an allergic reaction: symptoms, causes, and prevention - Fox News

Natalie Metzger is living a life that once seemed impossible. At only 35 years old, she's already an award-winning director, writer and producer. She travels extensively, and her films have premiered at top festivals around the world including Sundance, Cannes and more. Being a filmmaker was an ambitious goal, but it wasn't until Natalie took charge of her life behind the camera and became an advocate for her health that pursuing this Hollywood dream was even an option.

Rare and potentially fatal

Natalie lives with a very rare and potentially life-threatening genetic condition called hereditary angioedema, or HAE. It causes unpredictable episodes of uncontrolled and often severe swelling that can impact areas of the body such as the hands, feet, stomach, face and even the throat, which can be fatal.

Natalie's father has HAE, which meant she had a 50-50 chance of inheriting the disease. When she began having symptoms at the age of 17, her parents' fear was confirmed - she, too, had HAE.

HAE swelling can last for days, and attacks can happen multiple times per month, impacting the ability to participate in everyday activities such as school, work and social events. Natalie's attacks worsened as she went to college, and HAE began taking a significant toll on her life.

"I was having an attack every couple of weeks," said Natalie. "I was in and out of the hospital all of the time."

While HAE episodes can occur for seemingly no reason, common triggers include physical injury, as well as Natalie's most frequent cause of attacks - stress. Since stress comes with filmmaking and extensive travel is also required - often daunting for those with HAE given the need to be near a hospital knowledgeable of and able to treat HAE in case of a severe attack - Natalie thought that she might not be able to pursue it as a career.

But, determined to live the life she wanted to live, Natalie began taking a proactive approach to managing her HAE. And things began to change.

A proactive approach

HAE can be treated in two ways. Acute medication is used to lessen symptoms when an attack is imminent or underway. And preventative medication is taken on an ongoing basis to help prevent HAE attacks and minimize their severity. Because HAE is a lifelong disease, preventing attacks can be a key part of regaining a sense of normalcy.

For Natalie, finding the right prophylactic treatment has made all the difference. Her swelling attacks are now well controlled, and if she has occasional breakthrough swelling, it's generally mild.

"When I was in college and considering what I was going to be doing with my life, I wasn't sure I'd be able to handle the demands of film because of my HAE, but on demand and preventative medications have been life changing," said Natalie. "They've really allowed me to have the career of my dreams - I'm able to make movies and go all around the world for film productions and festivals. I don't think I would be able to be a filmmaker if I didn't have my medication."

Treatment advances for HAE have come a long way in recent years and include medications that are taken in different ways, requiring varying levels of skill and time commitment to administer, giving those with HAE more options for finding the right treatment plan that fits their unique needs and lifestyle.

"We talk a lot about the burden of the condition, but the burden of treatment is something we've become more aware of as options have advanced," said Marc A. Riedl, MD, Clinical Director, US HAEA Angioedema Center. "When designing a treatment plan, patients should be open with their medical team about both their treatment goals and how treatment fits into their lifestyle. We're now reaching a point where people with HAE are often able to do the things they want in life without HAE or their treatments interfering."

While many with HAE have learned to tolerate difficult or inconvenient aspects of their treatment or may be afraid to "rock the boat" by trying a new treatment option, Natalie's experience shows that investing the time to find the right approach can be life changing.

"I've tried all of the preventative treatments over the years - intravenous, subcutaneous, and oral," said Natalie. "They're getting easier and easier to use and less invasive on my day-to-day life. It's amazing to think how far I've come personally and how far we've evolved in the HAE space."

Important advice for those facing health challenges

Given all that Natalie has been through, she has a few pieces of advice for anyone navigating the challenges of a condition like HAE:

1. Assess what YOU really want: Think about your goals. Consider your lifestyle, what factors are most important to you, the impact of the disease on your life and how treatment fits into it.

2. Have a plan: Preparation is key, especially when living with a chronic condition. Whether jotting down notes in advance of a doctor's appointment or ensuring you travel with the necessary medication, having a plan is essential to success.

3. Go for it: Be open and honest with your medical team. Have an empowered conversation about your goals in treatment and life. You should have a shared voice in your treatment decision-making process - studies show it leads to better outcomes.

Natalie recently got married and is looking ahead to what life and her busy career have in store for her next.

"Through my work, I'm able to pursue another passion - raising awareness of HAE and highlighting the stories of people impacted by this rare disease, as I did in the documentary 'Special Blood,'" she said. "I will continue to advocate for those with HAE to take charge of their health and pursue their own dreams while I live out mine." -BPT

Read more here:
How one woman took control of her rare disease and achieved her dream - Times of Oman

Billionaire businessman Tilman Fertitta said he has always been a strong believer in the University of Houston medical schools mission to improve health care equity in Texas. Now hes donating $50 million to help make that vision a reality.

Fertitta and his family on Thursday announced what UH leaders say is a transformational donation for the fledgling medical school, which welcomed its first group of students just two years ago. In recognition, the school has been named the Tilman J. Fertitta Family College of Medicine, as it prepares to open a state-of-the-art, $80 million building this summer.

Fertitta, the owner of the Landrys Inc. hospitality empire and the Houston Rockets, played a critical role in establishing the medical school as the longtime chairman of the UH systems board of regents. But its the schools mission to improve health and health care in the community that inspired him to make such a large donation, he said.

Everybody should have the same medical treatment that anybody else has, he said. Thats one of the things that I like about this school, and where were trying to fit into the community. We want people to have good primary care, to take care of whatever you need to take care of.

The University of Houston's medical school will be named the Tilman J. Fertitta College of Medicine in recognition of the Fertitta Family Foundation's $50 million donation.

The University of Houston's medical school will be named the Tilman J. Fertitta College of Medicine in recognition of the Fertitta Family Foundation's $50 million donation.

The University of Houston's medical school will be named the Tilman J. Fertitta College of Medicine in recognition of the Fertitta Family Foundation's $50 million donation.

The school was founded in 2019 with a curriculum that emphasizes community health, behavioral and mental health, preventative medicine and social determinants of health the social and economic conditions that influence individual and community health.

The goal is for 50% of graduates to choose careers in primary care specialties, such as pediatrics and general internal medicine, to help address a shortage in Texas. The states Department of State and Human Services has estimated there will a shortage of 3,375 primary care physicians by 2030.

Improving health and health care equity have always been important issues in the medical community, which is why the school has focused on those areas from the outset. But the COVID-19 pandemic and the social justice movement have made them front-burner issues to a larger group of Americans, said Dr. Steven Spann, the medical schools founding dean.

This is something we were thinking about. This is our mission, Spann said. Its wonderful to see society, and health care in particular, beginning to understand the importance of that and embrace it.

The school is also focused on improving the diversity of physicians. Of the 60 students who have been part of the schools first two classes, 67% are from groups that are underrepresented in medicine, and more than half came from a lower socioeconomic background, according to a news release. By comparison, just 13% of students admitted to U.S. medical schools each year are Black or Hispanic.

Training the next generation of primary care physicians and improving health care equity are goals that go hand-in-hand, said Dr. Toi Harris, senior vice president and chief equity, diversity and inclusion officer for Memorial Hermann. If a medical school student has an opportunity to train in a primary care setting, it could help them understand how social determinants, such as socioeconomic status or access to education, affect a patients overall health.

I think its tremendously helpful and will be impactful in terms of how they approach patient care and how they engage with the community, Harris said. Gaining exposure to these types of models during training really can help inform your career pursuits and the way you deliver care.

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In his role as chairman of the UH board of regents, Fertitta has been aligned with the medical schools mission to improve health care access and equity from the start, university President Renu Khator said.

He really believes in its future and what it could do. He has a very clear idea of where it could be in 10 years, or where it could be in 15 years, she said. For him to come forward and give this kind of gift to help the medical school take off and be something better than what it would be without these kinds of transformational gifts, its amazing.

The $50 million donation will go toward efforts to hire top-notch faculty and invest in research at the medical school, Khator said.

Tilman Fertitta, owner of Landry's, Inc., and the Houston Rockets, poses for a portrait at the Post Oak Hotel at Uptown on Tuesday, May 28, 2019, in Houston.

Heres how the gift will be divided:

$10 million will go toward five endowed chairs; the school intends to hire renowned scholars who are focused on health care innovation. This $10 million will be matched as part of the universitys $100 Million Challenge for chairs and professorships.

$10 million will be used to establish an endowed scholarship fund to support endowed graduate research stipends and fellowships for medical students.

$10 million will go toward covering start-up costs for the medical school to enhance research activities.

$20 million will be used to create the Fertitta Deans Endowed Fund to support research-enhancing activities.

Fertittas donation also kicks off a $100 million fundraising campaign for the medical school. The money will be used to support scholarships, recruit faculty and pay for operational needs, such as equipment.

This isnt the first time Fertitta, a UH alum, has given a substantial donation to his alma mater. Back in 2016, he donated $20 million to help fund a $60 million renovation of the universitys basketball arena, now known as the Fertitta Center.

The University of Houston's medical school will be named the Tilman J. Fertitta College of Medicine in recognition of the Fertitta Family Foundation's $50 million donation.

The University of Houston's medical school will be named the Tilman J. Fertitta College of Medicine in recognition of the Fertitta Family Foundation's $50 million donation.

The University of Houston's medical school will be named the Tilman J. Fertitta College of Medicine in recognition of the Fertitta Family Foundation's $50 million donation.

I love Houston. Houstons been very good to me. And the university is the namesake of our city, Fertitta said. Its one of the few large public universities that are in a city the size of Houston, and thats what makes it special.

As chairman of the board of regents, Fertitta led the effort to select a site for the new $80 million College of Medicine building. The board decided in 2018 to build the 130,000 square foot building on a 43-acre tract of previously undeveloped campus land. The building is part of a planned life sciences complex along Martin Luther King Boulevard.

The medical school welcomed its first class of 30 students in 2020. For the past two years, the colleges temporary home has been the Health 2 building on campus.

The new building features a state-of-the-art anatomy suite, a clinical skills lab, patient examination rooms, a simulation center and large team-based learning classrooms.

Fertittas donation is a morale-booster for the medical school as the new building is set to open this summer, Spann said.

We have this beautiful new building, and we now have a great name on our medical school, he said. It just builds momentum and builds enthusiasm. It will foster community support.

Fertitta is also hopeful that his familys donation will inspire others to support the medical school and its mission. He knows that his donation and the work being done at the medical school are just the start; further investments will be needed to improve health care equity in Texas and elsewhere in the U.S.

However, hes hopeful the $50 million donation will help to accomplish that goal. No one should have to spend 10 hours in an emergency room on a Saturday because they dont have a primary care doctor, he said.

This is going to be something thats extremely special, he said. You just have to have the vision to look into the future.

Read more here:
Tilman Fertitta donating $50 million to UH medical school, which will be renamed after him - Houston Chronicle

The first time a PC seemed magical to me was when it dozed off and colourful lines twisted across its screen. I'd launch Windows 3.1 just to watch screensavers, marvelling at Mystify and staring at Starfield. How wonderful that our computer needed to dream as preventative medicine! I relived this today with a new collection of customisable 3D screensavers, watching shoals of fish, taking a road trip through a museum of global electricity pylons, watching housing estates rise and fall, and seeing so many swirly colours.

Made by Jean-Paul Software (aka our very own RPS commenter, "Godwhacker"), The Jean-Paul Software Screen Explosion launched this week after a few months in early access. It packs 11 screensavers including a swirling shoal of fish, procedural models of housing estates coming together and breaking apart, a clockwork countdown to your estimated time of death, a vast warehouse run by Father Christmas and his reindeer, and a wild warpspeed starfield. Some have options to customise colours and such, and some even let you add your own custom models (or download others' through the Steam Workshop).

My personal favourite is Pylons Of The World, an endless drive along a colourful road criss-crossed by electricity pylons from around the globe. Yes, it tells you the origin of the pylons you're seeing. And yes, it drives on the left side of the road where appropriate.

I've not used a screensaver in years. They're not needed anymore, and my monitors automatically turn off when idle to save power anyway. Running 3D scenes which make my computer use more power when idle is the opposite of what I want. And yet. While I won't start using a screensaver now, I did enjoy playing with screensavers today.

I enjoyed restarting screensavers to see them with new colours or new patterns. I really enjoyed that drive past international pylons. I enjoyed watching colours. I felt the childhood magic of screensavers again.

The Jean-Paul Software Screen Explosion is out now on Steam for 4/4/$5.

The second time a PC seemed magical to me was the cascade after I won Solitaire for the first time.

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This new 3D screensaver collection includes a driving tour of global pylons - Rock Paper Shotgun

After 34 years serving Foxboro and the surrounding communities, Dr. Joseph Horan is retiring from family practice on May 25, 2022. A

fter spending his childhood in Readvilleand attending Xaverian Brothers High School, he attended St Francis Xavier University in Nova Scotia, Canada and then completed medical school at Dalhousie University in 1985. He completed his residency in family practice at UMass family medicine in Fitchburg and in 1988, after moving to the area with his family, he started at the Foxboro Area Health Center. He remains as part of the community now, where three of his grandchildren reside.

Despite the many difficulties that primary care physicians face, Dr. Horan has always remained true to himself -- putting his patients above all else. The role of a family practitioner is really to be a Jack of all Trades for patients from cradle to grave, and this is what Dr. Horan is. They are responsible for preventative care including yearly physicals and vaccines, but are also the first call when someone feels sick or notices something is wrong. They are cardiologists, gastroenterologists, dermatologists, neurologists, psychologists and much more. But maybe most importantly, they are advocates, which is a role Dr Horan has always taken very seriously throughout the years.

From squeezing another patient into his always jam-packed schedule, visiting an elderly patient in the comfort of their own homes, fielding phone consults from friends and family and beyond, or extending his condolences to families who have lost their loved ones who he cared for during his entire career, Dr. Horan always went the extra mile. It is impossible for his family to count the number of stories heard and times they witnessed him going above and beyond for his patients to get the care they need and support them as they navigated some of the scariest times of their lives.

Growing up in the town where he practiced, a week did not pass without his children hearing your dad is my doctor from someone in the community, and often his wifes five-minute grocery run would become a 30-minute conversation with one of his patients. But even though he had so many responsibilities in his practice, he never missed a chance to see his kids play sports, or perform in the band, or spend time skiing with them on the weekends.

Many of his patients had such kind words to share. One family he cared for over 30 years who had two children with intense medical needs described him as a witness to their lives, someone who never tired of helping us, always a phone call away. The many nurses and medical staff that worked with him throughout the years cherished their time working with him and described him as a brilliant and caring man, who never rested until he knew what was wrong with his patient.

Dr. Horan has considered it a great privilege and honor to have cared for so many generations of local families. While he is looking forward to the next chapter of his life, he has been humbled by the many cards, emails and gifts he has received as an expression of appreciation. This community has been touched by a great doctor and his quality care will be greatly missed. They truly dont make doctors like Dr. Horan anymore.

The author of this column, Pam Morrison, is the daughter of Dr. Joseph Horan

Originally posted here:
Dedication, generosity and compassion that had no limit! - The Sun Chronicle

Reestablishing a strong doctor-patient relationship

During Dr. Priester's tenure as internist and cardiologist in New York, he has built enduring relationships with his patient base, many of whom have been loyal to him for several decades. As his practices continued to grow, so did the administrative demands of operating and maintaining a private practice.

Like many other private internal medicine physicians, Dr. Priester has found himself at a crossroads: either continue to practice high-volume medicine, seeing many patients a day, but spending a limited amount of time with each of them or let his practice evolve to deliver highly personalized, preventative care and a chance to empower his patients with greater education and information.

The Priester CCPHP Membership

The concierge (membership-based) model continues to be a rewarding experience for physicians and patients alike. The increased time and flexibility allow concierge physicians, like Dr. Priester, to schedule patients for an hour appointment, if desired.

I've always believed in the importance of the doctor-patient relationship," says Dr. Priester. "This concierge model will not only support that relationship, but allow it to go one step further, by allowing more time with each patient."

Concierge patients of Priester CCPHP receive a host of added amenities as Members, including 24/7 connectivity to Dr. Priester via a direct phone number and a customized telehealth app, same/next day appointments with limited to no wait times regardless of medical necessity, and a robust wellness program called the SENS Solution Wellness Program powered by CCPHP, which focuses on Sleep, Exercise, Nutrition, and Stress Management.

Through the partnership with CCPHP, Dr. Priester also has access to Castle Connolly's Top Doctor Network of nearly 60,000 top recognized physicians nationwide. Being a recognized Top Doctor himself, Dr. Priester can consult with and refer patients to top physicians of similar distinction.

About Dr. Priester

William D. Priester, MD is a board-certified internist and cardiologist serving the community of New York, NY. Dr. Priester earned his Doctor of Medicine from the University of Iowa and completed his internship and residency in internal medicine at Metropolitan Hospital in New York. He completed his fellowship in cardiology at Lenox Hill Hospital, where he continues as an Adjunct Attending Physician.

Learn more about Dr. Priester's concierge program, Priester CCPHP:

About CCPHP

Castle Connolly Private Health Partners (CCPHP) works with exceptional physicians to create and support concierge (membership-based) healthcare programs that enable the optimal practice environment and the physician-patient relationship. Members (patients) pay an affordable fee to take advantage of a wide array of enhancements for a more convenient, comprehensive, collaborative, and personalized approach to support health and wellbeing. For more information, go toccphp.net.

SOURCE Castle Connolly Private Health Partners, LLC

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Manhattan internist and cardiologist, Dr. William Priester collaborates with Castle Connolly Private Health Partners to create a new concierge medical...

The human immunodeficiency virus (HIV) has remained a significant challenge for researchers as there is currently a lack of cure or vaccine for this disorder.

Image Credit:PENpics Studio/Shutterstock.com

While antiretrovirals have improved the types of therapy available for patients, the ineffective requirement of lifetime treatment, as well as the development of resistance, is a major hurdle. However, the emergence and growth of nanotechnology may be a promising solution for a higher level of effective treatment as well as prevention of both HIV and acquired immunodeficiency syndrome (AIDS).

HIV was first identified in 1983 as the causative agent that resulted in AIDS, which was first reported in 1981.

The progression of the virus and the associated disease has been reported to be a global pandemic as one of the global lead causes of mortality in adults. The World Health Organization (WHO) has estimated the number of people living with HIV in 2020 was approximately 37.7 million; this can be translated as 0.7% of the global population, with Africa comprising the highest prevalence compared to other continents.

This majorly infectious disease consists of a primary strain, HIV-1, that can be traced to the chimpanzee species. This virus is an enveloped retrovirus that consists of two copies of single-stranded RNA.

There are three distinct stages of HIV, which describe the progression of the virus, including acute HIV infection, chronic HIV infection, and AIDS.

These can be summarized as the multiplying of the HIV virus, including the initial rapid destruction of CD4 T lymphocytes within the host, causing flu-like symptoms. This can then progress into the second asymptomatic stage, where the virus continues to multiply at low levels; within this chronic stage, the infection can progress into AIDS in 10 years or longer without antiretroviral therapy.

The final stage of HIV consists of AIDS, which is the most severe stage of the infection and can be characterized as having a high level of damage to the immune system, where the body is unable to fight against opportunistic infections. A diagnosis of AIDS is made when HIV patients have a CD4 count of 200 cells/mm3.

HIV/AIDS treatments have focused on antiretroviral therapies, with early treatment being only effective to a certain extent; the first drug that was FDA approved was in 1987, and since, approximately 25 drugs have received approval.

The progression of research, which included the release of protease inhibitors as well as the emergence of triple-drug therapy within the mid-1990s was highly promising for the efficacy of HIV/AIDS treatment. Currently, the highest standard of HIV/AIDS treatment consists of highly active antiretroviral therapy, involving three or more drugs provided simultaneously.

With further research into disease prevention strategies, vaccines have been considered the most effective agent for fighting global infections, evidenced by efficient control over infectious diseases such as measles, mumps, and rubella.

The challenges that can be associated with this chronic disease consist of requiring patient compliance for lifetime treatment, which can be difficult to adhere to. A lack of adherence to treatment can increase the probability of treatment failure and increase the likelihood of developing resistant strains of the virus.

Another limitation includes poor aqueous drug solubility, as this can impact the availability of the drug within the body and result in ineffective treatment of HIV.

The advancement in nanotechnology and nanomedicine has provided a promising future for HIV/AIDS therapeutics.

With the advancement of nanomedicine, strategies have been explored to overcome current challenges associated with HIV treatment. This includes oral administration of antiretroviral drugs and improving the water solubility of drugs, such as through solid drug nanoparticles (SDN).

Research into SDN formulations has been produced through a freeze-drying approach, which has been predicted to provide a similar pharmacokinetic standard as a conventional anti-HIV drug. However, this nanomedicine formulation was theorized to allow patients to take a 50% lower dose while experiencing the same effect. This prediction was validated with in vivo experimentation.

The development of SDN formulations has enabled success in superseding conventional oral drug formulations, such asritonavir-boosted lopinavir, which utilizes 42% ethanol and 15% propylene glycol. The use of lopinavir SDN formulations can achieve the production of an effective oral drug without the inclusion of ethanol.

Additionally, the potential inclusion of nanomedicine within this field of therapeutics allows for low-cost production of effective drugs as well as a decrease in required doses for patients.

Other subsets of nanomedicine that can be used for HIV therapeutics include long-acting injectable formulations (LAI), which can provide a solution to patient issues associated with low adherence to lifetime treatments.

An example of a drug that has been re-formulated to carry a nanomedicine component includes the non-nucleoside reverse transcriptase inhibitor, rilpivirine, which has been available as an oral medication from 2011, before being nanoformulated as a LAI.

This LAI nanomedicine has been proven to be effective, with concentrations being detected in rats up to 2 months after subcutaneous and intramuscular administration as well as detected in dogs for up to 6 months after administration.

New research in this area has included the Herbert Wertheim College of Medicine(HWCOM), who have undertaken nanotechnology research into the delivery of anti-HIV drugs across the blood-brain barrier, aiding in targeting HIV reservoirs within the brain. This research has included the development of a revolutionary technique consisting of using tiny magneto-electric nanoparticles as drug carriers.

Nagesh Kolishetti, one of the studys corresponding authors, stated, This delivery system can reduce the viral load, the amount of virus present, which normally contributes to neurological problems.

This type of combination therapy with the nanoparticles could result in a highly effective treatment regimen for the HIV-infected population who are addicted to a substance of abuse.

This is significant as HIV can cause neurological problems and disorders such as dementia and memory loss, which can be further increased by substance abuse

The future of HIV therapeutics can be said to be greatly intertwined with nanomedicine, with research into the use of nanoformulations that attempt to overcome the challenges of current HIV treatments.

With reports from WHO stating that 73% of HIV patients are treated with antiretroviral therapy and 680,000 deaths in 2020, this field requires a revolutionary change to traditional medicine to provide better treatment and even preventative care for this chronic disease.

Curley, P., Liptrott, N. and Owen, A., 2018. Advances in nanomedicine drug delivery applications for HIV therapy.Future Science OA, 4(1), p.FSO230. Available at: 10.4155/fsoa-2017-0069

FIU News. 2022.Researchers advance the use of nanoparticles to deliver HIV/AIDS drugs to the brain. [online] Available at: https://news.fiu.edu/2021/fiu-researchers-advance-the-use-of-nanoparticles-to-deliver-hivaids-drugs-to-the-brain

Hivinfo.nih.gov. 2022.The Stages of HIV Infection | NIH. [online] Available at:https://hivinfo.nih.gov/understanding-hiv/fact-sheets/stages-hiv-infection

Mamo, T., Moseman, E., Kolishetti, N., Salvador-Morales, C., Shi, J., Kuritzkes, D., Langer, R., Andrian, U. and Farokhzad, O., 2010. Emerging nanotechnology approaches for HIV/AIDS treatment and prevention.Nanomedicine, 5(2), pp.269-285. Available at: 10.2217/nnm.10.1

Worldpopulationreview.com. 2022.HIV Rates by Country 2022. [online] Available at: https://worldpopulationreview.com/country-rankings/hiv-rates-by-country

Disclaimer: The views expressed here are those of the author expressed in their private capacity and do not necessarily represent the views of AZoM.com Limited T/A AZoNetwork the owner and operator of this website. This disclaimer forms part of the Terms and conditions of use of this website.

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Nanomedicine and HIV Therapeutics - AZoNano

Whether youre planning summer activities at home or abroad, it is important to think about ways to avoid seasonal mosquitos if you want to ensure your recreational activities remain enjoyable. Besides the itchy and painful bites mosquitos leave behind, they can carry diseases that are easily transmitted to humans.

While the bites and infections they spread can often be treated, the best course of action is to prevent the bites altogether. If you have control of the environment and can think ahead, there are several ways you can sidestep the pests.

A good place to start is to make sure you have screens to block mosquitos from coming indoors and to be sure to eliminate standing water, where they can lay eggs. When evaluating for standing water, dont forget to check flower pots, rain gutters, plastic furniture covers, and toys.

If you are out and about, wearing long pants and sleeves can help cover bare skin, which gives mosquitoes easy access. In areas of high mosquito concentrations, treating clothing with permethrin, an anti-parasite cream, adds additional protection. While there are a number of different topical products on the market that claim to repel mosquitos, the validity of these claims is not always the same across brands. When looking for safe and effective ways to prevent mosquito bites, there are some products that demonstrate both safety and efficacy.

DEET is most strongly recommended by the Centers for Disease Control and Prevention and the Environmental Protection Agency (EPA). Some recommended alternatives to DEET are Picaridin and IR3535. While there are many natural mosquito repelling products, unfortunately, most have not been shown to be effective. The exception to this is oil of lemon eucalyptus, which has an efficacy comparable to DEET.

To be sure the product you would like to use is appropriate, the EPA has a free search tool that allows you to find specific products that will repel mosquitos, ticks, or both. When evaluating products, use caution with treated wristbands. Even though these may contain mosquito-repelling agents, they dont provide a wide enough protection zone to provide adequate coverage for the whole body.

And if your plans include international travel, scheduling an appointment with your physician is important to discuss ways to avoid mosquitos, as well as to obtain preventative medications for mosquito-borne illnesses. While mosquitos are certainly an unpleasant addition to outdoor plans, taking steps to avoid them contributes to having a safe and healthy summer.

Jessica Mayer, DO Program Director Suburban Family Medicine ResidencyVice-Chair Family Medicine Department

Suburban Family Medicine at Norristown2705 DeKalb Street, Suite 202Norristown, PA 19401610-275-7240

Dr. Mayer sees patients of all ages and is dedicated to providing compassionate care for the whole person. She is board certified in Family Medicine and director of Suburban Family Medicine Residency program and vice-chair of Family Medicine Department at Suburban Community Hospital.

Dr. Mayer completed her medical education at the Philadelphia College of Osteopathic Medicine (Pennsylvania) in 2008, internship at Crozer-Chester Medical Center (Pennsylvania) in 2009, and Residency at Mercy Suburban Hospital in 2011.

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Tips on avoiding mosquitos this summer - morethanthecurve.com