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CDC, National Chlamydia Coalition Partner To Raise Awareness, Testing Rates
The National Chlamydia Coalition is partnering with the Centers for Disease Control and Prevention to increase public awareness and screening efforts for chlamydia, the most common sexually transmitted infection in the U.S., the Wall Street Journal reports. According to CDC, there were 1.1 million recorded cases of chlamydia in 2007, although experts estimate that there are twice as many cases that are not detected largely because the infection often causes few symptoms and many people go unscreened. The infection is three times more common in women than men, which experts say could be because men eliminate it from their bodies more readily than women. Chlamydia is treatable with a single dose of antibiotics, but if left untreated, it can lead to infertility or increased risk for ectopic pregnancies in women.CDC recommends that all sexually active women younger than age 26 be tested annually for the infection, as well as older women who have had a change of sexual partners. However, fewer than 40% of women in those groups are tested, the Journal reports. Chlamydia is particularly prevalent in women ages 15 to 19 and blacks, although sample studies have shown nearly 10% of all female Army recruits, 10% of female college freshmen and 14% of women in managed care plans are infected with chlamydia.Despite its prevalence, chlamydia is one of the least known STIs, which has compounded the difficulty of promoting screening efforts, the Journal reports. It causes few symptoms, and many people are unaware they were exposed to it. According to the Journal, many patients do not ask to be screened for the disease because the few symptoms it causes -- such as bleeding between periods, occasional vaginal discharge, pain during intercourse, pelvic pain in women, and burning upon urination in men -- are common to many conditions. While most screening efforts aim to identify active cases in younger women, there is a serious risk of infertility to older women who were exposed to the bacteria when they were younger, the Journal reports.According to the Journal, the chlamydia bacteria can move to a woman"s upper genital tract and set off pelvic inflammatory disease, which often leaves inflammation and scar tissue that obstructs a woman"s fallopian tubes and fertilization. PID is the most common cause of ectopic pregnancy and can cause endometriosis, a condition in which small portions of the uterine lining tissue grow outside the uterus, which can cause infertility and pain. Miklos Toth, a New York City-based ob-gyn, said, "It"s not the infection itself but the body"s response to get rid of the bacteria that causes scarring. And even if just some fragments of the bacteria remain, the immune system thinks an active infection is still present."According to the Journal, about 25% of women treated for chlamydia are re-infected within six months likely because of a partner who was not treated. CDC recommends that doctors prescribe a second course of antibiotics for partners of people with the infection. However, many doctors do not screen for or discuss chlamydia during office visits with their patients, especially pediatricians who may be uncomfortable discussing sexual activity with their younger patients, the Journal reports. Lynn Barclay, president of the American Social Health Association, said, "A lot of health care providers aren"t making the connection when they are dealing with adolescents. But to pretend that teenagers aren"t having sex is very dangerous."The Journal reports that the issue of how minors can pay for chlamydia testing can also create barriers. All 50 states allow minors to be tested and treated for STIs without parental consent. However, if a minor"s health insurance is provided by his or her parents, a lab fee listed on an explanation of benefits report for the testing could be considered a breach of confidentiality. Although some doctors suggest that minors pay the $40 to $90 cost for the test in cash, many refer younger patients to STI or family planning clinics that offer low- or no-cost testing. The Jour

Health Insurance Exchanges Gain Attention
Kaiser Health News reports on health insurance exchanges, a concept now being considered in the context of Congress"s health overhaul proposals. "The seemingly simple idea behind exchanges - one-stop shopping for insurance - masks the cornerstone role they may play in a national overhaul of the health system. President Obama supports the idea, and exchanges are included in most of the health care proposals now before Congress. Done right, proponents say, exchanges could transform how insurance is sold, giving individuals and small businesses improved purchasing power, increasing price competition among insurers and creating standardized benefits. Done poorly, analysts and critics say, exchanges could drive up insurance costs and encourage employers to drop coverage, unraveling the system that insures most working Americans. While it"s still unclear what Congress will do, Senate Democrats have looked closely at Massachusetts. Here"s how it works there: The state established its exchange, called the Health Connector, mainly for the benefit of individuals who aren"t insured by employers. They include the self-employed and the unemployed, two categories of people who traditionally have the most difficulty obtaining policies. Although not required to buy through the exchange, doing so gives them group-purchasing power. Lower-income people are eligible for state subsidies."
News of the day
Helping Mentally Ill People Find Jobs Could Save Federal Government $368 Million A Year
A national program to help mentally ill people on Social Security disability programs find jobs could spur greater independence while saving the federal government $368 million annually, according to a study by Robert Drake of Dartmouth Medical School and colleagues in the May-June 2009 issue of Health Affairs.
Cardiovascular

Statement By Merck & Co., Inc. Regarding FOSAMAX® (alendronate Sodium) And Rare Cases Of Osteonecrosis Of The Jaw

Merck is committed to putting patients first and providing accurate information regarding the efficacy, safety and tolerability of our medicines. Merck offers the following statement concerning the osteoporosis medication FOSAMAX® (alendronate sodium) and reports of jaw problems associated with delayed healing and infection of the jaw often following tooth extraction. The condition is known as osteonecrosis of the jaw (ONJ). ONJ is not well understood and may occur for a number of reasons. Most reported cases of bisphosphonate-associated osteonecrosis have been in cancer patients treated with intravenous bisphosphonates, but cases have occurred in patients with postmenopausal osteoporosis and other diagnoses. Known risk factors for osteonecrosis include a diagnosis of cancer, concomitant therapies (e.g., chemotherapy, radiotherapy, corticosteroids), poor oral hygiene, and co-morbid disorders (e.g., pre-existing dental disease, anemia, coagulopathy, infection). In controlled clinical trials involving more than 28,000 patients (over 17,000 of whom were treated with FOSAMAX), contributing as much as 10 years" data with alendronate, there have been no reports of ONJ. This includes ~3000 osteoporosis patients taking alendronate for 3-5 years and ~800 patients taking alendronate for 8-10 years. Since their market introduction, over 225 million total prescriptions have been dispensed for FOSAMAX/FOSAMAX Plus D, Actonel (risedronate) and Boniva (ibandronate) in the U.S. In worldwide post-marketing experience with FOSAMAX/FOSAMAX Plus D, rare reports consistent with osteonecrosis of the jaw have been received. Many of these reports lack sufficient clinical details to make definitive assessments and/or are confounded, particularly since a generally accepted definition of ONJ in the general population is unknown. As of January 15, 2009, Merck estimates the worldwide, cumulative reporting rate of osteonecrosis of the jaw to range between 1.6/100,000 patient-treatment-years and 3.84/100,000 patient-treatment-years, regardless of causality. On January 31, 2005, Merck received a request dated January 24, 2005 from the Food and Drug Administration to update the label for FOSAMAX to include bisphosphonate class labeling for ONJ. Merck submitted a draft revised label to FDA on March 1, 2005. FDA comments on this draft revised label were received in June 2005, and the new label was made publicly available in July 2005. Rare cases of ONJ have also been reported in patients who do not have osteoporosis and who have not taken any bisphosphonate medicines. These cases have been discussed in articles that have been published in the medical literature. All products containing FOSAMAX include the following language pertaining to ONJ in the "Precautions" section of their respective package circular: -- Osteonecrosis of the jaw, generally associated with tooth extraction and/or local infection, often with delayed healing, has been reported in patients taking bisphosphonates. Most reported cases of bisphosphonate-associated osteonecrosis have been in cancer patients treated with intravenous bisphosphonates, but some have occurred in patients with postmenopausal osteoporosis. Known risk factors for osteonecrosis include a diagnosis of cancer, concomitant therapies (e.g., chemotherapy, radiotherapy, corticosteroids), poor oral hygiene, and co-morbid disorders (e.g., preexisting dental disease, anemia, coagulopathy, infection). -- Patients who develop osteonecrosis of the jaw (ONJ) while on bisphosphonate therapy should receive care by an oral surgeon. Dental surgery may exacerbate the condition. For patients requiring dental procedures, there are no data available to suggest whether discontinuation of bisphosphonate treatment reduces the risk for ONJ. Clinical judgment of the treating physician should guide the management plan of each patient based on individual benefit/risk assessment. Information for ONJ is also provided in the "Adverse Reactions" section of the package circular as well as in the patient package insert for the products containing FOSAMAX. As part of a review of your medical history with your healthcare providers (such as dentists, physicians, oral surgeons or others), be sure to include any product containing FOSAMAX in your list of medicines and talk to your healthcare provider if you have any questions about FOSAMAX. FOSAMAX is indicated for the treatment of osteoporosis in postmenopausal women. For the treatment of osteoporosis, FOSAMAX increases bone mass and reduces the incidence of fracture, including those of the hip and spine. FOSAMAX is also indicated to increase bone mass in men with osteoporosis. Osteoporosis, the most prevalent bone disease in the U.S., can lead to bone loss and an increased risk of fractures. Over 10 million Americans over the age of 50 have osteoporosis and another 34 million have low bone mass. Osteoporosis is especially common in women after menopause, but also occurs in older men. Most often, it is due to an increase in the rate of resorption (breakdown) of bone tissue that is not matched by the rate of bone formation. The risk of having an osteoporosis-related fracture increases with age. According to the Surgeon General, osteoporosis is a national health threat and by 2020 one in two Americans over the age of 50 will be at risk for fractures from osteoporosis or low bone mass. In fact, one out of every two women over age 50 will have an osteoporosis-related fracture in their remaining lifetime, with the risk of fracture increasing with age. Important Information About FOSAMAX FOSAMAX, like other bisphosphonate containing products, should be used with caution in people with certain stomach or digestive problems. FOSAMAX should not be used if the patient has certain disorders of the esophagus that delay emptying or if the patient is unable to stand or sit upright for at least 30 minutes. In addition, FOSAMAX should not be used in patients with severe kidney disease or low levels of calcium in their blood, in patients who are allergic to FOSAMAX or in patients who are pregnant or nursing. Patients who have difficulty swallowing liquids should not take FOSAMAX oral solution. Some patients may develop severe digestive reactions including irritation, inflammation or ulceration of the esophagus. The risk of severe esophageal experiences appears to be greater in patients who fail to follow dosing instructions (see prescribing information for more details). Patients who experience new or worsening heartburn, difficulty or pain when swallowing or chest pain should stop taking the drug and call their doctor right away. Patients who develop severe bone, joint and/or muscle pain at any time should contact their doctor. The standard dosing regimen for FOSAMAX includes swallowing the tablet with six to eight ounces of plain water the first thing upon arising for the day and at least 30 minutes before the first food, beverage or medication of the day. After swallowing FOSAMAX, patients should not lie down for at least 30 minutes and not until after consuming their first food of the day. Patients should not chew or suck on a tablet of FOSAMAX. Merck


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