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Puerto Rico’s Health Faces Prolonged Recovery

As President Donald Trump signals impatience to wind down emergency aid to Puerto Rico, the challenges wrought by Hurricane Maria to the health of Puerto Ricans and the island’s fragile health system are in many ways just beginning. Three weeks after that direct hit, nearly four dozen deaths are associated with the storm. But the true toll on Puerto Rico’s 3.4 million residents is likely to involve sickness and loss of life that will only become apparent in the coming months and in indirect ways. As victims continue to be found and stranded people reached, it will take time to assess the consequences of their missed care or undertreatment. The situation in Puerto Rico’s health system is far more vulnerable than those in Texas or Florida, which also weathered hurricanes this fall — medically, economically and politically. A month after Hurricane Katrina in 2005, only about half of the final official fatalities had been tallied. Puerto Rico has a  higher rate of diabetes  tha

'Change the Conversation' About Hormone Therapy in Menopause

PHILADELPHIA — The new position statement on hormone therapy from the North American Menopause Society is in the public eye here at the 2017 annual meeting, where fears about treatment are being discussed and women and healthcare providers are being reassured that hormone therapy is safe and effective for menopausal symptoms that disrupt a woman's quality of life ( Menopause .  2017;24:728-753 ). "Fear has been driving the conversation about hormone therapy," said JoAnn Pinkerton, MD, from the Midlife Health Center at the University of Virginia in Charlottesville, who is executive director of NAMS and chair of the 20-member position statement advisory panel. But "hormone therapy remains the most effective treatment for vasomotor symptoms and the genitourinary syndrome of menopause, and has been shown to prevent bone loss and fracture," she said. Hormone therapy is approved by the US Food and Drug Administration for vasomotor symptoms in women without con

Kindergarten Vaccination Rates Hold Steady

Kindergarten vaccination coverage rates for measles, mumps, and rubella vaccine (MMR); diphtheria, tetanus, and acellular pertussis vaccine (DTaP); and varicella vaccine each approached 95% in the United States, according to the latest data from the Centers for Disease Control and Prevention (CDC). The CDC report included 2016 to 2017 MMR, DTaP, and varicella vaccination coverage submitted by immunization programs in 48 states and the District of Columbia. Oklahoma and Wyoming did not report data. The median vaccination coverage across the nation for two doses of MMR was 94.0%. The median vaccination rate for the state-required number of doses of DTaP was 94.5%. The median vaccination coverage rate for two doses of varicella vaccine was 93.8%. Ranee Seither, MPH, an epidemiologist at the CDC in Atlanta, Georgia, and colleagues report that four states (California, New York, North Dakota, and Tennessee) all experienced increases in coverage of at least 1.5 percentage points for a

Insulin Glargine/Breast Cancer Link Seen Again in Type 2 Diabetes

In a large observational study, women with type 2 diabetes who received long-acting insulin glargine ( Lantus , Sanofi) had a 1.4-fold increased risk of breast cancer compared with women who were given intermediate-acting neutral protamine Hagedorn (NPH) insulin during roughly 4 years and up to 12 years of follow-up. In contrast, those who received insulin detemir ( Levemir , Novo Nordisk) did not have any increased risk of breast cancer. Of note, the breast-cancer signal with insulin glargine was only significant among prior insulin users and not new users. And this signal does not mean clinicians should change clinical practice without a review by regulatory agencies, caution the investigators, led by Jennifer W Wu, MD, of McGill University, Montreal, Quebec, who published their paper in the  Journal of Clinical Oncology . "Despite these findings, the benefits and risk of insulin glargine must be considered by drug regulatory agencies before any changes in clinical p

FDA Urges Clinicians to Help Limit Opioid Prescriptions

WASHINGTON ― US Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, said the agency wants to find ways to limit both the number of opioid prescriptions and the duration of those prescriptions and is asking healthcare providers to step up and support this effort. "Some limits on duration of use are an inevitability," said Dr Gottlieb, who spoke at a special session of the  annual meeting  of the National Academy of Medicine (NAM) here. He fleshed out more details on the agency's stated intentions to address the opioid epidemic. The pharmaceutical industry is supporting limits to duration of use, the supply chain has imposed restrictions, and about 20 states have put limits on first-time opioid prescriptions, noted Dr Gottlieb. "In an optimal world, we would see the provider community decide to work with these bodies," he said. But, he said, "We do see pushback from the provider community to a point about what this represents for intru

Burnout May Be Costing Your Institution Millions Each Year

SAN FRANCISCO — Burned out physicians are more likely to leave their job, and replacing them could be costing your institution millions of dollars each year, researchers reported October 13 at the 2017 American Conference on Physician Health. Burnout is widespread among physicians in the United States, with numerous surveys showing rates above 50%. However, the effect of burnout on physician turnover in hospitals and academic medical centers is less well understood. To learn more about its effects, Maryam S. Hamidi, PhD, associate director of scholarship and health promotion at Stanford Medicine WellMD Center in Palo Alto, California, and colleagues conducted a longitudinal study of physicians at Stanford Health Care and Stanford Children's Health. Of 831 physicians invited, 473 completed the Stanford Physician Wellness Survey in 2013 and consented to have their unique identifier numbers included for data linkage. The survey included questions on burnout, work hours, and su

Cardiac Motion: The Next Log-In Biometric?

BUFFALO, NY — The latest in state-of-the-art innovations using distinct biometric measures for security identification goes straight to the heart—literally. The Cardiac Scan, described as a "noncontact and continuous heart-based user authentication system," utilizes low-level Doppler radar to identify not just each individual's unique heart dimensions but its function and motion as the security code allowing entry to a system such as a laptop and then continues to monitor the heart to make sure the security hasn't been breached by an unauthorized user [ 1 ] . "Cardiac motion is an automatic heart deformation caused by self-excitement of the cardiac muscle, which is unique to each user and is difficult, if not impossible, to counterfeit," explained the authors of a pilot study on the system, to be presented this month at  MobiCom 2017 , the  Annual International Conference on Mobile Computing and Networking, a conference sponsored by the Association for