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Seasonal flu vaccination for all pregnant women is beneficial

MD-FM Thursday January 17, 2013



GENERIQUE
Carillon
 
Sarah:
MD FM — Medical News from around the world with Peter Goodwin.

P1

PETER:
Hello, and with me is Sarah Maxwell. To begin with: the Norwegian Institute of Public Health strongly recommends that all pregnant women should have regular seasonal influenza vaccinations…
 
SARAH:
Yes, this comes after a study — published in the New England Journal of Medicine — showed two important things: First, that the vaccine introduced during the 2009 pandemic influenza-A was safe for pregnant women — it wasn’t associated with increased fetal mortality or stillbirth, as some anecdotal reports had previously suggested. Second: that influenza itself was a risk factor for stillbirth! These findings were from Norway, where over half of all pregnant women were vaccinated during the 2009 pandemic.
 
PETER:
OK. So this adds to the body of literature proving that pregnancy’s a strong risk factor for severe complications during the flu, and that pregnant women should get vaccinated for influenza — pandemic or seasonal... Actually many countries already recommend vaccinating pregnant women for seasonal influenza.

SARAH:
Well, yes. …
and Dr Camilla Stoltenberg, principal investigator of the study said they’re now taking a step in that direction:

Bob Stoltenberg: “After this, we now recommend that pregnant women should also get vaccination against seasonal influenza regularly. So that’s a new recommendation in Norway. And the main conclusion we’d draw out of this is that in addition to being a serious risk to pregnant women, influenza poses a threat to the pregnancy and to the fetus.”
 
SARAH:
Camilla Stoltenberg, Director of the Norwegian Institute of Public Health, in Oslo.
 
P2

PETER:
People with HIV should get antiretroviral therapy as soon as possible — whatever their CD4 cell count is. That’s according to data published in the New England Journal of Medicine confirming treatment guidelines…
 
SARAH:
Yes, initiating antiretrovirals during the four months immediately following HIV infection, helped more patients to normalize CD4 cell counts — of about 900.
Susan Little, was one of the study’s principle investigators:
 
Bob Little -1: “that’s the period when we think the immune system is more able to recover. If you give therapy after that window of time, it is less able to recover, even when given fully suppressive therapy.”
 
SARAH:
That was Doctor Susan Little, from the University of California in San Diego.
 
PETER:
Ok, this sounds good but in practice, but screening patients that close to time they got infected is going to prove a real challenge?
 
SARAH:
Well yes. There are tests sensitive enough out there but they aren’t widely available, and screening’s a big issue. But the main message coming out of these data is that patients should be put on ART as soon as they’re diagnosed with HIV:
 
Bob Little -2 : “The earlier you can start antiretroviral therapy to reduce that immune damage, presumably the more likely you are to reduce further damage and allow the immune system a chance at complete recovery. But the longer you delay, you are going to delay that recovery significantly.”
 
SARAH:
Susan Little, from San Diego.

VIRGULE MUSICALE

P3

PETER:
And a second study published in the New England Journal of Medicine gives more support for early antiretroviral therapy. A short course of ART — 48-weeks — begun during the six months after HIV infection, delayed disease progression and the consequent need for long-term antiretroviral therapy. However, the delay wasn’t significantly longer than the treatment duration and an even shorter course of ART didn’t bring any benefit to a 12-week course of ART.

VIRGULE MUSICALE
 
P4

PETER:
The existence of NON-celiac wheat sensitivity as a distinct clinical condition, has been confirmed by a study reported in the American Journal of Gastroenterology…
 
SARAH:
Yes, researchers identified two populations of people with gluten sensitivity who tested negative for the celiac disease antibody: Either, those who were sensitive to wheat alone or people who were hypersensitive to multiple foods — not only wheat.

PETER:
The actual existence of non-celiac wheat sensitivity has been debated for quite some time, because specific markers for it are lacking aren’t they?
 
SARAH:
Yes. But this study suggests the condition does exist. Lead study author, Antonio Carroccio says, practitioners should be attentive to their patients’ complaints even if they come up negative for celiac disease antibody testing:
 
Bob Carroccio: “Most of these patients report themselves the gluten sensitivity. These patients ask their physicians to make a diagnosis of celiac disease or wheat allergy, but the physicians are unable to make this diagnosis because these patients do not satisfy the criteria for celiac disease and wheat allergy. Probably these patients could be suffering from gluten sensitivity. So the first approach could be to follow a gluten-free diet for some weeks and if the patient improve they need to be re-challenged with wheat and if they are again symptomatic this could be the simple method to perform a diagnosis.”
 
SARAH:
That was Dr Antonio Carroccio, from Agrigento in Italy.


VIRGULE MUSICALE

P5

PETER:
Giving naloxone kits to heroin users so they can treat an overdose themselves is cost-effective…

SARAH:
Yes, results from a computer simulation published in the Annals of internal Medicine showed, it would cost about $400 for every year of healthy life gained, which is well below the customary $50,000 cutoff for medical interventions…

PETER:
Well, we knew naloxone saved people from heroin overdose — there’ve been no doubts about that — but there have been debates around the cost-effectiveness of naloxone programs weren’t there. And users who overdose tend to overdose again don’t they...

SARAH:
Yes and this study accounted for people who overdose repeatedly. Here’s lead study author Dr Philip Coffin:

Bob-Coffin: “Really no matter how you slice it, now matter how you think lay naloxone may be at reducing overdose it’s still cost effective and no matter how much you tax drug users to survive in your economic models naloxone is still an economic intervention and it’s cost effective like vaccinating like kids for the flu or checking your blood pressure in a primary care clinic, even in a conservative model,”

SARAH:
That was Philip Coffin, from the San Francisco Department of Public Health in California, who added that many users who have problems with overdoses are reluctant to pursue naloxone programs because of the costs involved, but hopefully these results should encourage them otherwise.

BREVE 1 Sur fond musical
 
PETER:
Finally, in brief:

Drug users were five times more likely to experience psychotic symptoms while taking methamphetamine relative to periods of no use. That’s from a longitudinal prospective study with 278 people, published in JAMA Psychiatry. The risk appeared to be “strongly” dose-dependent, and frequent cannabis and/or alcohol use also further increased the odds of psychotic episodes.

And…..
 
BREVE 2
 
Children aged one to six who’ve had a diphtheria vaccine in the thigh muscle, are around half as likely to be brought in for medical attention because of an injection-site reaction, compared to having the jab in the arm. These findings were reported in Pediatrics and the authors say they back-up current recommendations for child vaccination.

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then, from me Peter Goodwin, goodbye!
 
JINGLE FIN     

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Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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