How Well Does Stroke Thrombectomy Work for Children? – Multicenter study suggests most recover with little disability

by Crystal Phend

Stent retrievers and other endovascular thrombectomy treatments appeared as safe for selected children as seen in adult trials, and also had good neurologic outcomes, in the Save ChildS Study.

Among 73 children treated at 27 centers in the U.S. and Europe, the most feared complication — symptomatic intracerebral hemorrhage — occurred in only one, for a 1.37% rate that was favorable compared with the 2.79% rate in the HERMES meta-analysis of adult trials.

No vascular complications, such as dissections or vessel rupture, were reported by Peter Sporns, MD, MHBA, of Universitätsklinikum Muenster in Germany, and colleagues in JAMA Neurology.

The only periprocedural complication was transient vasospasm on angiography in four patients (5%) that resolved without clinical sequelae. Malignant infarction followed by decompressive hemicraniectomy occurred in three children (4%). One patient with preexisting congenital heart disease died of cardiac arrest after complete recanalization.

“This study may support clinicians’ practice of off-label thrombectomy in childhood stroke in the absence of high-level evidence,” the researchers concluded.

Neurologic improvement also “showed a similar pattern as observed in the adult trials,” as median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score improved from 14.0 at admission to 4.0 at day 7.

Median modified Rankin scale (mRS) score was 1.0 on the 6-point scale at both 6 and 24 months, with 80% having a favorable neurologic outcome (mRS ≤2) at discharge and more than 85% at the same point by 180 days.

None of the seven trials in the adult-trial meta-analysis reached much beyond 70% at 90 days on that measure.

However, an accompanying editorial expressed deep reservations about how much could be made of the findings, given the methods.

First, 24-month neurologic outcome data were missing for more than one-third of the children, “introducing the possibility of selection bias,” wrote Christine Fox, MD, of the University of California San Francisco, and Nomazulu Dlamini, MBBS, PhD, of the Hospital for Sick Children in Toronto.

“Data for earlier outcomes were more complete, but because deficits may emerge over time in children, early outcomes may not provide the full picture,” they wrote. “Cognitive and language deficits may initially go unrecognized in a toddler but become apparent as skills required for success in school grow increasingly complex.”

And using historical data from the meta-analysis for comparison “has pitfalls,” they added. “Given differences in the interpretation of outcome instruments and timing of outcome measures in the Save ChildS study compared with the HERMES trials, comparisons between these studies are of questionable value.”

Clinical trials are unlikely to be done to support the guidelines suggesting mechanical thrombectomy with stent retrievers as reasonable to consider for some patients <18 years with large-vessel occlusion, Sporns' group noted. The one trial that had started had to be abandoned for lack of recruitment. Sporns' study included all patients ages ≤18 years diagnosed with arterial ischemic stroke who underwent endovascular recanalization from 2000 through 2018 at participating centers. Most treatment was with clot retrievers (82%), while distal thromboaspiration was used in 10%, along with a smattering of other tools. All patients immediately went to the pediatric ICU after endovascular treatment. The researchers cautioned that, although all types of stroke sources were included, only seven patients had focal or bilateral cerebral arteriopathy. "Thus, an a priori selection bias of thrombectomy against children with potential inflammatory vasculopathy may be inherent to a seemingly low overall hemorrhagic risk," they wrote. "Vascular fragility and risk of hemorrhage need to be considered and weighted carefully against a potential benefit of a recanalization treatment in this specific patient population," they noted. "Underlying abnormalities are often unknown at the time of admission; therefore, the emergency decision on whether to perform thrombectomy frequently has to be made without detailed knowledge about the cause of the stroke."

9 Foods That Cause Acne

By Andrea Stanley

Your diet may be to blame for your breakouts. While food isn’t the be-all and end-all cause of acne, it can exacerbate it, says Ranella Hirsch, MD, past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery and dermatologist practicing in Boston. If you’ve already tried every beauty product with “acne” on the label, it’s time to rethink the role these foods play in your diet.

Skim Milk

Got milk? Malaysian research revealed that those who regularly consumed milk were four times more likely to have acne drama than those who didn’t (the hormones in dairy are thought to make your skin go haywire). More surprising: Skim may be worse than whole or low-fat milk, according to the American Academy of Dermatology. The exact reason why is still unclear, although it may have to do with the different proteins found in skim.

Ice Cream

Dealing with a rash of acne breakouts lately? Your go-to pint of ice cream may be to blame. (Sorry, cookie dough!) “Sugars can cause inflammation in the skin,” Hirsch says. And the not-so-sweet cherry on top? Ice cream contains dairy, too. So between the high sugar content and dairy, it may be time to cease those late-night freezer raids.

Potato Chips

Carbs, specifically those with a high glycemic index, cause inflammation, which can lead to breakouts, says Hirsch. In fact, when it comes to foods that cause acne, many dermatologists say high-GI foods are the biggest culprit. The next time you’re hankering for a handful of potato chips, reach for some peanuts instead (they have a low glycemic index).

Read more…

Home-Cooked Meals Linked to Lower PFAS in the Body

People who eat more home-cooked meals had lower levels of hormone-disrupting PFAS chemicals in their blood compared to others, according to a new study.

People who reported eating popcorn, mostly the kind that’s pre-packaged for cooking the microwave, had significantly higher PFAS blood levels.

The study — which drew its data from the government’s long-running National Health and Nutrition Examination Survey — compared blood levels of certain kinds of per- and polyfluoroalkyl (PFAS) substances to the foods people said they remembered eating on dietary questionnaires between 2003 and 2014.

The most important finding of the new study is that it showed people who tended to eat more fresh food and food prepared at home had slightly lower levels of five “long-chain” PFAS chemicals in their blood, compared to those who ate more of their meals at fast-food and other types of restaurants. The study was observational, which means it can’t show cause and effect.

PFAS blood levels tested in the study have been dropping over past 2 decades, as chemical manufacturers have voluntarily phased out the production of some kinds — the “long-chain” ones. In 2016, the FDA revoked regulations that allow long-chain PFAS chemicals in food packaging.

But shorter-chain PFAS chemicals have replaced them in many products, and researchers say not enough is known about whether these compounds are any better for the environmental or our health. The CDC calls the chemicals a “public health concern” and says more research is needed to better understand the health effects of PFAS exposure.

Experts who were not involved in the study say it is useful because it shows that food choices can impact the chemical loads we carry in our bodies.

“Making food at home minimizes contact with food packaging and exposure to chemicals that affect the developing thyroid gland and are associated with a host of health consequences,” says Leonardo Trasande, MD, a professor of pediatrics and environmental medicine at New York University’s Langone Health. He’s also wrote a book called Sicker, Fatter, Poorer, about how hormone-disrupting chemicals affect your health.

‘Forever Chemicals’

There are thousands of different kinds of synthetic PFAS chemicals. They have been used since the 1950s to make products such as stain-resistant carpets, cosmetics, waterproof fabrics, and nonstick cookware. They have contaminated water supplies because of the heavy use of firefighting foams that contain PFAS.

PFAS chemicals leach into food through wrappers and containers that are coated to make them grease-proof. They may also creep into food during processing.

They’re sometimes called “forever chemicals,” because many don’t break down in the environment. They take years to break down in our bodies.
Previous studies have shown PFAS chemicals can interfere with a body’s natural hormones and may make it harder to get pregnant. They’ve been linked to growth and learning problems in kids. They may cause problems with the immune system such as reducing the body’s response to vaccines. Other studies have linked them to increased cholesterol levels and cancer.

PFAS chemicals may even influence body weight. A 2018 study by researchers at Harvard and Pennington Biomedical Research Institute found that people with higher PFAS levels were more likely to regain lost weight, possibly because of changes to their resting metabolic rate — the number of calories the body burns at rest.

Concerns about PFAS health impacts are mounting. Washington recently became the first state in the U.S. to ban PFAS chemicals in consumer products and firefighting foams. Denmark also recently banned PFAS from food packaging.

Scientists: Watch What You Eat

Researchers say it stands to reason that eating less packaged and processed food could cut a person’s exposure.

“We all know that eating more fresh foods and eating more home-cooked is better for our health for a wide range of reasons. This study provides yet another reason to eat more fresh foods and foods cooked at home,” says study author Laurel Schaider, PhD, a research scientist at Silent Spring Institute in Newton, MA.

The study also found that people who reported eating more fish and shellfish were more likely to have higher PFAS levels. That finding isn’t surprising. Previous studies have found that larger fish take on the chemicals of the smaller fish they eat. So larger predatory fish can wind up with substantial amounts of PFAS in their flesh, which would otherwise be healthy to eat.

Trasande says the solution to that is to eat smaller fish, like sardines, and smaller shellfish, like shrimp and scallops.

Popcorn was another big culprit.

“We found a strong association with microwave popcorn,” Schaider says. Levels of one kind of PFAS chemical, called PFDA, were 63% higher in those who reported eating popcorn at least once daily over the past year. Surveys showed most of the popcorn eaten in the study was microwave popcorn.

Schaider says that while that’s not great news, there are easy substitutes.

“I personally have high blood pressure, so I make popcorn on the stove,” she says.

If you want to stick with your microwave, you can add unpopped kernels to a plain brown paper bag to avoid PFAS chemicals. Schaider says previous testing of these kinds of bags didn’t detect any PFAS chemicals in them.

Trasande says the study is straightforward.

“It shows that the decisions about what we eat and where that food comes from can have measurable changes on our PFAS exposures,” he says.

The FluoroCouncil, an industry group that represents companies that make fluoropolymer products, says the use of PFAS chemicals in food packaging is safe.

According to a statement posted on the group’s website: “The use of PFAS in food packaging is strictly regulated by the FDA, which has determined the specific PFAS currently used are safe for their intended use. In addition, a robust body of scientific data demonstrates these FDA-reviewed PFAS substances do not pose a significant risk to human health or the environment.”

Contraception must not be ignored in climate change debates

Wider distribution of contraceptives through investment in family planning programmes would have a profound effect on the climate and the environment, as well as on human welfare, experts have argued. They said population growth is fuelling greenhouse gas emissions and the environmental crisis and almost half of pregnancies globally are unintended, yet the climate debate has so far largely ignored the importance of improving access to effective contraception.

In their commentary* in today’s BMJ Sexual & Reproductive Health, Dr John Bongaarts and Dr Regine Sitruk-Ware of the Population Council in New York point out that contentious ongoing policy debate about potential interventions against global climate change focuses on switching to renewable energy sources and increasing energy use efficiency, but they say we must prioritise other approaches to limit greenhouse gas emissions given the urgency of the problem and the lack of political will. They recommend improving global access to effective contraception as one such policy, because: population growth is a key driver of climate change; higher and more effective use of contraception reduces unplanned pregnancies and hence population growth; and many more women and men would freely choose to use contraception if only it were available and acceptable.

They cite research that has found that women who want to avoid pregnancy might still not use contraceptives for a mixture of social, economic, health and service-related reasons. These include lack of access and high cost for women in poor areas, as well as myths about hormones, traditional social norms (particularly in traditional and/or patriarchal societies) and disapproval of husbands, noting: “Fear of side effects and dissatisfaction with available methods are often the dominant reasons women are reluctant to use (or continue to use) contraception.”

They call for culturally sensitive media campaigns developed in collaboration with community leaders, investment in men’s and women’s education and careful counselling, to change norms around women’s roles in society and expectations around their ability to exercise their reproductive preferences, and to address concerns and incorrect rumours about contraceptive methods and side effects. They add: “Access to a wide range of options is essential to maximise the chances that clients’ needs and concerns are satisfied at different times of their reproductive lives.”

They discuss methods still under development for both male and female contraception, noting that these will offer more choices to women and men, thus reducing unplanned births and abortions – but insisted we need not and must not wait for these innovations.

They conclude: “Wider distribution of contraceptives already on the market through greater investment in voluntary but underfunded family planning programmes is sufficient to raise contraceptive use substantially. This in turn would have a profound positive impact on human welfare, the climate and the environment.”

Simple Home Workouts

By Kara Mayer Robinson

For days when you don’t feel like going to the gym or gearing up for an outdoor workout like running or biking, make it simple with these at-home cardio workouts.

Circuit Train

Circuit training pumps up your heart rate and builds strength in a short amount of time.

To create an at-home circuit, first choose three to four cardio exercises like jumping jacks, jogging in place, step-ups, mountain climbers, burpees, and jumping rope. Then choose three strength training exercises like pushups, planks, abdominal crunches, tricep dips, wall sits, lunges, and squats.

Alternate between cardio and strength training exercises. Do 30-second bursts of each for 3 to 4 minutes. Repeat this circuit two to three times.

Jump Rope

Jumping rope burns calories, elevates your heart rate, and improves coordination, muscle elasticity, and brain function. Plus, it’s fun, easy, and takes up very little space.

After a short warmup, do 30-second intervals of jumps, followed by 15 to 30 seconds of rest. Mix it up with a combination of single-leg jumps, split-leg jumps, wide-to-narrow jumps, running in place, and taking off and landing on both feet.

Bump up the time as you get better. Cool down with calf and quadriceps stretches.

Box or Kickbox

“Think inside the box,” says Grant Roberts, an Internal Sports Medicine Association-certified fitness trainer who works with celebs like Eva Longoria and Zachary Levi. Boxing and kickboxing are stellar conditioning workouts you can easily do at home while channeling your inner aggressor and relieving stress.
Fire up YouTube or on-demand TV for a wide range of boxing and kickboxing workouts to follow along with at home. Or create your own. Alternate 1-minute intervals of jabs, crosses, and kicks and 1-minute intervals of active recovery like shadow boxing, jogging in place, or skipping rope. Gradually increase the time of your active intervals. “If you can work your way up to three 12-minute rounds with 1-minute rests in between, you’ll feel like a champion,” Roberts says.

Climb Stairs

“Got some stairs in your home?” asks Roberts. “Include them in your cardio workout.” An at-home stair-climbing workout is about as simple as it gets. Set a timer for your preferred workout length, walk up and down your stairs, and repeat until it beeps. Start with just a few minutes, then work your way up to longer stair-climbing workouts as you feel stronger.

Strength training bonus: Take breaks for calf raises. Put the balls of your feet on one step, then use your calf muscles to raise up as high as you can. Lower your body as far as you can, then return to your starting position and repeat.

Measuring up: how does the UK compare internationally on cancer survival?

Our ambition is that 3 in 4 people will survive their cancer by 2034. And while cancer outcomes may differ from country to country, the goal of improving cancer survival is one that’s reflected across the world.

A good way for countries to monitor their progress in improving cancer care is by comparing how many people get cancer (incidence), how many survive (survival) and how many die from their cancer (mortality) to see how they measure up. If survival is higher, and incidence and mortality are lower, it’s clear that a country is on the right track.

“No one country manages cancer perfectly,” says John Butler, a consultant specialising in gynaecological cancer surgery. “ But international studies enable countries to learn lessons from one another to with the aim of improving their own cancer policies.”

And in the latest study, published in Lancet Oncology by the International Cancer Benchmarking Partnership, some promising trends have emerged. Survival has improved for the 7 cancer types studied in all countries between 1995 and 2014.

But the figures also underline how much progress still needs to be made in the UK to equal the best outcomes globally. With the exception of ovarian and oesophageal, the UK has the lowest survival figures for the cancers studied.

What do the latest figures show?

Big, international studies like this are a task for the International Cancer Benchmarking Partnership (ICBP). Led by clinicians, researchers and policymakers from around the world, the team compare trends in cancer survival, incidence and mortality rates across 7 countries with similar healthcare systems: UK, Australia, Canada, New Zealand, Denmark, Norway and Ireland. Something that’s never been done before.

Comparisons like this can be tricky – mainly because countries collect and record data in slightly different ways, something the ICBP is looking at in more detail. But despite the challenges, the latest figures from the ICBP are the best available and will only get better as more analysis is done.

The team has been collecting data from 7 cancer types – ovary, lung, colon, rectum, pancreas, oesophagus and stomach – since 1995.

And the latest figures, covering 1995 to 2014, reveal some stark differences in cancer survival between countries. Generally, cancer survival is higher in Australia, Canada and Norway than in Denmark, Ireland, New Zealand and the UK.

Similar trends can be seen for individual cancer types, like lung cancer. From the graphs we can see that Australia has the highest lung cancer survival, and Ireland has made the greatest increase in survival over time. But despite big improvements in lung cancer survival, the UK remains bottom of the list for this cancer type.

Why is the UK lagging behind?

There are many, complex reasons that could explain why we have lower survival compared to other countries.

Butler, the lead clinical advisor for ICBP, says there are some factors that will affect survival in all cancer types. “The UK health system is under great pressure, with increasing demands on cancer diagnostics and more urgent referrals”. And that could affect survival figures. Diagnosing and treating cancer early gives patients the best chance of surviving their cancer, but it relies on having enough NHS staff and funding in place to make this a reality – something the NHS doesn’t currently have.

But there are also more specific reasons that may explain differences between countries for some cancers.
Take ovarian cancer for example. Patients diagnosed in the UK appear to be diagnosed at similar stages to other countries, but survival is lower. This suggests there could be improvements in how these patients are treated.

And as Butler elaborated, this is amplified in older patients.

Older patients are more likely to have other health problems, which often make it more challenging to perform surgery or deliver chemotherapy. More is needed to be done to understand these patients’ complex needs and improve treatments for them, as we’ve blogged about before, as well as to understand why this is an issue particularly for the UK.

But when looking at survival as a whole, it’s useful to consider where we started. In 1995, the UK had some of the lowest survival estimates of the seven countries studied. This means that even though we have made improvements in certain cancers, we’re starting from a lower baseline. Which makes it that much harder for us to catch up with the countries who have higher survival.

And it’s where comparing our progress to other countries can help.

What can we learn from other countries?

Denmark was in a similar place to the UK with their survival in 1995. But as Jesper Fisker, chief executive officer of the Danish Cancer Society, told us “There’s been great progress in Danish cancer survival – which is the result of massive efforts and investments in the cancer field over the past 20 years”.

They’ve also made major strides towards centralising their cancer services, meaning cancer patients are treated in fewer, more specialised centres, with the best clinicians for their cancer type.

And it’s paid off – Denmark has seen real improvements in cancer survival – such as increasing their 1-year survival of lung cancer from 27.5% to 46.2% (from 1995-1999 to 2010-2014). The UK has made similar efforts to improve cancer services, with some success, but much more needs to be done.

And it’s not quite as straightforward as it sounds. While Denmark has made big improvements overall, this has not been universal for every cancer type. The same is true for all the countries studied and it’s something the ICBP is working to understand. They’re looking into variations in access people have to diagnostic tests, scans and treatment, as well as differences in healthcare systems that could help to explain the disparity.

Progress for the UK

On the bright side, the UK has made particularly good progress in increasing cancer survival in rectal, ovarian, and oesophageal cancers.

For example, from 1995 to 1999, 48 in 100 patients were estimated to survive their rectal cancer for at least 5 years. This has now increased to 62 in 100 patients for 2010-2014, only 8.7% behind Australia, who had the highest rectal cancer survival of the countries studied.

Butler called the progress “encouraging” and said there were lots of factors that could be behind the improvements. England produced its first national cancer plan in 2000 and appointed a national cancer director, who helps provide advice and leadership for our cancer services. Since then there’s been more guidance and greater scrutiny of how cancer services are performing, as well as more funding.

There’s also been a move towards cancers being treated in specialised centres, where there will be more relevant cancer expertise.

How can the UK catch up?

But despite the improvements, there’s clearly more work to be done in the UK.

For Butler, investigations into how well cancer services are performing could be a good way to start. For example, national audits in the UK for lung cancer have increased the number of people having surgery, as well as the number of specialised lung cancer surgeons. Replicating this approach could help the NHS direct its efforts to improve outcomes for other types of cancer.

And while the UK government have introduced a range of policies between 1995 and 2014 to improve cancer services and speed up diagnosis and treatment, these have added to the strain on NHS services.

It’s crucial that investment into cancer services is increased to match the ever-growing demand. As Butler told us, “one of the biggest challenges the UK faces is capacity of diagnostic services.”

Philippines to vaccinate millions as polio virus resurfaces in 2 children

Karen Lema

MANILA (Reuters) – The Philippines recorded its second case of polio on Friday, as it prepared to vaccinate millions of children against a disease it believed to have been eradicated two decades ago.
A five-year-old boy in Laguna, south of the capital Manila, tested positive for the polio virus, the health department said, the second case this week after a three-year-old girl was confirmed to be infected on Monday in a province about 1,400 km (870 miles) away.

Health officials appealed to parents and care givers of children to take part in the government’s polio vaccination programme, which comes as the Philippines grapples to tackle twin outbreaks of dengue and measles that have killed more than 1,000 people since January, most of them children.

“The polio vaccinations happen all year round, but our coverage dropped for the past five years,” Rolando Enrique Domingo, an undersecretary of the Department of Health, told Reuters.

“We’ve learned our lesson. It is time to move on and really start vaccinating all kids and make sure we sustain this every year.”
The polio virus was detected in the sewage systems of Davao in a nearby province two months ago, and in Tondo, a rundown area of Metro Manila notorious for slum communities, Domingo said.

Afghanistan, Nigeria and Pakistan are the last three countries where the disease is endemic. The last known case in the Philippines had been in 1993, the World Health Organization says.
Immunisation coverage in the Philippines is at 70%, below the recommended rate of 95%, Domingo said, as trust in vaccines declines.
The boy who tested positive in Laguna has been discharged from hospital already, officials said on Friday. The other case was confirmed on Monday and reported on Thursday in Lanao del Sur, one of the country’s poorest provinces.

Vaccination teams will aim to administer polio drops to every child younger than five, he added.

There is no cure for polio, which invades the nervous system and can cause irreversible paralysis within hours, but it can be prevented with vaccines.

The virus spreads rapidly among children, especially in unsanitary conditions in underdeveloped or war-torn regions where healthcare access is limited.
Children nationwide are at risk as long as a single child remains infected, the United Nations agency for children, UNICEF, has said.

The Philippines has faced a challenge recently in convincing parents to vaccinate children after it scrapped a dengue immunisation programme using Sanofi’s Dengvaxia in late 2017, following its linkage to child deaths.
More than 800,000 children received the vaccine. The records of 119 dead children are being examined to determine if Dengvaxia was to blame, a panel of medical experts said in March.

The inquiry continues and Sanofi has repeatedly said its vaccine is safe.

A vaccine campaign started in August in the historic heart of Manila will be expanded to cover more than 5 million children and go nationwide next year, Health Secretary Francisco Duque said in a speech on Friday.

The Beauty Benefits of Natural Oils

Why Try Natural Oils?
They are touted as alternatives to condition hair, moisturize skin, fight acne, and strengthen nails. Take a stroll down the beauty aisle of your drugstore and you’ll find them in many products. Do they work? You might need to experiment. Everyone’s skin is different, and it comes down to trial and error.

Marula
Made from the fruit of the marula tree, which is native to South Africa, this oil is rich and hydrating. It’s full of fatty acids, which dermatologists say soothe dry skin. It absorbs quickly and won’t leave you shiny or greasy.

Read more..

Patients, doctors may not share priorities for chronic diseases

Carolyn Crist

Patients and doctors often have different views about which chronic health conditions are their top priorities, suggests a study in France.

After separate surveys of patients and their physicians, researchers found that priorities matched up for some conditions, such as diabetes and hypothyroidism, but diverged on others, like anxiety and sleeping disorders.

“An increasing number of patients live with multiple chronic conditions, especially among younger cohorts,” said Dr. Stephanie Sidorkiewicz, a general practitioner in Paris and a researcher at Paris Descartes University, who led the study.

“Against this backdrop, physicians increasingly have difficulties understanding patient expectations and responding appropriately to their individual situations, especially given they at the same time face increased pressure on their time,” she told Reuters Health by email. “However, understanding patients’ perspectives is necessary to set realistic and shared treatment goals.”

As reported online September 9 in Annals of Family Medicine, Sidorkiewicz and colleagues surveyed 233 patients from 16 general practices in Paris in 2017. All patients had been seeing their doctor for at least a year. Patients and doctors checked off all of the patient’s current chronic conditions based on a list of 124 conditions and ranked the three top-priority conditions.

About 8 in 10 patients reported two or more chronic health conditions. The three most common were high blood pressure, osteoarthritis and chronic anxiety disorder.

Agreement between doctors and patients on the number of conditions a patient had was moderate, but agreement on specific chronic conditions ranged from poor to very good.

Among 153 patient-doctor pairs where each made a priority list, about 88% had at least one matching priority. However, 29% of patients’ first priorities didn’t appear anywhere on their doctors’ lists. In addition, 19 pairs, or about 12%, had no matching priorities.

Doctors and patients agreed the most on high blood pressure, hypothyroidism and diabetes, potentially because these have more concrete measurements and guidelines, the study team notes. They also agreed somewhat on asthma, obesity, osteoarthritis and eczema. However, patients tended to rate their chronic anxiety, sleeping and low-back pain conditions as higher priorities, likely due to the impact on their daily lives.
“We were somewhat expecting to find some discrepancies between patients’ and physicians’ priorities, but the extent of these discrepancies was much more severe than we had expected,” Sidorkiewicz said. “Patients and doctors even disagreed on the presence of certain diseases in patients.”

The results align with similar studies in other countries, including Switzerland, where doctors are unaware of patients’ priorities for about 1 in 4 patients, said Dr. Stefan Neuner-Jehle of the University of Zurich, who wasn’t involved in the current study.

“The patient has a role in this procedure as well, in terms of actively thinking about priorities of care before the encounter and openly talking during the encounter,” he told Reuters Health by email. “Standardized patient-centered approaches and tools may be helpful for both physicians and patients.”

Examples of such tools that are available online include the Mayo Clinic’s ICAN Discussion Aid (bit.ly/2miZT7t) and Patient Revolution’s Plan Your Conversation Cards (bit.ly/2lZottY).

“Clinicians have expertise in the guidelines, evidence and healthcare knowledge, and patients have expertise in their lived experience. We need both,” said Kasey Boehmer of the Mayo Clinic’s Knowledge and Evaluation Research Unit in Rochester, Minnesota, who also wasn’t involved in the study.

These two-way conversations can help especially with chronic conditions that are difficult to diagnose and treat and don’t fit under a traditional medical paradigm, such as chronic low back pain, fibromyalgia and autoimmune diseases, she said.
“That background knowledge that we may or may not be on the same page is helpful,” she told Reuters Health by phone. “Give yourself permission to share those experiences in your life and how your health and your healthcare is intertwined with your life.”

Trump signs order aimed at development of better flu vaccines

Reporting By Deena Beasley; Editing by Sonya Hepinstall

(Reuters) – U.S. President Donald Trump on Thursday signed an executive order aimed at spurring the development of better vaccines to protect against seasonal influenza as well as a potential pandemic flu outbreak.

The order does not allocate additional funding for now, but calls for an evaluation of current flu vaccine manufacturing abilities and a task force report including cost estimates, administration officials said on a call with reporters.
Each year the seasonal flu, which can kill tens of thousands of Americans, costs the United States about $50 billion, including lost productivity, one administration official said. A serious flu pandemic would push those costs to between $1.8 billion and $3.8 billion, he said.

Manufacturers such as GlaxoSmithKline Plc and Sanofi SA make millions of doses of flu vaccine for the U.S. market alone, growing the virus in chicken eggs. Usually the doses, which protect against strains that experts predicted the previous February, are ready in time and in sufficient quantity for the winter flu season.
But if the strain that appears during flu season was not the one experts forecast, the vaccines might not work. The appearance of H1N1 swine flu in 2009-2010 took experts by surprise, and the flu was already on its second wave before a vaccine was ready; an estimated 61 million people in the U.S. got swine flu and thousands died.

The Department of Health and Human Services will coordinate government efforts to modernize influenza vaccine production. The focus will be on recombinant technologies to quickly produce reliable vaccines as well as “universal” vaccines that would elicit immunity against parts of the virus that do not change from year to year.