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AHS Releases Updated Guidance on New Migraine Treatments

An updated consensus statement from the American Headache Society (AHS) offers detailed recommendations on the use of novel acute and preventive treatments in adult patients with migraine.

“Because the benefit–risk profiles of newer treatments will continue to evolve as clinical trial and real-world data accrue, the American Headache Society intends to review this statement regularly and update, if appropriate, based on the emergence of evidence with implications for clinical practice,” wrote lead author Jessica Ailani, MD, of the department of neurology at Medstar Georgetown University Hospital, Washington, and colleagues. The statement was published in Headache.

To assess recent data on the efficacy, safety, and clinical use of newly introduced acute and preventive migraine treatments, the AHS convened a small task force to review relevant literature published from December 2018 through February 2021. The society’s board of directors, along with patients and patient advocates associated with the American Migraine Foundation, also provided pertinent commentary.

New Migraine Treatment

Five recently approved acute migraine treatments were specifically noted: two small-molecule calcitonin gene-related peptide (CGRP) receptor antagonists — rimegepant and ubrogepant — along with the nonsteroidal anti-inflammatory drug celecoxib, the serotonin 5-HT1F agonist lasmiditan, and remote electrical neuromodulation (REN). Highlighted risks include serious cardiovascular thrombotic events in patients on celecoxib, along with driving impairment, sleepiness, and the possibility of overuse in patients on lasmiditan. The authors added, however, that REN “has shown good tolerability and safety in clinical trials” and that frequent use of rimegepant or ubrogepant does not appear to lead to medication-overuse headache.

Regarding acute treatment overall, the statement recommended nonsteroidal anti-inflammatory drugs (NSAIDs), nonopioid analgesics, acetaminophen, or caffeinated analgesic combinations — such as aspirin plus acetaminophen plus caffeine — for mild to moderate attacks. For moderate or severe attacks, they recommended migraine-specific agents such as triptans, small-molecule CGRP receptor antagonists (gepants), or selective serotonin 5-HT1F receptor agonists (ditans). No matter the prescribed treatment, the statement pushed for patients to “treat at the first sign of pain to improve the probability of achieving freedom from pain and reduce attack-related disability.”

The authors added that 30% of patients on triptans have an “insufficient response” and as such may benefit from a second triptan or — if certain criteria are met — switching to a gepant, a ditan, or a neuromodulatory device. They also recommended a nonoral formulation for patients whose attacks are often accompanied by severe nausea or vomiting.

More broadly, they addressed the tolerability and safety issues associated with certain treatments, including the gastrointestinal and cardiovascular side effects of NSAIDs and the dangers of using triptans in patients with coronary artery disease or other vascular disorders. And while gepants and ditans appeared in clinical trials to be safe choices for patients with stable cardiovascular disease, “benefit-risk should be assessed in each patient as the real-world database for these therapies grows,” they wrote.

Only one recently approved preventive treatment — eptinezumab, an intravenous anti-CGRP ligand monoclonal antibody (MAB) — was highlighted. The authors noted that its benefits can begin within 24 hours, and it can reduce acute medication use and therefore the risk of medication-overuse headache.

Regarding preventive treatments overall, the authors stated that prevention should be offered if patients suffer from 6 or more days of headache per month, or 3-4 days of headache plus some-to-severe disability. Preventive treatments should be considered in patients who range from at least 2 days of headache per month plus severe disability to 4 or 5 days of headache. Prevention should also be considered in patients with uncommon migraine subtypes, including hemiplegic migraine, migraine with brainstem aura, and migraine with prolonged aura.

Initiating Treatment

When considering initiation of treatment with one of the four Food and Drug Administration–approved CGRP MABs — eptinezumab, erenumab, fremanezumab, or galcanezumab — the authors recommend their use if migraine patients show an inability to tolerate or respond to a trial of two or more older oral medications or other established effective therapies.

Though they emphasized that oral preventive medications should be started at a low dose and titrated slowly until the target response is reached or tolerability issues emerge, no such need was specified for the parenteral treatments. They also endorsed the approach of patients staying on oral preventive drugs for a minimum of 8 weeks to determine effectiveness or a lack thereof; at that point, switching to another treatment is recommended.

The dual use of therapies such as neuromodulation, biobehavioral therapies, and gepants were also examined, including gepants’ potential as a “continuum between the acute and preventive treatment of migraine” and the limited use of neuromodulatory devices in clinical practice despite clear benefits in patients who prefer to avoid medication or those suffering from frequent attacks and subsequent medication overuse. In addition, it was stated that biobehavioral therapies have “grade A evidence” supporting their use in patients who either prefer nonpharmacologic treatments or have an adverse or poor reaction to the drugs.

From the patient perspective, one of the six reviewers shared concerns about migraine patients being required to try two established preventive medications before starting a recently introduced option, noting that the older drugs have lower efficacy and tolerability. Two reviewers would have liked to see the statement focus more on nonpharmacologic and device-related therapies, and one reviewer noted the possible value in guidance regarding “exploratory approaches” such as cannabis.

Not Everyone Agrees

Commenting on the AHS consensus statement, James A Charles, MD, and Ira Turner, MD, had this to say: “This Consensus Statement incorporates the best available evidence including the newer CGRP therapies as well as the older treatments. The AHS posture is that the CGRP abortive and preventive treatments have a lesser amount of data and experience than the older treatments which have a wealth of literature and data because they have been around longer. As a result, there are 2 statements in these guidelines that the insurance companies quote in their manual of policies:

1. Inadequate response to two or more oral triptans before using a gepant as abortive treatment

2. Inadequate response to an 8-week trial at a dose established to be potentially effective of two or more of the following before using CGRP MAB for preventive treatment: topiramate, divalproex sodium/valproate sodium; beta-blocker: metoprolol, propranolol, timolol, atenolol, nadolol; tricyclic antidepressant: amitriptyline, nortriptyline; serotonin-norepinephrine reuptake inhibitor: venlafaxine, duloxetine; other Level A or B treatments.”

Charles, who is affiliated with Holy Name Medical Center in Teaneck N.J., and Turner, who is affiliated with the Center for Headache Care and Research at Island Neurological Associates in Plainview, N.Y., further said that “giving the CGRP MABs and gepants second-class status because they have not been around as long as the old boys is an insult to the research, development, and successful execution of gepant and CGRP MAB therapies in the last several years.

The authors omitted the Hepp study and the long list of adverse effects of triptans leading to high discontinuance rates, and how trying a second triptan will probably not work.” Importantly, they said, “the authors have given the insurance carriers a weapon to deny direct access to gepants and CGRP MABs making direct access to these agents difficult for patients and physicians and their staffs.”

Charles and Turner point out that the AHS guidelines use the term “cost effective” – that it is better to use the cheaper, older drugs first. “Ineffective treatment of a patient for 8 weeks before using CGRP blocking therapies and using 2 triptans before a gepant is cost ineffective,” they said. “Inadequate delayed treatment results in loss of work productivity and loss of school and family participation and excessive use of ER visits. These guidelines forget that we ameliorate current disability and prevent chronification by treating with the most effective abortive and preventive therapies which may not commence with the cheaper old drugs.”

They explain: “Of course, we would use a beta-blocker for comorbid hypertension and/or anxiety, and venlafaxine for comorbid depression. And if a patient is pain free in 2 hrs with no adverse effects from a triptan used less than 10 times a month, it would not be appropriate to switch to a gepant. However, a treatment naive migraineur with accelerating migraine should have the option of going directly to a gepant and CGRP blocking MAB.”

Charles and Turner concur that the phrase in the AHS consensus statement regarding the staging of therapy — two triptans before a gepant and two oral preventatives for 8 weeks before a CGRP MAB — “should be removed so that the CGRP drugs get the equal credit they deserve, as can be attested to by the migraine voices of lives saved by the sound research that led to their development and approval by the FDA.”

Ultimately, Charles and Turner said, “the final decision on treatment should be made by the physician and patient, not the insurance company or consensus statements.”

Alan Rapoport, MD, clinical professor of neurology at the University of California, Los Angeles, former president of the International Headache Society, and editor-in-chief of Neurology Reviews, said, “Although I think the consensus statement is well done, and the authors have the right to make the statements they have made, Drs. Charles and Turner are excellent experienced clinicians and they should be heard. They properly state that the restrictive statements highlighted by the authors have already been used by insurance companies to prevent access to the more expensive but more effective therapies with fewer adverse effects.”

Rapoport goes on to say, “I believe that the patient’s individual headache history and past responses to therapies must be analyzed by the treating physician and an appropriate treatment be agreed upon between the patient and doctor. It is time to let experienced headache-interested doctors make their own correct decision about treatment without the heavy hand of the insurance company, which is often more intent on saving money than helping the patient.

The authors acknowledged numerous potential conflicts of interest, including receiving speaking and consulting fees, grants, personal fees, and honoraria from various pharmaceutical and publishing companies.

Suggested Reading:

Hepp Z et al. Adherence to oral migraine-preventive medications among patients with chronic migraine. Cephalalgia. 2015;35(6):478-88.

Alam A et al. Triptan use and discontinuation in a representative sample of persons with migraine: Results from Migraine in America Symptoms and Treatment (MAST) study. Headache. 2018;58:68‐69.

Buse DC et al. Adding additional acute medications to a triptan regimen for migraine and observed changes in headache-related disability: Results from the American Migraine Prevalence and Prevention (AMPP) study. Headache. 2015 Jun;55(6):825-39.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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This post originally posted here Medscape Medical News

“Career Success: Youth Mentorship and Career Guidance Program” (PHOTO)

In December 2020, Junior Achievement Azerbaijan in partnership with MOL Azerbaijan and the Ministry of Education launched the “Career Success: Youth Mentorship and Career Guidance” program. It was a mentorship and work readiness program that focuses on helping youth to develop employability skills and prepare them for the world of work. The overall goal of the program was to support young people in development of professional and business skills and cultivate the future business leaders’ character, creativity and leadership through mentorship.

Due to the pandemic situation the project was implemented online engaging more than thousand young people at age 13-25, across all over Azerbaijan. Youth living not only in the regions along the BTC line including Garadagh, Absheron, Hajigabul, Agsu, Kurdamir, Yevlax, Aghdash, Shamkir, Tovuz, Gazakh, and but also other regions such as Guba, Khachmaz, Lankaran, Gakh and Gabala showed high interest in the program. The eight months long program was a great opportunity, particularly for the young people living in rural areas.

The program was designed and delivered based on the age group of the participants. Tailor Made training programs have been offered to the secondary school children and university students separately. Training sessions and mentor meetings organized during the program aimed to help participants to estimate their strengths and weaknesses, to determine their interests, to understand the world of work and to improve personal skills needed to achieve career and lifelong learning success. Through the online workshops they were introduced to the fundamental business and economic concepts, explored career interests and opportunities, and developed work-readiness skills.

The program closing and award ceremony held on July 16, 2021. Project participants, trainers and mentors attended the event with greater enthusiasm. Mr. Bakhtiyar Akhundov, country manager at MOL Azerbaijan, underlined the value of the program for the career planning and development of youth as future professionals. This project opened and showed different perspectives and opportunities for the participants.

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This post originally posted here Trend – News from Azerbaijan, Georgia, Kazakhstan, Turkmenistan, Uzbekistan, Iran and Turkey.

New CDC School Guidance Calls for In-Person Classes, With Caveats

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

School may be out for summer, but the Centers for Disease Control and Prevention (CDC) is still in session. The agency released updated guidance July 9 that promotes in-person learning when K-12 students return in the fall, and relaxed mask recommendations for those fully vaccinated against COVID-19.

“Children and adolescents benefit from in-person learning, and safely returning to in-person school in the fall of 2021 is a priority,” the July 9 CDC statement reads.  

Why now? The CDC cites “widespread availability of safe and effective COVID-19 vaccine for people aged 12 and older [as well as] recent reductions in cases, hospitalizations, and deaths.”

Masks are still recommended for anyone aged 2 years or older, including students, who is not vaccinated. “While fewer children have been sick with COVID-19 compared with adults, children can be infected with the virus that causes COVID-19, can get sick from COVID-19, can spread the virus to others, and can have severe outcomes,” the CDC statement notes.

Together but Apart

The federal agency still calls for at least three feet between student desks — down from the six feet recommended prior to March 2021.

“Using a distance of at least 3 feet between students in classrooms could provide a feasible definition of physical distancing so long as other prevention strategies are maximized,” the agency notes on its updated Science Brief addressing transmission of SARS-CoV-2 in schools.

This guidance continues calls for a layered approach to COVID-19 prevention, including the familiar strategies such as proper ventilation, hand hygiene, and staying home if symptomatic or when exposed to someone who likely has COVID-19.

A Lesson in Controversy

Like previous moves the CDC has taken that relax their COVID-19 guidance, this one is not without controversy. On Twitter, for example, reactions to the CDC’s post about the new guidance ranged from outrage to applause.

Becky Cunningham, a mother with two children, for example, questioned how the guidance for the unvaccinated to keep wearing masks in schools will be enforced. “Hard to trust that folks will just do the right thing & follow the rules/be honest!!” she tweeted.

Another tweet raised the issue of enforcing the honor system for mask wearing. Ana Mercedes appeared to back the new guidance: “That’s great since my 17yr old is vaccinated.”

Other parents of children with underlying medical conditions or below the 12-year-old minimum age for vaccination were more concerned.

For example, “Eve” tweeted that the CDC’s new guidance “is ridiculously irresponsible.”

The CDC is not calling for proof of vaccination for teachers or students. Nor does the agency specifically outline how schools can determine which students are vaccinated and which are not, or how to enforce mask wearing among the unvaccinated.

The CDC, instead, said it is providing enough flexibility for local districts and schools to adapt the guidance as needed based on local conditions.

Sources:  Prevention in Kindergarten (k)-12 Schools / CDC and  Science Brief: Transmission of SARS-Cov-2 in K-12 Schools and Early Care and Education Programs – Updated / CDC, both updated July 9, 2021.

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.

For more news, follow Medscape on Facebook, Twitter, Instagram, YouTube, and LinkedIn.

Author: Damian McNamara
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State pension age rises force retirement plan changes – ‘vital’ funding guidance issued

State pension ages have been steadily rising in recent years as state legislation pushes retirement ages upwards. Currently, most people will reach their state pension age on their 66th birthday but this will rise over the coming years.

Canada Life detailed changes to state pension legislation have impacted the retirement plans of homeowners over 40, with only a quarter saying they will retire at their state pension age.

Nearly a third (31 percent) of respondents said they plan to work beyond their state pension age, with this increasing to 50 percent of the over 60s.

Equally, 34 percent plan to finish up work early and retire before their nominated state pension age. One in ten (11 percent) said they had already stopped working before their state pension kicked in.

When asked what they expect their main source of income to be in retirement, nearly a third (28 percent) of homeowners aged 40 and above expect the state pension will provide the “bedrock” of their income (22 percent for men vs 36 percent for women), even with the full state pension currently standing at just £179.60 per week, or £9,350 per year.

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When looking at what sources of income will be incorporated into retirement planning, a gender gap emerged.

Canada Life noted while men and women both expect to rely on the state pension equally, gaps emerged in the following assets:

  • Workplace pension – 67 percent (73 percent for men vs 61 percent for women)
  • Personal pension – 34 percent (38 percent for men vs 29 percent for women)
  • ISAs – 26 percent (30 percent for men vs 22 percent for women)
  • Financial investments – 15 percent (19 percent for men vs 11 percent for women)

“However, the amount received is not generous by any standard and, as a result, the onus is on individuals to take personal responsibility to save for retirement.

“Employees can build on the state pension and any workplace savings they have.

“Self-employed people face more of a challenge as they don’t have an employer to help fund their retirement.

“As the goalposts for the state pension shift, it is vital people check their state pension age, the amount they are due to receive, and whether they are eligible for the full state pension.

“It’s equally important that those who have spent time out of employment check their record, claim any National Insurance credits possible, and think about making any top-ups in order to be entitled to as much state pension as possible.

“Taking a proactive approach, seeking the help of an adviser, and making good decisions now will all help to fund retirements.”

Author: Connor Coombe-Whitlock
Read more here >>> Daily Express :: Finance Feed

ADA Guidance: Bring Type 1 Diabetes in Adults Out of the Shadows

A new draft consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) addresses diagnosis and management of type 1 diabetes in adults.

Type 1 Diabetes in Adults Out of the Shadows

The impetus for the document comes from the “highly influential” EASD-ADA consensus report on the management of type 2 diabetes, which led to the realization that a comparable document was needed for adults with type 1 diabetes, said writing panel cochair Anne L. Peters, MD, professor of clinical medicine at Keck School of Medicine, University of Southern California, Los Angeles

Read more on Medscape Medical News Headlines

Guidance Provided for Telepsychiatry in Tardive Dyskinesia

Tardive dyskinesia (TD) can be reasonably managed through telemedicine, but it should be employed as part of a hybrid strategy that ideally includes an office visit at the time of diagnosis and yearly intervals thereafter, according to an expert who spoke at a meeting presented by Current Psychiatry and the American Academy of Clinical Psychiatrists.

In psychiatry in general and in TD specifically, telepsychiatry is useful, but “is not a one-size-fits-all approach,” according to Rif S. El-Mallakh, MD, director of the mood disorder research program at the University of Louisville (Ky.).

Telepsychiatry was already growing as a strategy to expand psychiatric services to communities with limited resources in mental health when the COVID-19 pandemic arrived. Dependence on this type of patient care then exploded out of necessity but in advance of how it might best be applied in specific circumstances.

Best Practices Panel Convened in 2020

The project to develop best practices in TD began in July 2020, when the pandemic was still limiting normal clinician-patient interactions. It was expected from the beginning that recommendations would be applicable to postpandemic circumstances.

There is no reason to expect the forces driving the growth of telepsychiatry, which include convenience of patients and efficiency for clinicians, to dissipate once the pandemic resolves, El-Mallakh said at the virtual meeting, sponsored by MedscapeLive.

The process of developing best practices for telepsychiatry in TD began with semistructured qualitative interviews of the panelists, which consisted of six neurologists, three psychiatrists, and three psychiatric nurse practitioners. The goal was to gather information about the current practice of TD diagnosis and treatment in real-world settings.

With the information on current practices providing a baseline, a virtual roundtable was then convened to develop best-practices recommendations. The deliberations were performed on the basis of expert opinion. There were no statistical methods applied to data collected from the qualitative interviews.

Four Key Points in Recommendations

The panel agreed on four key points: an in-person visit is preferred for initial evaluation and diagnosis; when applied for the evaluation of TD, telepsychiatry should include video; virtual visits cannot completely replace in-person visits; and patients with TD should be evaluated in person at least once per year.

In addition, the panelists recommended specific steps aimed at maximizing the quality of the virtual visit, including confirming that patients have appropriate equipment for video and audio communication. It is also important to recognize that patients or caregivers may require instruction on how to set up the equipment.

Prior to a telemedicine visit, it is appropriate to provide patients with a checklist that includes instructions on adequate lighting and audio. In addition, patient expectations about the goals and processes in the video should be explained.

“Instructional videos prior to the visit might be helpful,” El-Mallakh said.

Immediately prior to each visit, visual and audio quality should be verified. This allows technical issues, if any, to be resolved.

For the evaluation of TD, the ability to adequately observe body movements is crucial but can pose a challenge in telepsychiatry. To capture hyperkinetic movements and functional impairments with adequate clarity, it might be necessary to engage caregivers to hold the camera or otherwise help the clinician gain an adequate view. Clinicians should consider the limitations of telepsychiatry.

In addition to the challenges of a differential diagnosis for TD that should include such entities as parkinsonism and other drug-induced movement disorders, El-Mallakh cautioned, “comorbidities add another layer of complexity to TD diagnosis.”

Some In-Office Visits Recommended

It is this complexity that led to the recommendation for an in-person evaluation for new-onset TD, although the expert panel did not characterize an initial in-office visit as mandatory.

Once a diagnosis of TD is established, telepsychiatry can be an efficient strategy for education and for confirming that treatments remain effective. However, El-Mallakh pointed out that patients can and often do have more than one drug-induced movement disorder at the time of diagnosis or develop additional clinical issues over time.

According to the expert panel, telepsychiatry should not be considered an adequate strategy to manage TD by itself, but “it can be an important component” of care of these patients if used judiciously.

“We have all come to recognize the benefits of telepsychiatry and some of the limitations,” said Jonathan M. Meyer, MD, clinical professor of psychiatry, University of California, San Diego. An author or coauthor of several articles on TD, including a recent study of patient awareness of TD symptoms while on vesicular monoamine transporter 2 inhibitors, Meyer identified technical problems as among the limitations.

“For movement disorders in particular, low bandwidth, poor video quality and lighting, and inadequate visualization of the trunk and limbs all present issues in diagnosing TD, scoring its severity, and differentiating it from other movement disorders,” he said.

“Nonetheless, I agree with the panel conclusions that in many instances, a video visit can be used to diagnose TD, assess severity, and monitor changes in symptoms over time,” he added, but he did express caution.

“For cases where the diagnosis is in doubt or where comorbid disorders require physical assessment, an in-person examination should be performed before embarking on any TD treatment strategy,” Meyer said.

MedscapeLive and this news organization are owned by the same parent company. El-Mallakh has ties with Allergan, Janssen, Lundbeck, Otsuka, Takeda, Teva, and Neurocrine Biosciences, which provided funding for this expert panel and summary. Meyer has ties with Acadia, Alkermes, Allergan, Merck, Neurocrine, Otsuka, Sunovion, and Teva.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

This post originally appeared on Medscape Medical News Headlines

AAP Updates Guidance for Return to Sports and Physical Activities

As pandemic restrictions ease and young athletes once again take to fields, courts, tracks, and rinks, doctors are sharing ways to help them get back to sports safely.

That means taking steps to prevent COVID-19.

It also means trying to avoid sports-related injuries, which may be more likely if young athletes didn’t move around so much during the pandemic.

For adolescents who are eligible, getting a COVID-19 vaccine may be the most important thing they can do, according to the American Academy of Pediatrics (AAP).

“The AAP encourages all people who are eligible to receive the COVID-19 vaccine as soon as it is available,” the organization wrote in updated guidance on returning to sports and physical activity.

“I don’t think it can be overemphasized how important these vaccines are, both for the individual and at the community level,” says Aaron L. Baggish, MD, an associate professor of medicine at Harvard Medical School and director of the Cardiovascular Performance Program at Massachusetts General Hospital in Boston.

Baggish, team cardiologist for the New England Patriots, the Boston Bruins, the New England Revolution, US Men’s and Women’s Soccer, and US Rowing, as well as medical director for the Boston Marathon, has studied the effects of COVID-19 on the heart in college athletes and written return-to-play recommendations for athletes of high school age and older.

“Millions of people have received these vaccines from age 12 up,” Baggish says. “The efficacy continues to look very durable and near complete, and the risk associated with vaccination is incredibly low, to the point where the risk-benefit ratio across the age spectrum, whether you’re athletic or not, strongly favors getting vaccinated. There is really no reason to hold off at this point.”

While outdoor activities are lower-risk for spreading COVID-19 and many people have been vaccinated, masks still should be worn in certain settings, the AAP notes.

“Indoor spaces that are crowded are still high-risk for COVID-19 transmission. And we recognize that not everyone in these settings may be vaccinated,” says Susannah Briskin, MD, lead author of the AAP guidance.

“So for indoor sporting events with spectators, in locker rooms or other small spaces such as a training room, and during shared car rides or school transportation to and from events, individuals should continue to mask,” adds Briskin, a pediatrician in the Division of Sports Medicine and fellowship director for the Primary Care Sports Medicine program at University Hospitals Rainbow Babies & Children’s Hospital.

For outdoor sports, athletes who are not fully vaccinated should be encouraged to wear masks on the sidelines and during group training and competition when they are within 3 feet of others for sustained amounts of time, according to the AAP.

Get Back Into Exercise Gradually

In general, athletes who have not been active for more than a month should resume exercise gradually, Briskin says. Starting at 25% of normal volume and increasing slowly over time — with 10% increases each week — is one rule of thumb.

“Those who have taken a prolonged break from sports are at a higher risk of injury when they return,” she notes. “Families should also be aware of an increased risk for heat-related illness if they are not acclimated.”

Caitlyn Mooney, MD, a team doctor for the University of Texas at San Antonio, has heard reports of doctors seeing more injuries like stress fractures. Some cases may relate to people going from “months of doing nothing to all of a sudden going back to sports,” says Mooney, who is also a clinical assistant professor of pediatrics and orthopedics at UT Health San Antonio.

“The coaches, the parents, and the athletes themselves really need to keep in mind that it’s not like a regular season,” Mooney says. She suggests gradually ramping up activity and paying attention to any pain. “That’s a good indicator that maybe you’re going too fast,” she adds.

Athletes should be mindful of other symptoms too when restarting exercise, especially after illness.

It is “very important that any athlete with recent COVID-19 monitor for new symptoms when they return to exercise,” says Jonathan Drezner, MD, a professor of family medicine at the University of Washington in Seattle. “A little fatigue from detraining may be expected, but exertional chest pain deserves more evaluation.”

Drezner — editor-in-chief of the British Journal of Sports Medicine and team doctor for the Seattle Seahawks — along with Baggish and colleagues, found a low prevalence of cardiac involvement in a study of more than 3000 college athletes with prior SARS-CoV-2 infection.

“Any athlete, despite their initial symptom course, who has cardiopulmonary symptoms on return to exercise, particularly chest pain, should see their physician for a comprehensive cardiac evaluation,” Drezner says. “Cardiac MRI should be reserved for athletes with abnormal testing or when clinical suspicion of myocardial involvement is high.”

If an athlete had COVID-19 with moderate symptoms (such as fever, chills, or a flu-like syndrome) or cardiopulmonary symptoms (such as chest pain or shortness of breath), cardiac testing should be considered, he notes.

These symptoms “were associated with a higher prevalence of cardiac involvement,” Drezner said in an email. “Testing may include an ECG, echocardiogram (ultrasound), and troponin (blood test).”

For kids who test positive for SARS-CoV-2 but do not have symptoms, or their symptoms last less than 4 days, a phone call or telemedicine visit with their doctor may be enough to clear them to play, says Briskin, who’s also an assistant professor of pediatrics at Case Western Reserve University School of Medicine.

“This will allow the physician an opportunity to screen for any concerning cardiac signs or symptoms, update the patient’s electronic medical record with the recent COVID-19 infection, and provide appropriate guidance back to exercise,” she adds.

Baggish, Briskin, Mooney, and Drezner had no relevant financial disclosures.

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This post originally appeared on Medscape Medical News Headlines

How to do CPR: Public urged to learn new Covid-safe guidance after Christian Eriksen saved

Christian Eriksen collapsed and suffered a cardiac arrest during Denmark’s opening Euro 2020 match against Finland on Saturday. His teammate, Simon Kjaer, has been hailed as a hero for his quick response to his teammate’s collapse. Kjaer rushed to Eriksen’s side, secured his neck, cleared the airways and started CPR before the medics arrived.

This action could have played a life-saving role in Eriksen’s recovery and now St John Ambulance is encouraging the public to learn how to perform CPR themselves.

A St John Ambulance spokesperson said on Twitter: “You don’t have to be a football fan to have been affected by the events at the Finland vs Denmark match.

“Ask us how CPR saves lives and why it is first aid everyone should know.”

CPR gives a person the best chance of survival following a cardiac arrest. It typically involves chest compressions and rescue breaths but, in light of the coronavirus pandemic, new guidance has been given, with people not to perform rescue breaths at all.

READ MORE:Fatty liver disease symptoms: Four signs on the hand

St John Ambulance’s updated guidance is as follows:

1. If you find someone collapsed, establish whether they are unresponsive and not breathing. Do not put your face close to theirs to do this.

2. You should ask someone to call 999 while you start CPR. If you are alone, use the hands-free speaker on a phone so you can start CPR while speaking to ambulance control.

3. Before you start CPR, use a towel or piece of clothing and lay it over the mouth and nose of the casualty.

Do not give rescue breaths.

This post originally appeared on Daily Express :: Life and Style Feed
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States Follow CDC Guidance, Drop Mask Mandates

It’s only been 5 days since the CDC made a long-awaited change to its mask guidance, and 23 states and Washington, DC, have already followed suit.

According to the new recommendations, fully vaccinated people no longer need to wear masks indoors or outdoors, regardless of gathering size. The CDC still advises travelers to wear masks while on airplanes, buses, or trains, and the guidance still calls for masks in some indoor settings, including hospitals, homeless shelters, and prisons. Those who are not vaccinated should still wear masks and physically distance, the CDC says.

“Anyone who is fully vaccinated can participate in indoor and outdoor activities, large or small, without wearing a mask or physically distancing,” CDC Director Rochelle Walensky, MD, said last week. “We have all longed for this moment when we can get back to some sense of normalcy.”

As a result, states and territories including Michigan, Washington, DC, and New York have given vaccinated residents the OK to ditch their masks.

The changes come as COVID-19 cases and deaths continue to decline. President Joe Biden said in remarks Monday that 60% of Americans have received at least one vaccine shot. COVID-related deaths are down by more than 80%, and the administration aims to have 70% of the U.S. at least partially vaccinated by July 4.

At a White House media briefing last week, the COVID-19 Response Team reported that since everyone 16 and over became eligible for vaccination, cases have dropped by 45%.

Walensky reported a 7-day average last Thursday of about 36,800 cases per day, a 23% decrease from the week-before average. During a media briefing today, Walensky said fewer than 18,000 new cases were reported Monday, the lowest number since June. The 7-day average of new hospital admissions was 3,500, down from 4,100  a week before.

Twenty-seven states never enacted masks rules. But, these are the states that did and now have adopted the CDC mask guidelines, although certain counties, towns, and businesses may still be enforcing their own rules:


White House COVID-19 Response Team media briefings, May 13, 2021, May 18, 2021.

Chicago Tribune: “Following CDC guidelines, Gov. J.B. Pritzker says those who are fully vaccinated can drop masks in most situations, but Chicago maintaining status quo for now.”

COVID19.CA.gov: “California will align its mask guidance with CDC’s on June 15, 2021.”

Colorado Department of Public Health and Environment: “Guidance for wearing masks.”

Michigan.gov: “May 15, 2021 Gatherings and Face Mask Order.”

Connecticut’s Official State Website: “Connecticut COVID-19 Response.”

Delaware.gov: “Governor Carney to Lift Delaware Mask Mandate Effective May 21.”

DCHealth: “Coronavirus Situational Update.”

Kentucky.gov: “Gov. Beshear: Economy Set for Liftoff as Final Capacity Limits End June 11.”

State of Maine: “Face Covering Executive Order FAQs.”

Office of Governor Larry Hogan: “Governor Hogan Announces End of Statewide Mask Mandate.”

NC Governor Roy Cooper: “Following New CDC Guidance on Face Coverings, Governor Cooper Lifts Many COVID-19 Restrictions.”

Minnesota COVID-19 Response: “Safely ending COVID-19 restrictions.”

Nevada Health Response: “Nevada Adopts Updated CDC Mask Guidance.”

Office of the Governor Michelle Lujan Grisham: “Updated public health order in effect; New Mexico adopts CDC mask guidance for fully vaccinated individuals.”

New York State: “Governor Cuomo Announces New York State to Adopt New CDC Guidance on Mask Use and Social Distancing for Fully Vaccinated Individuals.”

Ohio Department of Health: “Governor DeWine Statement on New CDC Mask Guidance.”

Oregon.gov: “Oregon Mask Requirements.”

Pennsylvania Department of Health: “Updated Order of the Secretary of the Pennsylvania Department of Health Requiring Universal Face Coverings.”

Rhode Island Department of Health: “Protect Your Household from COVID-19.”

Office of Governor Phil Scott: “Governor Phil Scott Lifts Mask Mandate For Vaccinated Individuals, Accelerates Vermont Forward Plan.”

Virginia Governor Ralph S. Northam: “Governor Northam Lifts Mask Mandate to Align with CDC Guidance, Announces Virginia to End COVID-19 Mitigation Measures on May 28.”

King County: “Statewide requirement to wear face coverings.”

Office of the Governor Jim Justice: “COVID-19 UPDATE: Gov. Justice lifts face covering requirement for fully vaccinated West Virginians.”

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

This post originally appeared on Medscape Medical News Headlines

New CDC mask guidance creating a caste system

The US Centers for Disease Control and Prevention’s (CDC) announcement that fully vaccinated individuals no longer need to wear masks in public has led to some stores dropping their mask requirements.

Boom Bust talks to Jeffrey Tucker, author of ‘Liberty or Lockdown’, about how businesses and consumers are reacting to the ruling.Tucker says it “has created a weird situation where the customers don’t have masks and employees all do, which is a way of broadcasting clean versus unclean, like a caste system.”

“That’s extremely dangerous, the CDC’s announcement was not for everyone, it was only for the vaccinated,” he says.  Children can’t get vaccines, so it means they will continue to be masked in schools, Tucker points out. “The science didn’t change with the CDC’s politics that suddenly shifted for, I would say, politically expedient reasons, and now the rest of the countries are scrambling to adapt.”

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Author: RT
This post originally appeared on RT Business News