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Congo to begin Ebola vaccinations on Monday

GOMA, Democratic Republic of Congo (Reuters) – Health workers in Democratic Republic of Congo will begin a vaccination campaign on Monday aimed at containing an outbreak of the deadly Ebola virus, a spokeswoman for the health ministry said.

Medecins Sans Frontieres (MSF) workers talk to a worker at an isolation facility, prepared to receive suspected Ebola cases, at the Mbandaka General Hospital, in Mbandaka, Democratic Republic of Congo May 20, 2018. REUTERS/Kenny Katombe

Jessica Ilunga said 4,000 doses of vaccine were shipped on Saturday to the city of Mbandaka, which last week registered the first cases in an urban area since the latest flare-up of the disease was announced earlier this month.

The outbreak is Congo’s ninth since the disease made its first known appearance in the 1970s. The cases in Mbandaka, a port city on the Congo river, have raised concerns that the virus could spread downstream to the capital Kinshasa, which has a population of 10 million.

According to Congolese health ministry data released late on Saturday, there have been four cases of Ebola confirmed through testing in Mbandaka’s Wangata neighborhood and another two suspected cases.

One confirmed Ebola patient has died there, the figures showed.

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The World Health Organization (WHO) said on Friday that the disease had killed 25 people since early April.

Confirmation of Ebola in Mbandaka, a city of about 1.5 million people, prompted the WHO last week to declare a “very high” public health risk for the country and a “high” risk for the region.

However, it said the outbreak could be brought under control and was not yet an international public health emergency.

“Previous outbreaks have demonstrated the importance of a rapid and well-resourced response in order to save lives, but also prevent an exponential increase in the economic cost of a response,” WHO spokesman Tarik Jasarevic said on Sunday.

The U.N. health body was heavily criticized as too slow to declare an international emergency during an outbreak in West Africa. That epidemic spread mainly through Guinea, Sierra Leone and Liberia, killing more than 11,300 people from 2013 to 2016.

Jasarevic said the WHO was seeking $ 26 million to fund the Ebola response in Congo.

The WHO is sending 7,540 doses of the vaccine developed by Merck (MRK.N) to Congo. It is also in talks about a second vaccine made by Johnson & Johnson (JNJ.N).

More than 30 health workers with experience administering Ebola vaccines are being deployed from Guinea to help with the campaign in Congo.

A government spokesman said late on Saturday that Congo’s partners had promised to make available 300,000 doses of vaccine.

Reporting by Fiston Mahamba in Goma and Issa Sikiti da Silva in Kinshasa; writing by Joe Bavier; Editing by Dale Hudson and Jason Neely

Congo to begin Ebola vaccinations on Monday: health ministry

ABIDJAN (Reuters) – Health workers in Democratic Republic of Congo will begin a vaccination campaign on Monday aimed at containing an outbreak of the deadly Ebola virus, a spokeswoman for the health ministry said on Sunday.

World Health Organization (WHO) medical supplies to combat the Ebola virus are seen packed in crates at the airport in Mbandaka, Democratic Republic of Congo May 19, 2018. REUTERS/Kenny Katombe

Jessica Ilunga said that 4,000 doses of vaccine were shipped on Saturday to the city of Mbandaka, which last week registered its first cases of the disease in an urban area since the outbreak was declared earlier this month.

Reporting by Fiston Mahamba; writing by Joe Bavier; editing by Jason Neely

In Congo city where Ebola resides, fear but not panic

MBANDAKA, Democratic Republic of Congo (Reuters) – In the city of Mbandaka in northwest Congo, Mbombo Roge does not shake hands with friends anymore: Ebola changed all that.

A Congolese man washes his hands as a preventive measure against Ebola in Mbandaka, Democratic Republic of Congo May 19, 2018. REUTERS/Kenny Katombe

Roge simply bowed when he met a group of friends on Saturday afternoon, obeying one of the key lessons taught by health officials since an outbreak of the deadly virus was confirmed in the city of 1.5 million people this week.

“Ebola doesn’t forgive,” said Roge on a street in the center of Mbandaka “We just greet each other with words so as to not get contaminated.”

The outbreak of Ebola in Congo, the vast central African country’s ninth since the disease made its first known appearance near the northern Ebola river in the 1970s, is believed to have cost the lives of 25 people since April.

The outbreak is dwarfed by the epidemic which killed over 11,300 in Guinea, Liberia and Sierra Leone between 2013 and 2016, but it brings with it some worrying echoes.

A motorcyclist rides along the main street in Mbandaka, Democratic Republic of Congo May 19, 2018. REUTERS/Kenny Katombe

The first confirmed case in Mbandaka on Thursday raised concerns it could spread much faster than in the rural areas where it had previously been detected.

Mbandaka, a crowded trading hub on the banks of the Congo River where people live in close proximity, has road, water and air links to the capital Kinshasa, whose population is 10 million.

Since Thursday, three other cases have been confirmed in Mbandaka. The World Health Organization (WHO) has declared a “very high” public health risk to the country since those cases were detected. Over 4,000 vaccines are expected to be deployed to the region early next week.

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The Ebola virus causes hemorrhagic fever and is spread through direct contact with body fluids from an infected person, who suffers severe bouts of vomiting and diarrhea.

So far, the changes in Mbandaka are subtle, but they point to a growing trepidation. At the small regional airport, health inspectors check the temperature of arriving passengers. Local aid agencies have gone to churches and schools to try to educate people of the dangers.

Soap dispensers have been put outside some local businesses so people can wash their hands before entering. Meat sales at riverside markets have dropped off, traders say, because of the fear of eating contaminated bush meat which can pass Ebola on to humans.

“We are scared of this epidemic. We can’t make contact with people coming from outside,” said border hygiene inspector Bolongoyi Juptie.

Not everyone is convinced of the dangers, and one resident said that Ebola can be cured through prayer.

But the general wariness is encouraging for health officials who remember how mistrust of doctors, nurses, authorities and western aid agencies made containment more difficult during the 2013-16 epidemic.

“There is a need to increase awareness,” said Joseph Bolongo, former project manager at the NGO Gashe and local resident, “so that ignorance does not facilitate the spread of the disease.”

Writing by Edward McAllister; Editing by Chris Reese

Obamacare tied to earlier cancer detection in young women

(Reuters Health) – Under the Affordable Care Act (ACA) provision allowing adult children to stay on their parents’ health insurance policy until age 26, young women with gynecological cancers were diagnosed and treated sooner, researchers say.

Before the law, often called Obamacare, went into effect, one in three women aged 19 to 26 years had health insurance, and today more than four in five women in this age group are insured, the study team notes in Obstetrics & Gynecology.

In a comparison of young women who would have had access to insurance coverage under the law, and slightly older women who would not have had the same access, researchers found that 3.6 percent more of the younger group had their cancers diagnosed at an early stage.

“Each year in the U.S., several thousand young women are diagnosed with gynecological cancers, including cervical, endometrial, ovarian and vulvovaginal cancers,” the study’s authors, Drs. Anna Smith and Amanda Fader, told Reuters Health in an email.

“We know that diagnosing and treating women in the earlier stage of disease helps them live longer and healthier, which is particularly important for young women. However, prior to the ACA, young people were more likely to be uninsured than any other group of Americans,” said Smith and Fader, both gynecologists at Johns Hopkins School of Medicine in Baltimore.

Although cancer is diagnosed less frequently in young adults compared with older people in the U.S., it’s a leading cause of death in this population, Smith and Fader said.

“Additionally, while the incidence of many types of cancer in the U.S. is plateauing or decreasing, the incidence of some gynecologic cancers and pre-cancers is increasing. This means that more younger women are potentially susceptible,” they noted.

For example, because endometrial cancer is strongly associated with obesity and there is a major obesity epidemic in the U.S. and globally, we are seeing the incidence of this cancer rise over the last two decades, and more women under the age of 45 are being diagnosed, Smith and Fader said.

For their study, the researchers analyzed data from a national cancer database. They included in the analysis women aged 21 to 35 diagnosed with uterine, cervical, ovarian, vulvar or vaginal cancer during the years 2004 to 2009, before the ACA went into effect, and 2011 to 2014, after the ACA went into effect.

Among women diagnosed at ages 21 to 26, the study team identified a total of 1,912 gynecologic cancer cases before the ACA and 2,059 during the ACA, and among women diagnosed between 27 and 35, there were 9,782 cases before ACA and 10,456 cases during the ACA.

In addition to the younger women being more likely to be insured and diagnosed when their cancer was at an earlier stage, women in both age groups were more likely to receive fertility-sparing cancer treatments during the ACA years, the study found.

“This study adds to the evidence of the positive effects of improved coverage through the ACA on young women’s healthcare costs and choices,” Dr. Laura Havrilesky, a gynecologist at Duke University Medical Center in Durham, North Carolina, writes in an editorial accompanying the study.

“This is an important study looking at the effects of the Affordable Care Act on insurance coverage in young women with a cancer diagnosis,” Havrilesky told Reuters Health in an email.

The immediate extension of insurance coverage to dependents under age 26 by the ACA in 2010 resulted in improved insurance coverage rates and earlier stage at diagnosis of uterine cancer in young women aged 21 to 25, she added.

“This is important because younger women with low-stage cancer can sometimes be candidates for fertility-sparing surgery,” Havrilesky said.

Young women have traditionally faced discriminatory insurance practices such as higher insurance premiums than men at the same age and denial of maternity care coverage, she noted.

“The ACA has resulted in a measurable reduction in the rate at which women skip recommended screening and prevention tests as well as a huge savings from improved oral contraceptive coverage,” Havrilesky said.

These are just two examples of areas where the coverage of young women ultimately affects the entire population, she said.

SOURCE: bit.ly/2IjhvdF and bit.ly/2rLzXQT Obstetrics and Gynecology, online May 7, 2018.

Pediatricians urged to warn vulnerable kids away from '13 Reasons Why' Netflix series

(Reuters Health) – A report in the journal Pediatrics warns that watching “13 Reasons Why,” a popular Netflix series about a teen girl’s suicide, may be inadvisable for some youngsters.

Mental health professionals have raised alarms that the series – which closes with a graphic depiction of the main character killing herself – could push other young people toward suicide. The second season of the show will air on May 18, while the first season remains available on Netflix.

In an article titled, “13 Things Pediatricians Should Know (and do) About 13 Reasons Why,” Dr. Michael B. Pitt and colleagues of the University of Minnesota Masonic Children’s Hospital in Minneapolis encourage doctors to warn vulnerable young patients – and their parents – away from the show.

“The first thing that we have been surprised by is how few of our colleagues even know about this show,” Pitt told Reuters Health by email. While “13 Reasons” raised a pop culture buzz amid concerns the show might trigger a wave of suicides, he added, “there hasn’t been much digging deep into what the science was.”

Best practices established by the World Health Organization, the International Association for Suicide Prevention, the Centers for Disease Control and Prevention and others address how the media can portray suicide in ways that do not trigger “copycat” deaths among vulnerable individuals.

The CDC guidelines, published in 1994, state that simplistic explanations for suicide, reports that serve as a “how to” for suicide, and coverage that glorifies the person who died by suicide, among other factors, can promote suicide contagion.

“One of the best practices is not to portray suicide, period,” Pitt said. “What struck me watching this now as a parent is the nature of the kind of hero worship that happens. It essentially makes her the most popular kid in school after she’s killed herself.”

In reviewing records at their own health system, the authors identified more than 60 documented references to the show by 31 pediatric patients treated in the six months after “13 Reasons” first aired. Three-quarters of the patients were receiving treatment related to a suicide attempt, and more than half of the children’s parents said they feared the show had made their child’s mental health symptoms worse.

The authors urge pediatricians to follow the American Academy of Pediatrics’ new guidelines calling for universal depression screening for patients aged 12 and older, and to ask their patients about their media consumption.

“Physicians need to not only be aware of the show and the potential ramifications, but also really become comfortable asking their patients about whether or not they are thinking of suicide,” Dr. Kimberly O’Brien, a research scientist at Boston Children’s Hospital Education Development Center and an instructor of psychiatry at Harvard Medical School, told Reuters Health by phone. Dr. O’Brien’s research focuses on suicidal adolescents, but she did not take part in the new study.

O’Brien said she and her colleagues saw a “huge spike” in people admitted to inpatient psychiatric care who reported identifying with the show’s main character, and wanted to kill themselves like she did, in the few months after the show first aired in 2017. In recent years, she noted, suicide has climbed from the third to the second leading cause of death among teens.

“We’re also seeing a spike in attempts in this age range, and it’s disproportionately affecting certain demographics like sexual- and gender-minority youth,” she said.

While watching the show may not be harmful for someone who has never had suicidal thoughts, “for the kids who have been struggling with suicidal thoughts for perhaps their whole lives, this could be really detrimental for them to watch,” O’Brien said.

“I think really the most problematic piece of the whole show was how they depicted Hannah Baker’s suicide. I really feel they could have had the same positive impact without actually showing it in such graphic detail,” she added.

“I do have some hope for the second season that they will really listen to us and make the changes that need to be made,” she said.

In an email to Reuters Health, a Netflix spokesperson cited a recent survey from Northwestern University that found the show led to conversations about bullying, suicide and mental health between teens and their parents.

“That said, we want viewers to be informed and make the right choice for themselves and their families, which is echoed in the video warning message from the cast that plays before each season,” the spokesperson said, noting that Netflix offers a range of parental controls to restrict what kids can watch.

Netflix said it is offering other resources including a discussion guide for families and educators, a video discussion series and a website where viewers can find support locally (13reasonswhy.info).

SOURCE: bit.ly/2rNvBJ9 Pediatrics, online May 15, 2018.

U.S. agency rescinds order banning Louisiana distributor from opioid sales

WASHINGTON (Reuters) – The U.S. Drug Enforcement Administration on Friday reversed an order that halted a Louisiana drug wholesaler’s opioid sales over allegations it failed to report suspiciously large orders by pharmacies for the narcotics, court documents showed.

Seeking to battle a national opioid abuse crisis, the agency of the Justice Department imposed the suspension on Shreveport-based Morris & Dickson Co on May 2. It accused the 177-year-old company of failing to “properly identify large suspicious orders for controlled substances sold to independent pharmacies.”

The company immediately disputed the charge, and last week a U.S. District Court judge in Shreveport entered a temporary restraining order blocking the DEA from enforcing the suspension.

“This is a striking vindication for our family company,” Paul Dickson, president of Morris & Dickson, said in a statement posted on the company’s website on Friday.

“This proves what we’ve said all along – that DEA’s hasty action was unjustified. We have always taken our responsibility to prevent diversion seriously.”

The DEA’s order marked the first time during President Donald Trump’s administration that it had moved to immediately block narcotic sales by a distributor as the agency attempts to combat a national opioid abuse epidemic.

A DEA probe focusing on purchases of the highly addictive painkillers oxycodone and hydrocodone showed that, in some cases, pharmacies were allowed to buy as much as six times the quantity of narcotics they would normally order, the agency said.

The U.S. government is trying to crack down on opioid abuse through a number of measures, including a proposal last month to tighten rules governing the amount of prescription opioid painkillers that drugmakers can manufacture in a given year.

Reporting by Eric Walsh; Editing by Cynthia Osterman

Exclusive: HCA, KKR team up for Envision bid – sources

(Reuters) – U.S. hospital operator HCA Healthcare Inc (HCA.N) and private equity firm KKR & Co (KKR.N) have joined forces to make an offer for U.S. physician services provider Envision Healthcare Corp (EVHC.N), people familiar with the matter said on Friday.

FILE PHOTO: CEO of Kohlberg Kravis Roberts & Co (KKR) Henry Kravis (C) departs after meeting India’s Prime Minister Narendra Modi at a breakfast in the Manhattan borough of New York September 29, 2014. REUTERS/Carlo Allegri/File Photo

The move is aimed at giving HCA and KKR an edge over buyout firms that are also pursuing Envision, which has a market capitalization of $ 5.1 billion and long-term debt of $ 4.6 billion, the sources said.

HCA, which has a market capitalization of $ 36 billion and long-term debt of $ 31.6 billion, wants to acquire Envision’s AmSurg ambulatory surgery business, with KKR taking the over the remainder, according to the sources.

Nashville-based Envision has asked potential acquirers to submit final offers later this month, the sources said. Other private equity firms competing for Envision include a consortium of Carlyle Group LP (CG.O) and TPG Global, the sources added.

The sources asked not to be identified because the matter is confidential. KKR, Carlyle and TPG declined to comment. Envision and HCA did not immediately respond to requests for comment.

Envision announced last year it was reviewing a range of strategic alternatives after reporting disappointing third-quarter earnings, which it attributed partly to the effects of hurricanes Harvey and Irma as well as a slowdown in the growth of patient demand.

Last year, Envision agreed to sell its ambulance unit, AMR, to Air Medical, a medical helicopter business owned by KKR, for $ 2.4 billion.

The year prior, it merged with AmSurg in an all stock deal that valued the combined companies at the time at around $ 10 billion. HCA’s and KKR’s bid would reverse that combination.

A sale of Envision would be the latest in a spate of mergers and acquisitions activity among physician networks, a business that has struggled in recent years to adapt to changes in how U.S. health insurers reimburse providers.

Federal reimbursement programs such as Medicare and Medicaid, for example, have been trying to shift to a “value-based” payment model, whereby providers sometimes receive fixed payments to encourage them to control costs.

Last year, U.S. kidney care-provider DaVita Inc (DVA.N) agreed to sell its medical group business, Davita Medical Group, to UnitedHealth Group Inc. (UNH.N) for $ 4.9 billion.

Envision’s rival MEDNAX Inc (MD.N) has also been exploring strategic alternatives, including a sale, Reuters has reported.

In 2016, buyout firm Blackstone Group LP (BX.N) acquired hospital staffing provider Team Health Holdings Inc for $ 6.1 billion.

Reporting by Joshua Franklin and Carl O’Donnell in New York; Editing by Cynthia Osterman

Congo northwest city Mbandaka confirms three new Ebola cases

KINSHASA (Reuters) – Three new cases of Ebola were confirmed in northwest Congo’s regional capital of Mbandaka on Friday, in a part of the city lying next to the Congo River, the health ministry said.

The ministry statement late on Friday said the suspected cases had been reported in the neighborhood of Wangata, next to the river, on Thursday. Samples had been taken for testing. A further suspected case also arrived on Friday in the city of one million, it said.

Reporting by Amedee Mwarabu; Writing by Tim Cocks; Editing by Chris Reese

Ebola experts from U.S. Centers for Disease Control ready to go to Congo

CHICAGO (Reuters) – Ebola experts from the U.S. Centers for Disease Control and Prevention are ready to go to the Democratic Republic of Congo (DRC) where an Ebola outbreak has spread to a major African city, increasing the risk of a global outbreak.

The CDC, which played a major role in responding to the 2014 Ebola outbreak in West Africa, already has experts in a field office in Kinshasa, the capitol of the Democratic Republic of Congo, who are working with the health ministry there, CDC spokesman Tom Skinner said.

The World Health Organization (WHO) warned on Friday that the DRC faced a “very high” public health risk from the outbreak, which has already killed 25 people.

Earlier this week the CDC issued a level 1 travel alert for the DRC, Skinner said, warning travelers that there is a disease outbreak and to take precautions.

“Right now, we’re thinking the risk of importation of Ebola to the United States is very low,” Skinner said. “We’re not recommending any additional border intervention or enhanced screening at the moment.”

As part of its Global Outbreak Alert & Response Network, the World Health Organization asked the CDC for a list of about a dozen experts in epidemiology, diagnostics and healthcare worker safety who are ready to travel to the hot zone if asked to do so by WHO, Skinner said.

On Monday, WHO said it had received permission from the DRC to import and use an experimental Ebola vaccine in the country. Vaccinations could begin by next Monday.

There are no direct flights between DRC and the United States.

Skinner said the CDC was monitoring the situation and planned to post notices to travelers in airports on the way to DRC and traveling back to the United States on any flights that originated in the DRC.

Inbound travelers would be reminded to avoid contact with other people’s blood or body fluids and to seek treatment immediately if they develop symptoms of Ebola, which include fever, headache, body aches, sore throat, diarrhea, vomiting, stomach pain, rash or red eyes during or after travel.

The CDC’s actions so far are part of the standard response during such outbreaks, Skinner said.

Reporting by Julie Steenhuysen; Editing by Toni Reinhold

Parents' mental health issues may spoil children's friendships

(Reuters Health) – Parenting styles and a parent’s mental health problems, particularly depression, play a role in a child’s ability to keep friends in elementary school, suggests a recent study in Finland.

With data on 1,523 Finnish children and their parents, researchers compared mothers’ and fathers’ parenting styles and depressive symptoms to predict how long friendships formed in the first grade would last, and how quickly friends would fall away.

It’s natural for children to make new friends and drift apart from others over the years, and the study team found that, on average, only 8 percent of friends from first grade remained friends in sixth grade. But a parent’s serious depression, for example, could raise the rate at which a child’s friendships lapsed each year by more than 100 percent above the average, the researchers report in the Journal of Family Psychology.

Kids with parents, especially mothers, who were significantly more psychologically controlling than average, engaging in behaviors like using guilt, shame or withdrawing love, for instance, lost friends at a rate 26 percent higher than average each year.

“We believe psychological control is harmful to children’s friendships because children adopt the same strategies of psychological manipulation with their friends so they can’t keep them,” said lead author Brett Laursen, a psychology professor at Florida Atlantic University in Boca Raton.

Friends also don’t want to come over to a child’s house if their parents behave badly, Laursen said in a telephone interview.

For the study, Laursen’s team, along with Noona Kiuru and Jari-Erik Nurmi of the University of Jyvaskyla in Finland, recruited parents and first-grade children at four schools in Finland. They had parents answer questionnaires about themselves and their children, and kids were asked which three classmates they liked to spend time with during recess and which three they least liked to spend time with. The kids were asked the same questions in subsequent years.

Based on the parents’ responses when their kids were in first grade, researchers rated their levels of controlling behavior as well as depression symptoms on a scale of 1 to 5, establishing a middle ground of around 2.5 as the average level of these characteristics in these groups of parents. Researchers then categorized individual parents by how much above or below this norm they fell.

Analyzing the children’s changing friendships over the years, researchers found that a large proportion formed in first grade, 48 percent, were dissolved by the second grade. By third grade, just 27 percent were still intact, and by fifth grade, it was 17 percent.

But when parents fell somewhat below the average for psychological control, for example, their child’s risk of friendship dissolution in second grade was 8 percent lower.

And when a parent had significantly higher than average depression symptoms, the child’s risk of friendship dissolution in second grade rose from 46 percent to 64 percent, in third grade it rose from 35 percent to 53 percent, and this heightened risk persisted through sixth grade.

A parent’s level of depression was also associated with higher levels of behavioral control, such as curfews and monitoring, as well as psychological control and lower levels of affection, researchers found.

Laursen noted that children with depressed parents don’t have the kinds of engaging relationships with their parents that leave them well adjusted. They often have mood regulation problems, such as temper issues and anxiety.

These parents are also less likely to plan activities with their children like play dates so children get left out because they’re not a desirable friend, he said.

“One thing I hope parents realize from this study is that the way they interact with their children has effects that extend beyond the household,” he added. “One good reason to get help with depression is to do it for your children.”

One limitation of the study was that Scandinavian parenting styles may not be generalizable to parents elsewhere.

“I think the big risk of a study like this is that it overly and narrowly defines how people ought to parent,” said Dr. Steven Schlozman, co-director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital in Boston, who was not involved in the study. “The study should be taken in the context of your unique family system and your culture, community and values,” he said in a phone interview.

“Parents should take some assurance in this study that as long as they’re managing their own mental wellbeing that it won’t negatively impact their children’s friendships,” said Christina DiBartolo of NYU Langone in New York, who was not involved in the study.

SOURCE: bit.ly/2KARvXR Journal of Family Psychology, online May 10, 2018.