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Urine culture, empirical antibiotics most cost-effective UTI strategy



September 10, 2021

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In most cases, a urine culture combined with empirical antibiotics is the most cost-effective strategy for urinary tract infections, the researchers said.

“We conducted this cost-benefit study because urinary tract infections are estimated to cost an estimated $ 1.6 billion annually in the United States and are an area of ​​health care availability that can be improved.” Rui Wang, MD, from the Department of Women’s Health at Hartford Hospital, Connecticut, said Healio. “We evaluated the cost effectiveness of several different UTI testing and treatment strategies, taking into account the societal costs of antibiotic resistance.”

Wang R. et al. At J Obstet Gynecol. 2021; doi: 10.1016 / j.ajog.2021.08.014.

To determine the cost effectiveness of various UTI strategies, Wang and colleagues did Christine LaSala, MD, also from Hartford Hospital, designed a decision tree that would model four treatment approaches. This included empirical antibiotics first, followed by culture-directed antibiotics if symptoms persist; initial urine culture followed by culture directed antibiotics; Urine culture combined with empirical antibiotics followed by culture-directed antibiotics if symptoms persist; and initial symptomatic treatment, followed by culture-directed antibiotics if symptoms persist.

To address both patient and community concerns, Wang and LaSala developed three versions of their model with three different outcome measures: quality-adjusted life years (QALYs), symptom-free days, and antibiotic courses administered. The researchers modeled the societal cost of antibiotic resistance for each antibiotic therapy, analyzing the likelihood of urinary tract infection and the degree of antibiotic resistance from 0% to 100%. They also expanded their model to include patients who need a catheter to collect urine. The estimates of the model parameters were based “wherever possible” on medical literature, the researchers wrote.

The primary endpoint was the incremental cost-effectiveness ratio (ICER), which the researchers defined as the difference between strategies in mean costs divided by the difference in mean QALYs. A strategy was defined as “dominated” and therefore rejected if it was more costly and less effective than another strategy. Meanwhile, a strategy was “dominant” when it was less costly and more effective than any other strategy. A strategy was defined as cost-effective if it had an ICER below the willingness-to-pay threshold of $ 150,000 per QALY compared to another strategy. This threshold varied in the sensitivity analyzes.

According to the researchers, urine culture concurrently with empirical antibiotics under a baseline assumption of 20% antibiotic resistance was the most cost-effective strategy to maximize symptom-free days. It showed the lowest cost – $ 79.91 – and the highest effectiveness – 24.44 Quality Adjusted Life Days (QALDs). However, empirical antibiotics were the most cost-effective option when antibiotic resistance fell below 6%, while symptomatic treatment was the most cost-effective plan when resistance rose above 80%.

In the meantime, symptomatic treatment first was always the best strategy, followed by urine culture first to minimize antibiotic use with an average of 0.29 cycles administered. Sensitivity analyzes with other input parameters had no influence on the results on cost efficiency. When the researchers expanded their model to include a practice visit for catheterized urine samples, empirical antibiotics became the most cost-effective plan.

“The main finding is that in most cases, collecting urine cultures with empirical antibiotics was the best strategy,” said Wang. “This had a greater than 80% chance of being the most cost-effective strategy.

“It was cost effective to start only with empirical antibiotics when antibiotic resistance is very low – less than 6% – while starting only symptomatic treatment was cost effective when antibiotic resistance was very high – more than 80%,” says she added. “Our model can be used to guide testing and management plans for patients with sporadic UTIs or those with recurrent UTIs.”


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Victoria Scott, MD)

Victoria Scott, MD

This study examines a very important question about treating urinary tract infections in an age of rising antibiotic resistance and the growing recognition of the importance of antibiotic stewardship. Evidence that sending a urine culture concurrently with empirical antibiotics is both optimally cost-effective and maximizes symptom-free days for most patients with UTI symptoms should reassure providers to require urine testing in these patients rather than the historical strategy of empirical Antibiotics alone. It is also important that the authors acknowledge that symptomatic treatment initially is the best strategy for situations where there is great concern about antibiotic resistance.

The next important step will be to assess patient satisfaction with this treatment strategy. As concerns about the prudent use of antibiotics grow in many patients, both on a personal and societal level, it is very likely that they will have an increased satisfaction with the evaluation of the urine culture for each episode of UTI symptoms.

Victoria Scott, MD

Cedars-Sinai Medical Center

Disclosure: Scott does not report any relevant financial information.


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Women’s Health

In Response to NH Executive Council Vote to Defund Granite State Family Planning Organizations, NH Delegation Urges Biden Admin to Swiftly Award Supplemental Assistance Directly to Impacted Providers




(Manchester, NH) – U.S. Senator Jeanne Shaheen (D-NH) headed a letter today with U.S. Senator Maggie Hassan (D-NH) and Representatives Annie Kuster (NH-02) and Chris Pappas (NH-01) The Department of Health and Human Services (HHS) Secretary Xavier Becerra urged HHS to make additional grants directly to the New Hampshire family planning providers that were recently withdrawn by the New Hampshire Executive Council and are not receiving Title X program funding.

On Wednesday, the delegation slammed the Executive Board after it voted to terminate several contracts for family planning organizations, effectively cutting off critical services to women’s health care providers across New Hampshire, such as planned parenting.

Today the delegation wrote: “As a result of the actions of the Executive Board, several family planning providers are facing budget constraints that will affect the availability of health care for thousands of granite staters, mostly women, who rely on family planning providers for their vital health. “Including breast cancer screening, cervical cancer screening, birth control and other reproductive health services. Low-income women and rural women will be disproportionately affected by the reckless decision of the Executive Board. We are deeply concerned about the health care gap that will be inevitable without immediate federal support. “

They continued, “With the situation looming in New Hampshire, we ask HHS to review all available means to provide immediate support to affected family planning providers in our state. We appreciate HHS efforts to repeal the harmful Title X-Gag rule and restore federal funding for family planning providers in New Hampshire and across the country. However, the family planning providers in New Hampshire need immediate help. We therefore demand that the providers be provided with additional funds quickly and directly in order to close the funding gap they are confronted with. “

You can read the letter in full here.

Wednesday’s Executive Council vote is particularly egregious as it follows the Trump administration’s years of attacks on women’s reproductive health, particularly President Trump’s implementation of the Title X Gag Rule, which controls the majority of family planning providers in New Hampshire rules out federal grants. In June, Senator Shaheen sent a letter to Secretary of Health and Welfare Xavier Becerra urging him to support family planning providers in New Hampshire who will lose government funds under the New Hampshire Draft Budget. This support is urgently needed to help these vendors fill the funding gap until the Biden administration can complete its repeal of the Trump administration rule.

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Women’s Health

Taliban Seize Women’s Ministry Building for Use by Religious Police



KABUL, Afghanistan – The Taliban have converted the women’s ministry building into offices for the Religious Morality Police, which once fueled fears of their oppression of women and the brutal enforcement of Sharia law by the militant government two decades ago in Afghanistan.

The renovation of the building in Kabul, the country’s capital, indicated at least a symbolic slap in the face from a ministry that embodied the rise of women in Afghanistan after the Taliban was ousted in 2001.

A video posted by Reuters showed women employed by the ministry protesting in front of the building because the Taliban had denied them entry and told them to go home.

It remains unclear whether the Department of Women was abolished by the Taliban, who regained power after the collapse of the US-backed government last month. But when the Taliban announced their incumbent cabinet members for the new government earlier this month, there was no appointment to oversee women’s affairs.

And in another ominous sign of renewed gender discrimination among the Taliban, the Ministry of Education ordered male teachers back to work and said secondary school classes for boys would resume on Saturday. There was no talk of girls.

The Ministry of Women’s new resident, the Ministry of Inviting, Guiding, and Promoting Virtue and Preventing Vice, appears to be just a slightly renamed name for the notorious Taliban standards of conduct enforcer who made the group a global pariah in the 1990s.

The Ministry’s police officers have been known to beat or flog women who ventured outside their homes without full body covering and male escorts. They banned girls from school after elementary school and banned women from looking for work. Unmarried couples risked death by stoning for adultery.

While the Taliban leaders have recognized that Afghanistan has evolved after two decades of American-led occupation, they have also left women fearful of what the future may bring. No women have been appointed to positions of authority under the new Taliban government, and steps have been taken to separate men and women in public spaces.

Earlier this week, Minister of Higher Education Abdul Baqi Haqqani said women could continue to study in universities and postgraduate courses, but only in gender-segregated classrooms in appropriate Islamic clothing.

The building that formerly housed the Ministry of Women is in a former liberal district of Kabul that is full of cafes and a popular Turkish-run shopping mall with clothing stores, a counterfeit Apple store, and restaurants ranging from fast food chains to high profile Restaurants littered -end steak house.

Now a white Taliban flag is waving over the armored gate of the building complex, adorned with a sign for the ministry, who is its new resident, while Taliban security forces stand guard.

Understanding the Taliban takeover in Afghanistan

Map 1 of 6

Who are the Taliban? The Taliban emerged in 1994 amid the unrest following the withdrawal of Soviet forces from Afghanistan in 1989. They used brutal public punishments, including flogging, amputation and mass executions, to enforce their rules. Here is more about their genesis and track record as rulers.

Who are the Taliban leaders? These are the top leaders of the Taliban, men who for years have been on the run, in hiding, in prison and dodged American drones. Little is known about them or how they plan to govern, including whether they will be as tolerant as they say they are. A spokesman told the Times the group wanted to forget about their past, but there would be some restrictions.

The walls surrounding the site are still adorned with murals and signs depicting the work of the Ministry of Women, but some have had women’s faces vandalized, a type of vandalism that has occurred elsewhere in Afghanistan since the Taliban regained power is to be observed.

A sign that reads “Supporting women who are victims of violence is our human duty” shows a woman with a black eye. Another is from the United States Agency for International Development, which has been a major resource for Afghanistan, and read, “Keep your city green and clean.”

Even critics of the American military’s long stay in Afghanistan have recognized the progress made by Afghan women over the past two decades. Under the Ministry of Women’s Affairs, women’s health, literacy rates and employment all rose. Assistance and shelter were given to abused women. Women entered the legislature and other positions of power.

A revealing barometer of growth was shown in the changing composition of the workforce. A World Bank study found that women made up 22 percent of the workforce in 2019, compared to 15 percent in 2009. A survey conducted two years ago by the Asia Foundation also showed growing public support for women in the workplace, with 76 percent of Afghans support women’s right to work outside the home.

The news of the Taliban’s conversion of the Ministry of Women came when the United Nations Security Council reassigned the organization’s six-month mission to Afghanistan. The United Nations Assistance Mission in Afghanistan (UNAMA), which was established in the aftermath of the US invasion in 2002, is the primary tool for monitoring Taliban’s behavior following the chaotic US military withdrawal last month.

Stéphane Dujarric, the UN spokesman in New York, said he knew nothing about the development of the Ministry of Women and could not comment on it. Nevertheless, there have been “worrying developments in recent times, but we are continuing our dialogue and our advocacy for women’s rights, for girls’ rights, especially in the field of work and education”.

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Women’s Health

Addressing the pandemic’s toll on women’s health in the workplace



Released: September 18, 2021

Alex Perry, CEO at Bupa UK Insurance

September 16, 2021

The global pandemic was a world changing event and it is inevitable that it has had, and will continue to have, an impact on almost every segment of society. While it continues to affect lives and livelihoods around the world, we can already see the resulting consequences affect gender equality. McKinsey estimates that women’s jobs are 1.8 times more vulnerable to this crisis than men’s jobs; The burden of unpaid childcare during school closings and the care of relatives during the lockdown was disproportionately borne by women with the closure of schools, and unfortunately the rate of domestic violence is also increasing.[1]

The pandemic is adding to another area of ​​gender inequality – health. It has shed a harsh light on some of the persistent health inequalities, and research by Bupa in the 2021 Census of Workplace Wellbeing found that a significantly larger proportion of women than men think the pandemic is negatively affecting them Life has an impact on health and wellbeing – two-thirds of women (66%) versus 57% of men.

While it is inevitable that the scale of a global pandemic will affect almost everyone, its impact on women and their working lives is undeniable – our census showed that a third (32%) of women felt that their mental health was affecting their work , and many are struggling with the transition to working from home. A quarter (26%) have seen blurred lines between work and personal life with the World Health Organization (WHO)[2] This suggests that many women find themselves in an impossible situation of multiple caring responsibilities, with some returning to traditional household roles as well as their professional workload. While every woman’s situation is different, it is clear that COVID-19 continues to exacerbate existing inequalities for many. In addition, the long-term effects of the pandemic will have social and economic repercussions for women for many years to come.

[3]How can organizations react effectively and create conditions for optimal equality for women? In recent years, companies have recognized the importance of diversity and inclusion in the workplace. This is stronger today than ever as companies with more diversity are more likely to outperform less heterogeneous ones in terms of profitability. The pandemic is therefore providing a unique opportunity for companies to rethink how they can support women at all stages of life so they can realize their career potential, with no better starting point than women’s health. Employers have a responsibility to support their employees and create an inclusive culture where everyone can thrive and do their best mentally and physically.

There are still some taboos and information gaps surrounding women’s health. One of the few benefits of the pandemic is that we are prioritizing our health more than ever. Let’s take this golden opportunity to rethink how we can better support the health and wellbeing of women, starting in the workplace.


Effects of COVID-19 on Women and Gender Equality | McKinsey during-the-covid-19-pandemic-and-beyond

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