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    SOBRE NOTICIAS EN ESPAÑOLNoticias en español es una sección de Kaiser buy kamagra tablets Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en los Estados Unidos. Use Nuestro Contenido buy kamagra tablets Este contenido puede usarse de manera gratuita (detalles). La temporada de influenza se verá diferente este año, ya que los Estados Unidos se enfrentan a una pandemia de erectile dysfunction que ya ha matado a más de 176.000 personas.Muchos estadounidenses son reacios a ir al médico y los funcionarios de salud pública temen que las personas eviten vacunarse. Aunque a veces se considera incorrectamente como un buy kamagra tablets resfriado, la gripe también mata a decenas de miles de personas en el país cada año. Los más vulnerables son los niños pequeños, los adultos mayores y las personas con enfermedades subyacentes.

    Cuando se combina con los efectos de erectile dysfunction treatment, los expertos en salud pública dicen que es más importante que nunca vacunarse contra la gripe.Si una cantidad suficiente de la población se vacuna, más del 45% lo hizo la temporada de gripe pasada, podría ayudar a evitar un escenario de pesadilla este invierno, con hospitales llenos de pacientes con erectile dysfunction treatment y los que sufren los efectos graves de la influenza.Además de la posible carga para los hospitales, existe la posibilidad de que las personas contraigan ambos kamagra y “nadie sabe qué sucede si se contrae influenza y erectile dysfunction treatment simultáneamente porque nunca sucedió antes”, dijo la doctora Rachel Levine, secretaria de Salud de Pennsylvania, a reporteros.En respuesta, este buy kamagra tablets año los fabricantes están produciendo más suministros de vacunas, entre 194 y 198 millones de dosis, unas 20 millones más de las que se distribuyeron la temporada pasada, según los Centros para el Control y Prevención de Enfermedades (CDC).Mientras se acerca la temporada de gripe, aquí hay algunas respuestas a preguntas frecuentes:P. ¿Cuándo debo vacunarme contra la gripe?. La publicidad ya ha comenzado y algunas farmacias y clínicas ya tienen buy kamagra tablets sus suministros. Pero, debido a que la efectividad de la vacuna puede disminuir con el tiempo, los CDC recomiendan no recibir la dosis en agosto.Muchas farmacias y clínicas comenzarán las inmunizaciones a principios de septiembre. Generalmente, los kamagra de la influenza comienzan a circular a mediados o fines buy kamagra tablets de octubre, pero se expanden masivamente más tarde, en el invierno.

    Se necesitan aproximadamente dos semanas después de recibir la inyección para que los anticuerpos, que circulan en la sangre y frustran las infecciones, se acumulen.“Las personas jóvenes y sanas pueden comenzar a vacunarse contra la gripe en septiembre, y las personas mayores y otras poblaciones vulnerables pueden hacerlo en octubre”, dijo el doctor Steve Miller, director clínico de la aseguradora Cigna.Los CDC recomiendan que las personas “se vacunen contra la influenza a fines de octubre”, pero señalaron que se puede recibir la vacuna más tarde porque “aún puede ser beneficiosas y la vacunación debe ofrecerse a lo largo de toda la temporada de influenza”.Aun así, algunos expertos recomiendan no esperar demasiado este año, no solo por erectile dysfunction treatment, sino también en caso de que haya escasez debido a la abrumadora demanda.P. ¿Cuáles son las razones por las que las que debería ofrecer mi brazo buy kamagra tablets para vacunarme?. Hay que vacunarse porque brinda protección contra la gripe y, por lo tanto, contra la propagación a otras personas, lo que puede ayudar a disminuir la carga para los hospitales y el personal médico.Y hay otro mensaje que puede resonar en estos tiempos extraños.“Le da a la gente la sensación de que hay algunas cosas que pueden controlar”, dijo Eduardo Sánchez, director médico de prevención de la American Heart Association.Si bien una vacuna contra la gripe no evitará erectile dysfunction treatment, recibirla podría ayudar al médico a diferenciar entre las dos enfermedades si se desarrolla algún síntoma (fiebre, tos, dolor de garganta) que ambas infecciones comparten, explicó Sánchez.Y aunque las vacunas contra la gripe no evitarán todos los casos de gripe, vacunarse puede reducir la gravedad si la persona se enferma, dijo.Todas las personas elegibles, especialmente los trabajadores esenciales, los que sufren de afecciones subyacentes y aquellos en mayor riesgo, incluidos los niños muy pequeños y las mujeres embarazadas, deben buscar protección, dijeron los CDC. La entidad recomienda la vacunación a partir de buy kamagra tablets los 6 meses.P. ¿Qué sabemos sobre la efectividad de la vacuna de este año?.

    Se deben producir nuevas vacunas contra la gripe cada año, porque el kamagra muta y la efectividad de la vacuna varía, dependiendo de qué tan bien coincida con el kamagra circulante.Se calculó que la formulación del año pasado tuvo una eficacia de buy kamagra tablets aproximadamente un 45% para prevenir la gripe en general, con una efectividad de aproximadamente un 55% en los niños. Las vacunas disponibles en el país este año tienen como objetivo prevenir al menos tres cepas diferentes del kamagra, y la mayoría cubre cuatro.Todavía no se sabe qué tan bien coincidirá el suministro de este año con las cepas que circularán en los Estados Unidos. Las primeras indicaciones del hemisferio buy kamagra tablets sur, que atraviesa su temporada de gripe durante nuestro verano, son alentadoras. Allí, las personas practicaron el distanciamiento social, usaron máscaras y se vacunaron en mayor número este año, y los niveles mundiales de gripe son más bajos de lo esperado. Sin embargo, expertos advierten que no se debe contar con una temporada igual de suave en los Estados Unidos, en parte porque los esfuerzos por usar mascara facial y de distanciamiento social buy kamagra tablets varían ampliamente.P.

    ¿Qué están haciendo diferente los seguros y sistemas de salud este año?. Las aseguradoras y los sistemas de salud contactados por buy kamagra tablets KHN dicen que seguirán las pautas de los CDC, que exigen limitar y espaciar la cantidad de personas que esperan en las filas y las áreas de vacunación. Algunos están programando citas para vacunas contra la gripe para ayudar a controlar el flujo.Health Fitness Concepts, una compañía que trabaja con UnitedHealth Group y otras empresas para establecer clínicas de vacunación contra la gripe en el noreste del país, dijo que está “fomentando eventos más pequeños y frecuentes para apoyar el distanciamiento social” y “exigiendo que se completen todos los formularios y arremangarse las camisas antes de entrar al área de vacunación contra la influenza”.Se requerirá que todos usen máscaras.Además, a nivel nacional, algunos grupos médicos contratados por UnitedHealth instalarán carpas, para que las inyecciones se puedan administrar al aire libre, dijo un vocero.Kaiser Permanente planifica las vacunas directamente en autos en algunos de sus centros médicos y está probando los procedimientos de detección y registro sin contacto en algunos lugares.Geisinger Health, un proveedor de salud regional en Pennsylvania y Nueva Jersey, dijo que también tendría programas de vacunación contra la influenza al aire libre en sus instalaciones.Además, “Geisinger exige que todos los empleados reciban la vacuna contra la influenza este año”, dijo Mark Shelly, director de prevención y control de infecciones del sistema. €œAl dar este paso, buy kamagra tablets esperamos transmitir a nuestros vecinos la importancia de la vacuna contra la influenza para todos”.P. Por lo general, me vacunan contra la gripe en el trabajo.

    ¿Seguirá siendo una opción buy kamagra tablets este año?. Con el objetivo de evitar riesgosas reuniones en interiores, muchos empleadores se muestran reacios a patrocinar las clínicas de gripe en oficinas como han ofrecido en años anteriores. Y con tanta gente que sigue trabajando desde casa, hay menos necesidad de llevar buy kamagra tablets las vacunas contra la gripe al lugar de trabajo. En cambio, muchos empleadores están alentando a los trabajadores a que reciban vacunas de sus médicos de atención primaria, en farmacias u otros entornos comunitarios. El seguro generalmente cubrirá el costo de la vacuna.Algunos empleadores están considerando ofrecer cupones para vacunas contra la buy kamagra tablets gripe a sus trabajadores sin seguro o a aquellos que no participan en el plan médico de la compañía, dijo Julie Stone, directora general de salud y beneficios de Willis Towers Watson, una firma consultora.Estos cupones podrían, por ejemplo, permitir a los trabajadores obtener la vacuna en un laboratorio en particular sin costo.Algunos empleadores están comenzando a pensar en cómo podrían usar sus estacionamientos para administrar vacunas contra la gripe enlos autos, dijo el doctor David Zieg, líder de servicios clínicos para el consultor de beneficios Mercer.Aunque la ley federal permite a los empleadores exigir a los empleados que se vacunen contra la gripe, ese paso generalmente lo toman solo los centros de atención médica y algunas universidades donde las personas viven y trabajan en estrecha colaboración, dijo Zieg.Pero sucede.

    El mes pasado, el sistema de la buy kamagra tablets Universidad de California emitió una orden ejecutiva que requiere que todos los estudiantes, profesores y personal se vacunen contra la gripe antes del 1 de noviembre, con limitadas excepciones.P. ¿Qué están haciendo las farmacias para alentar a las personas a vacunarse contra la gripe?. Algunas farmacias están haciendo un esfuerzo adicional para salir a la comunidad y ofrecer vacunas contra la gripe.Walgreens, que tiene casi 9,100 farmacias en todo el país, continúa una asociación iniciada en 2015 con organizaciones comunitarias, iglesias y empleadores que ha ofrecido alrededor de 150,000 clínicas de gripe móviles hasta la fecha.El programa pone especial énfasis en trabajar con poblaciones vulnerables y en áreas desatendidas, dijo el doctor Kevin Ban, director médico de la cadena de farmacias.Walgreens comenzó a ofrecer vacunas contra la gripe a mediados de agosto y está animando a las personas a no demorar en vacunarse.Tanto Walgreens como CVS están estimulando a las personas a programar citas y hacer trámites en línea este buy kamagra tablets año para minimizar el tiempo que pasan en los locales.En los CVS MinuteClinic, una vez que los pacientes se han registrado para recibir la vacuna contra la gripe, deben esperar afuera o en su automóvil, ya que las áreas de espera interiores ahora están cerradas.“No tenemos un arsenal contra erectile dysfunction treatment”, dijo Ban, de Walgreens. €œPero quitar la presión del sistema de atención médica proporcionando vacunas por adelantado es algo que sí podemos hacer”. Julie buy kamagra tablets Appleby.

    jappleby@kff.org, @Julie_Appleby Michelle Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Noticias En Español Public Health erectile dysfunction treatment Insurers treatmentsThis story was produced in buy kamagra tablets partnership with PolitiFact. This story can be republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with few participants wearing masks, he touched on a range of topics, including many related to the erectile dysfunction treatment kamagra and health care in general.Throughout, the partisan crowd applauded and chanted “Four more years!. € And, even as the nation’s erectile dysfunction treatment buy kamagra tablets death toll exceeded 180,000, Trump was upbeat. €œIn recent months, our nation and the entire planet has been struck by a new and powerful invisible enemy,” he said.

    €œLike those brave Americans before us, buy kamagra tablets we are meeting this challenge.”At the end of the event, there were fireworks.Our partners at PolitiFact did an in-depth fact check on Trump’s entire acceptance speech. Here are the highlights related to the administration’s erectile dysfunction treatment response and other health policy issues:“We developed, from scratch, the largest and most advanced testing system in the world.” This is partially right, but it needs context.It’s accurate that the U.S. Developed its erectile dysfunction treatment testing system from scratch, because the government buy kamagra tablets didn’t accept the World Health Organization’s testing recipe. But whether the system is the “largest” or “most advanced” is subject to debate.The U.S. Has tested more individuals than any other buy kamagra tablets country.

    But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested. Another useful metric would be the buy kamagra tablets percentage of the population that has been tested. The U.S. Is one of the most buy kamagra tablets populous countries but has tested a lower percentage of its population than other countries. Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter.

    The buy kamagra tablets U.S. Was also slower than other countries in rolling out tests and amping up testing capacity. Even now, many states are experiencing delays in reporting test results to positive individuals.As for “the most advanced,” Trump may be buy kamagra tablets referring to new testing investments and systems, like Abbott’s recently announced $5, 15-minute rapid antigen test, which the company says will be about the size of a credit card, needs no instrumentation and comes with a phone app through which people can view their results. But Trump’s comment makes it sound as if these testing systems are already in place when they haven’t been distributed to the public.“The United States has among the lowest [erectile dysfunction treatment] case fatality rates of any major country in the world. The European Union’s case fatality rate is nearly three times higher than ours.”The case fatality rate buy kamagra tablets measures the known number of cases against the known number of deaths.

    The European Union has a rate that’s about 2½ times greater than the United States.But the source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a kamagra, the case fatality rate is a poor measure of the mortality risk of the disease.”A better way to measure the threat of the kamagra, experts say, is to look at the number of deaths per 100,000 residents. Viewed that way, the buy kamagra tablets U.S. Has the 10th-highest death rate in the world.“We will produce a treatment before the end of the year, or maybe even sooner.”It’s far from guaranteed that a erectile dysfunction treatment will be ready before the end of the year.While researchers are making rapid strides, it’s not yet known precisely when the treatment will be available to the public, which is what’s most important. Six treatments are in the third phase buy kamagra tablets of testing, which involves thousands of patients. Like earlier phases, this one looks at the safety of a treatment but also examines its effectiveness and collects more data on side buy kamagra tablets effects.

    Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective treatment for erectile dysfunction treatment by January 2021.”And federal health officials and other experts have generally predicted a treatment will be available in early 2021. Federal committees are working on recommendations for treatment distribution, including which groups buy kamagra tablets should get it first. €œFrom everything we’ve seen now — in the animal data, as well as the human data — we feel cautiously optimistic that we will have a treatment by the end of this year and as we go into 2021,” said Dr. Anthony Fauci, the nation’s top buy kamagra tablets infectious diseases expert. €œI don’t think it’s dreaming.”“Last month, I took on Big Pharma.

    You think buy kamagra tablets that is easy?. I signed orders that would massively lower the cost of your prescription drugs.”Quite misleading. Trump signed four executive orders on July buy kamagra tablets 24 aimed at lowering prescription drug prices. But those orders haven’t taken effect yet — the text of one hasn’t even been made publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for it than others do. In 2017, buy kamagra tablets Trump supported congressional efforts to repeal the ACA.

    The Trump administration is now backing GOP-led efforts to overturn the ACA through a court case. And Trump has also expanded short-term health plans that don’t have to comply buy kamagra tablets with the ACA.“Joe Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading. During a June 2019 Democratic primary debate, candidates were asked. €œRaise your hand if your government plan would provide coverage for undocumented immigrants.” All candidates buy kamagra tablets on stage, including Biden, raised their hands. They were not asked if that coverage would be free or subsidized.Biden supports extending health care access to all immigrants, regardless of immigration status.

    A task force recommended that he allow immigrants who are in the country illegally to buy health insurance, without federal subsidies.“Joe Biden claims he has empathy for the vulnerable, yet the buy kamagra tablets party he leads supports the extreme late-term abortion of defenseless babies right up to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling in Roe v. Wade and related precedents. This would generally limit abortions buy kamagra tablets to the first 20 to 24 weeks of gestation. States are allowed under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between 24 and 28 weeks from the mother’s last menstrual period — and 43 states do. But the rulings require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds that “every woman should have access to quality reproductive health care services, including safe and legal abortion — regardless of where she lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, buy kamagra tablets Jon Greenberg, Louis Jacobson, Noah Y.

    Kim, Bill McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight contributed to this report. Related Topics Elections Health buy kamagra tablets Industry Pharmaceuticals Public Health The Health Law Abortion erectile dysfunction treatment Immigrants KHN &. PolitiFact HealthCheck Preexisting Conditions Trump Administration treatmentsThis story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a erectile dysfunction kamagra that has killed more than 172,000 people. Many Americans are reluctant to visit a doctor’s office and public health officials worry people will shy away from being immunized.Although sometimes incorrectly regarded as just another buy kamagra tablets bad cold, flu also kills tens of thousands of people in the U.S. Each year, with the very young, the elderly and those with underlying conditions the most vulnerable.

    When coupled with the effects of erectile dysfunction treatment, public health experts say it’s more important than ever buy kamagra tablets to get a flu shot.If enough of the U.S. Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both erectile dysfunction treatment patients and those suffering from severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both kamagraes — and “no one knows what happens if you get influenza and erectile dysfunction treatment [simultaneously] because it’s never happened before,” Dr. Rachel Levine, Pennsylvania’s secretary of health, told reporters this month.In response, manufacturers are producing more treatment supply this year, between 194 million and 198 million doses, or about 20 million more than they distributed buy kamagra tablets last season, according to the Centers for Disease Control and Prevention. Email buy kamagra tablets Sign-Up Subscribe to KHN’s free Morning Briefing. As flu season approaches, here are some answers to a few common questions:Q.

    When should I get buy kamagra tablets my flu shot?. Advertising has already begun, and some pharmacies and clinics have their supplies now. But, because the effectiveness of the treatment can wane over time, the CDC buy kamagra tablets recommends against a shot in August.Many pharmacies and clinics will start immunizations in early September. Generally, influenza kamagraes start circulating in mid- to late October but become more widespread later, in the winter. It takes about two weeks after getting a shot for antibodies — which circulate in the blood and thwart s — to build buy kamagra tablets up.

    €œYoung, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations can begin in October,” said Dr. Steve Miller, chief clinical officer for insurer Cigna.The CDC has recommended that people “get a flu treatment by the end of buy kamagra tablets October,” but noted it’s not too late to get one after that because shots “can still be beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of erectile dysfunction treatment, but also in case a shortage develops because of overwhelming demand.Q. What are the reasons I should roll up my sleeve for this?. Get a shot because it protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent erectile dysfunction treatment, he said, getting one could buy kamagra tablets help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get influenza from having a flu treatment.All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said. It recommends that children over 6 months old get vaccinated.Q.

    What do we know about the effectiveness of this year’s buy kamagra tablets treatment?. Flu treatments — which must be developed anew each year because influenza kamagraes mutate — range in effectiveness annually, depending on how well they match the circulating kamagra. Last year’s formulation was estimated to be buy kamagra tablets about 45% effective in preventing the flu overall, with about a 55% effectiveness in children. The treatments available in the U.S. This year are aimed at preventing at least three strains of the kamagra, and most cover four.It isn’t yet known how well this year’s buy kamagra tablets supply will match the strains that will circulate in the U.S.

    Early indications from the Southern Hemisphere, which goes through its flu season during our summer, are encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global flu buy kamagra tablets levels are lower than expected. Experts caution, however, not to count on a similarly mild season in the U.S., in part because masking and social distancing efforts vary widely.Q. What are insurance plans and buy kamagra tablets health systems doing differently this year?. Insurers and health systems contacted by KHN say they will follow CDC guidelines, which call for limiting and spacing out the number of people waiting in lines and vaccination areas.

    Some are setting appointments for flu shots to help manage the flow.Health Fitness Concepts, a company that works with UnitedHealth Group and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent buy kamagra tablets events to support social distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set up tent areas so shots can be given outdoors, a spokesperson said.Kaiser Permanente plans drive-thru vaccinations at some of its medical facilities and is testing touch-free screening and check-in procedures at some locations. (KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said it, too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu treatment this year,” said Mark Shelly, the system’s director of prevention and control. €œBy taking this step, we hope to convey to our neighbors the importance of the flu buy kamagra tablets treatment for everyone.”Q. Usually I get a flu shot at work. Will that be an option this year? buy kamagra tablets.

    Aiming to avoid risky indoor gatherings, many employers are reluctant to sponsor the on-site flu clinics they’ve offered in years past. And with so many people continuing to work from home, there’s less need to bring flu shots to buy kamagra tablets employees on the job. Instead, many employers are buy kamagra tablets encouraging workers to get shots from their primary care doctors, at pharmacies or in other community settings. Insurance will generally cover the cost of the treatment.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm. The vouchers could allow workers to get the shot at a particular lab at no cost, for example.Some employers are starting to think buy kamagra tablets about how they might use their parking lots for administering drive-thru flu shots, said Dr.

    David Zieg, clinical services leader for benefits consultant Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities where people live and work closely together, Zieg said.Q. What are pharmacies doing to encourage people to get flu shots? buy kamagra tablets. Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr. Kevin Ban, chief medical officer for the buy kamagra tablets drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since the indoor waiting areas are now closed.“We don’t have tons of arrows in our quiver against erectile dysfunction treatment,” Walgreens’ Ban said. €œTaking pressure off the health care system by providing treatments in advance is one thing we can do.” Julie Appleby.

    jappleby@kff.org, @Julie_Appleby Michelle buy kamagra tablets Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Public Health erectile dysfunction treatment Insurers treatmentsUse Our Content This story can be republished for free (details). As the smoke thickened near her home in Santa Cruz, California, last week, Amanda Smith kept asking herself the same questions. Should we leave? buy kamagra tablets. And where would we go?. The wildfire evacuation zone, at buy kamagra tablets the time, ended a few blocks from her house.

    But she worried about what the air quality — which had reached the second-highest warning level, purple for “very unhealthy” — would do to her children’s lungs. Her 4-year-old twins had spent time buy kamagra tablets in the neonatal intensive care unit. One was later diagnosed with asthma, and last year was hospitalized with pneumonia.By Tuesday, said Smith, “we all had headaches, the kids were coughing a little bit, and it was raining ash.” The family had been conscientiously isolating at home because of the erectile dysfunction treatment kamagra, and leaving meant potential exposures. But on Wednesday, Smith said, “I looked at my partner and said, maybe we should leave.”She called a friend buy kamagra tablets in Orange County, about 380 miles south, who offered her parents’ empty condo. But the next day, the friend’s child spiked a fever — a possible case of erectile dysfunction treatment — and the plan fell through amid the distraction.Amanda Smith takes a selfie of herself and her twin children in Santa Cruz, California, in April.

    (Amanda Smith)So Smith looked on Airbnb, careful to seek out hosts who detailed buy kamagra tablets their erectile dysfunction treatment precautions, and found an apartment in San Bruno, about an hour’s drive north. She stuffed photos and documents into a suitcase, grabbed the go-bags, and her family headed out.“It’s coming out of our savings to stay here,” Smith said from the safety of her apartment rental, which runs about $1,150 a week. €œIt was a really fraught decision to leave, but buy kamagra tablets as soon as we got over the hill and the sky was blue, I took a big sigh of relief and knew that it had been a good decision.”As the twin disasters of erectile dysfunction treatment and fire season sweep through California, thousands of residents like Smith are weighing difficult options, pitting risk against risk as they decide where to evacuate, whether from imminent flames or the toxic air. Amid a virulent kamagra, which is safest?. Doubling up at buy kamagra tablets a friend’s home?.

    A hotel?. An evacuation center? buy kamagra tablets. And when do the risks of smoke inhalation outweigh the risk of a deadly ?. €œObviously the most important thing is for people to do what they buy kamagra tablets can to protect their lives, not only from the fire, but also from erectile dysfunction treatment,” said Detective Rosemerry Blankswade, public information officer for the San Mateo County Sheriff’s Office, which is helping coordinate response to the massive CZU Lightning Complex fires.“You have to evaluate the big picture here. If fire is your most imminent danger, maybe take the erectile dysfunction treatment risk.

    But if you can avoid both of them, buy kamagra tablets that’s obviously going to be the best option. It’s kind of a little bit of triage that we’re buy kamagra tablets asking for people to do in their own lives right now.” Email Sign-Up Subscribe to KHN’s free Morning Briefing. In San Mateo, one of two counties where the CZU Lightning Complex fires are blazing, officials are advising people to head to an evacuation center, where county workers will assist them in finding a hotel room. Meanwhile, in neighboring Santa Cruz, where tens of thousands of residents have evacuated and shelters have limited space, officials are asking those under orders to leave to stay with buy kamagra tablets family and friends whenever possible.What’s the right choice when all options pose additional risks?. We spoke with several experts to help guide your thought process.You have to evacuate.

    Where should you go? buy kamagra tablets. If your region is under an evacuation order, do not hesitate. Leave immediately buy kamagra tablets. If you can afford it, booking a room at a hotel or motel outside the evacuation zones may be the best option, said Dr. Michael Wilkes, a professor at the University of California-Davis School of Medicine buy kamagra tablets.

    They almost always have air-conditioning units, which help filter the air from both smoke and kamagra. Many hotels are buy kamagra tablets implementing new cleaning processes. Ask staffers to detail what they’re doing to sanitize rooms, and consider skipping the daily cleaning service during your stay. You might buy kamagra tablets also check review sites such as TripAdvisor to see what other guests report. When possible, avoid the lobby and other shared spaces, and opt for contactless check-in.Amanda Smith at home in Santa Cruz, California, with her twin children.

    Smith and her buy kamagra tablets family decided to voluntarily evacuate their home on Aug. 20, due to heavy smoke in the area from the CZU Lightning Complex fires in the nearby Santa Cruz Mountains. (Anna Maria buy kamagra tablets Barry-Jester/KHN)With so many people in Northern California fleeing the fires, many hotels are already full, especially in more remote areas. So what about staying with family or friends?. After months of being shut in and avoiding close contact beyond immediate family, moving into someone else’s home means a host of buy kamagra tablets potential exposures.

    Consider whether you or anyone else in the home is at high risk from erectile dysfunction treatment because of age or a preexisting condition.“If so, that’s a reason to think twice before going to someone’s home,” said Dr. Gina Solomon, a program director at the Oakland-based Public Health Institute.Consider, too, what precautions your buy kamagra tablets friends or family have been taking. Sheltering with someone whose job brings them into frequent contact with other people may not be as safe as sheltering with people who largely have been staying home. Another question is how buy kamagra tablets crowded the home is. If you have your own room and, preferably, your own bathroom, that makes staying with friends a better option.

    If a separate bedroom is not available and smoky skies are not a problem, you might consider pitching a tent in their backyard.For those with an RV or tent, camping can present another good option — although, with hundreds of wildfires burning buy kamagra tablets across California, it may be challenging to drive far enough away to avoid fire and smoke. If you do camp, try to find a site away from wooded areas. And think twice before using group bathrooms.Is an buy kamagra tablets evacuation center safe?. Many counties have implemented new precautions at emergency shelters to prevent the spread of the erectile dysfunction. In Santa Cruz, for example, officials are scaling back buy kamagra tablets the capacity in each shelter to allow for social distancing, providing tents for people to use as shielding inside and allowing camping in the parking lots.Still, staying in a shelter should probably not be your first choice.

    In terms of erectile dysfunction treatment risk, deciding between a hotel and a friend’s house is “nipping at the edges,” buy kamagra tablets said Dr. John Swartzberg, a clinical professor emeritus at the UC-Berkeley School of Public Health, while “being in a congregate setting is only better than being completely exposed to the elements.”If an evacuation shelter is your best immediate option, again, do not hesitate. €œYou have these standards you want to practice for yourselves,” Swartzberg said, “but when something worse comes buy kamagra tablets along, it trumps how careful we can be with erectile dysfunction treatment because the need for shelter is greater.” You can lower your risk of by wearing a mask, washing hands frequently and sanitizing surfaces.Smith’s partner, Grant Whipple, walks with their children in Big Sur on March 7. That was their last camping trip before the erectile dysfunction treatment kamagra hit, Smith says. That area buy kamagra tablets is now under threat from wildfire.

    (Amanda Smith)If you aren’t in a fire zone, should you invite friends and family to stay with you?. Deciding whether to open your home to friends who are evacuating is an intensely personal decision and may depend on whether anyone in your family has a preexisting condition.“I guess it depends on how good a friend they are and how desperate they are,” buy kamagra tablets said Swartzberg. It may also depend on how much space you have. If your guests buy kamagra tablets can have their own bedroom and bathroom, it might be safer.If you do offer your home, experts advise against simply considering yourself a new pod with your guests. Instead, take steps to lower your chances of .“It might not be pleasant, but wearing a mask anytime you’re not in your own bedroom is the safest way to go,” said Solomon.

    Stay outside as much as possible, she added, and consider eating meals outdoors or eating in shifts to avoid being maskless with those outside buy kamagra tablets your family unit. Sanitize surfaces and wash hands frequently. If air quality permits, keep the buy kamagra tablets windows open to improve airflow.If you’re in a region with hazardous smoke conditions, should you leave?. If your area has dense smoke but no imminent fire risk, the thought of heading somewhere else may be appealing, especially if you have respiratory issues. But in most cases, Wilkes said, it would be buy kamagra tablets safer not to leave your erectile dysfunction treatment bubble.

    And given the expanse of California’s fires, anywhere you flee could end up having lousy air quality by the time you arrive.“The better part of rationality,” Wilkes said, “would be to stay at home, not exercise [outdoors], stay inside as much as you can, turn on the air conditioning.”California Healthline senior correspondent Anna Maria Barry-Jester contributed to this report. Jenny buy kamagra tablets Gold. jgold@kff.org, @JennyAGold Related Topics California Public Health States erectile dysfunction treatment Environmental Health Natural DisastersIn the 2014 elections, Republicans rode a wave of anti-Affordable Care Act sentiment to pick up nine Senate seats, the largest gain for either party since 1980. Newly elected Republicans such as Cory Gardner in Colorado and Steve Daines in Montana had hammered their Democratic opponents over the health care law during the campaign buy kamagra tablets and promised to repeal it.Six years later, those senators are up for reelection. Not only is the law still around, but it’s gaining in popularity.

    What was once a winning strategy has become a political liability.Public sentiment about the ACA, also known as Obamacare, buy kamagra tablets has shifted considerably during the Trump administration after Republicans tried but failed to repeal it. Now, in the midst of the erectile dysfunction treatment kamagra and the ensuing economic crisis, which has led to the loss of jobs and health insurance for millions of people, health care again looks poised to be a key issue for voters this election. Don't Miss A Story buy kamagra tablets Subscribe to KHN’s free Weekly Edition newsletter. With competitive races in Colorado, Montana, Arizona, North Carolina and Iowa pitting Republican incumbents who voted to repeal the ACA against Democratic challengers promising to protect it, attitudes surrounding the health law could help determine control of the Senate. Republicans hold a slim three-vote majority in the Senate but are defending 23 buy kamagra tablets seats in the Nov.

    3 election. Only one Democratic Senate seat — in Alabama, where incumbent Doug Jones is up against former Auburn University football coach Tommy Tuberville — is considered in play for buy kamagra tablets Republicans.“The fall election will significantly revolve around people’s belief about what [candidates] will do for their health coverage,” said Dr. Daniel Derksen, a professor of public health at the University of Arizona.The Affordable Care Act has been a wedge issue since it was signed into law in 2010. Because it then took four years to enact, its opponents talked for years about how bad the not-yet-created marketplace for insurance would be, said Joe Hanel, spokesperson for the Colorado Health Institute, a buy kamagra tablets nonpartisan nonprofit focused on health policy analysis. And they continued to attack the law as it took full effect in 2014.Gardner, for example, ran numerous campaign ads that year criticizing the ACA and, in particular, President buy kamagra tablets Barack Obama’s assertion that “if you like your health care plan, you’ll be able to keep your health care plan.”But now, Hanel said, the ACA’s policies have become much more popular in Colorado as the costs of health exchange plans have dropped.

    Thus, political messaging has changed, too.“This time it’s the opposite,” Hanel said. €œThe people bringing up the Affordable Care Act are the Democrats.”Despite Gardner’s multiple votes buy kamagra tablets to repeal the ACA, he has largely avoided talking about the measure during the 2020 campaign. He even removed his pro-repeal position from his campaign website.Democratic attack ads in July blasted Gardner for repeatedly dodging questions in an interview with Colorado Public Radio about his stance on a lawsuit challenging the ACA.His opponent, Democrat John Hickenlooper, fully embraced the law when he was Colorado governor, using the measure to expand Medicaid eligibility to more low-income people and to create a state health insurance exchange. Now, he’s buy kamagra tablets campaigning on that record, with promises to expand health care access even further.Polling DataPolling conducted by KFF for the past 10 years shows a shift in public opinion has occurred nationwide. (KHN is an editorially independent program of KFF, the Kaiser Family Foundation.)“Since Trump won the election in 2016, we now have consistently found that a larger share of the public holds favorable views” of the health law, said Ashley Kirzinger, associate director of public opinion and survey research for the foundation.

    €œThis really solidified in 2017 after the failed repeal in buy kamagra tablets the Senate.”The foundation’s polling found that, in July 2014, 55% of voters opposed the law, while 36% favored it. By July 2020, that had flipped, with 51% favoring the law and 38% opposing it. A shift was seen across all political groups, though 74% of Republicans still viewed it unfavorably in the latest poll.Public support for individual provisions of the ACA — such as protections for people with preexisting conditions or allowing young adults to stay on their parents’ health plans until age 26 — buy kamagra tablets have proved even more popular than the law as a whole. And the provision that consistently polled unfavorably — the mandate that those without insurance must pay a fine — was eliminated in 2017.“We’re 10 years along and the sky hasn’t caved in,” said Sabrina Corlette, a health policy professor at Georgetown University.Political MessagingFollowing the passage of the ACA, Democrats didn’t reference the law in their campaigns, said Erika Franklin Fowler, a government professor at Wesleyan University and the director of the Wesleyan Media Project, which tracks political advertising.“They ran on any other issue they could find,” Fowler said.Republicans, she said, kept promising to “repeal and replace” but weren’t able to do so.Then, in the 2018 election, Democrats seized on the shift in public opinion, touting the effects of the law and criticizing Republicans for their attempts to overturn it.“In the decade I have been tracking political advertising, there wasn’t a single-issue topic that was as prominent as health care was in 2018,” she said.As the global health crisis rages, health care concerns again dominate political ads in the 2020 races, Fowler said, although most ads haven’t explicitly focused on the ACA. Many highlight Republicans’ support buy kamagra tablets for the lawsuit challenging preexisting condition protections or specific provisions of the ACA that their votes would have overturned.

    Republicans say they, too, will protect people with preexisting conditions but otherwise have largely avoided talking about the ACA.“Cory Gardner has been running a lot on his environmental bills and conservation funding,” Fowler said. €œIt’s not difficult to figure out why he’s doing that. It’s easier for him to tout that in a state like Colorado than it is to talk about health care.”Similar dynamics are playing out in other key Senate races. In Arizona, Republican Sen. Martha McSally was one of the more vocal advocates of repealing the ACA while she served in the House of Representatives.

    She publicly acknowledged those votes may have hurt her 2018 Senate bid.“I did vote to repeal and replace Obamacare,” McSally said on conservative pundit Sean Hannity’s radio show during the 2018 campaign. €œI’m getting my ass kicked for it right now.”She indeed lost but was appointed to fill the seat of Sen. Jon Kyl after he resigned at the end of 2018. Now McSally is in a tight race with Democratic challenger Mark Kelly, an astronaut and the husband of former Rep. Gabby Giffords.“Kelly doesn’t have a track record of voting one way or another, but certainly in his campaign this is one of his top speaking points.

    What he would do to expand coverage and reassure people that coverage won’t be taken away,” said Derksen, the University of Arizona professor.The ACA has proved a stumbling block for Republican Sens. Thom Tillis of North Carolina and Joni Ernst of Iowa. In Maine, GOP Sen. Susan Collins cast a key vote that prevented the repeal of the law but cast other votes that weakened it. She now also appears vulnerable — but more for her vote to confirm Brett Kavanaugh’s nomination to the Supreme Court and for not doing more to oppose President Donald Trump.In Montana, Daines, who voted to repeal the ACA, is trying to hold on to his seat against Democratic Gov.

    Steve Bullock, who used the law to expand the state’s Medicaid enrollment in 2015. At its peak, nearly 1 in 10 Montanans were covered through the expansion.As more Montanans now face the high cost of paying for health care on their own amid kamagra-related job losses, Montana State University political science professor David Parker said he expects Democrats to talk about Daines’ votes to repeal cost-saving provisions of the ACA.“People are losing jobs, and their jobs bring health care with them,” Parker said. €œI don’t think it’s a good space for Daines to be right now.” Markian Hawryluk. MarkianH@kff.org, @MarkianHawryluk Related Topics Elections Health Care Costs Health Care Reform Insurance States Arizona Colorado Montana North Carolina Obamacare Plans.

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    Credit http://karenthefengshuilady.com/2011/01/15/430/ buy kamagra uk review. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this buy kamagra uk review population.

    The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised buy kamagra uk review scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over.

    The prevalence of those with fibroids buy kamagra uk review was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids.

    The findings buy kamagra uk review translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she buy kamagra uk review says.

    However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous buy kamagra uk review tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

    The other buy kamagra uk review authors on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit.

    The New England Journal of Medicine Share Fast Facts This study clears buy kamagra uk review up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The buy kamagra uk review “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows.

    The finding, published in the Dec. 21 New buy kamagra uk review England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

    As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines buy kamagra uk review have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

    The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others buy kamagra uk review to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear buy kamagra uk review.

    To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor buy kamagra uk review samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation.

    The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden buy kamagra uk review of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

    It’s one of those things that buy kamagra uk review doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive buy kamagra uk review skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors.

    However, he explains, this cancer type is often caused by a kamagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t buy kamagra uk review yet been tried.

    Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether buy kamagra uk review cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

    Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

    Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population.

    The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over.

    The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids.

    The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says.

    However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

    The other authors on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit.

    The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows.

    The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

    As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

    The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

    To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation.

    The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

    It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors.

    However, he explains, this cancer type is often caused by a kamagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried.

    Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

    Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

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    The Ministry has kamagra buy online canada revised the guidance to the Mental Health (Compulsory Assessment and Treatment) Act 1992 (the Act), outlining the rights of compulsory mental can i buy kamagra online health consumers and the obligations of mental health clinicians. This guidance is intended to promote the protection of compulsory mental health consumers’ rights by clarifying the responsibilities of mental health services and clinicians and offering guidance on how sections of the Act can be administered. A number of key changes and emerging issues have been signalled in the revision of these Guidelines. In particular can i buy kamagra online lowest price kamagra. the growing influence of rights-based approaches and how these can be better promoted within the parameters of the current Mental Health Act.

    The need to give greater emphasis to our obligations under Te Tiriti o Waitangi the impact of He Ara Oranga and, in particular, the feedback from people with lived experience and families and whānau on how they experience the current administration of the Mental Health Act. Please also read the companion document to these guidelines, Human Rights and the Mental Health (Compulsory Assessment and Treatment) Act 1992, which offers guidance to thinking about and applying a human rights approach and supported decision-making when implementing the Act..

    The Ministry has revised the guidance to the Mental Health navigate to this web-site (Compulsory Assessment and Treatment) Act 1992 (the Act), outlining the buy kamagra tablets rights of compulsory mental health consumers and the obligations of mental health clinicians. This guidance is intended to promote the protection of compulsory mental health consumers’ rights by clarifying the responsibilities of mental health services and clinicians and offering guidance on how sections of the Act can be administered. A number of key changes and emerging issues have been signalled in the revision of these Guidelines. In particular buy kamagra tablets. the growing influence of rights-based approaches and how these can be better promoted within the parameters of the current Mental Health Act.

    The need to give greater emphasis to our obligations under Te Tiriti o Waitangi the impact of He Ara Oranga and, in particular, the feedback from people with lived experience and families and whānau on how they experience the current administration of the Mental Health Act. Please also read the companion document to these guidelines, Human Rights and the Mental Health (Compulsory Assessment and Treatment) Act 1992, which offers guidance to thinking about and applying a human rights approach and supported decision-making when implementing the Act..

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    Researchers from the University of Minnesota, with support from Medtronic, have developed read this a groundbreaking process for multi-material 3D printing of lifelike models of the heart's aortic valve and the surrounding structures that mimic the exact look and feel of a real patient.These patient-specific organ models, which include 3D-printed soft sensor arrays integrated into the structure, are fabricated using specialized inks and a customized 3D printing just naturals kamagra process. Such models can be used in preparation for minimally invasive procedures to improve outcomes in thousands of patients worldwide.The research is published in Science Advances, a peer-reviewed scientific journal published by the American Association for the Advancement of Science (AAAS).The researchers 3D printed what is called the aortic root, the section of the aorta closest to and attached to the heart. The aortic just naturals kamagra root consists of the aortic valve and the openings for the coronary arteries. The aortic valve has three flaps, called leaflets, surrounded by a fibrous ring. The model also included part of the left ventricle just naturals kamagra muscle and the ascending aorta."Our goal with these 3D-printed models is to reduce medical risks and complications by providing patient-specific tools to help doctors understand the exact anatomical structure and mechanical properties of the specific patient's heart," said Michael McAlpine, a University of Minnesota mechanical engineering professor and senior researcher on the study.

    "Physicians can test and try the valve implants before the actual procedure. The models can also help patients better understand their own anatomy and the procedure itself."This organ model was specifically designed to help doctors prepare for a procedure called a Transcatheter Aortic Valve Replacement (TAVR) in which just naturals kamagra a new valve is placed inside the patient's native aortic valve. The procedure is used to treat a condition called aortic stenosis that occurs when the heart's aortic valve narrows and prevents the valve from opening fully, which reduces or blocks blood flow from the heart into the main artery. Aortic stenosis is one of the most common cardiovascular conditions in the elderly and affects about 2.7 million adults over the age of 75 in North America just naturals kamagra. The TAVR procedure is less invasive than open heart surgery to repair the damaged valve.

    advertisement The aortic root models are made by using CT just naturals kamagra scans of the patient to match the exact shape. They are then 3D printed using specialized silicone-based inks that mechanically match the feel of real heart tissue the researchers obtained from the University of Minnesota's Visible Heart Laboratories. Commercial printers currently on the market can 3D print the shape, but use inks that are often too rigid to just naturals kamagra match the softness of real heart tissue.On the flip side, the specialized 3D printers at the University of Minnesota were able to mimic both the soft tissue components of the model, as well as the hard calcification on the valve flaps by printing an ink similar to spackling paste used in construction to repair drywall and plaster.Physicians can use the models to determine the size and placement of the valve device during the procedure. Integrated sensors that are 3D printed within the model give physicians the electronic pressure feedback that can be used to guide and optimize the selection and positioning of the valve within the patient's anatomy.But McAlpine doesn't see this as the end of the road for these 3D-printed models."As our 3D-printing techniques continue to improve and we discover new ways to integrate electronics to mimic organ function, the models themselves may be used as artificial replacement organs," said McAlpine, who holds the Kuhrmeyer Family Chair Professorship in the University of Minnesota Department of Mechanical Engineering. "Someday maybe these 'bionic' organs can be as good as or better than their biological counterparts."In addition to McAlpine, the team included University of Minnesota researchers Ghazaleh Haghiashtiani, co-first author and a recent mechanical engineering Ph.D just naturals kamagra.

    Graduate who now works at Seagate. Kaiyan Qiu, another co-first author and a former mechanical engineering just naturals kamagra postdoctoral researcher who is now an assistant professor at Washington State University. Jorge D. Zhingre Sanchez, a just naturals kamagra former biomedical engineering Ph.D. Student who worked in the University of Minnesota's Visible Heart Laboratories who is now a senior R&D engineer at Medtronic.

    Zachary J just naturals kamagra. Fuenning, a mechanical engineering graduate student. Paul A just naturals kamagra. Iaizzo, a professor of surgery in the Medical School and founding director of the U of M Visible Heart Laboratories. Priya Nair, senior scientist at Medtronic just naturals kamagra.

    And Sarah E. Ahlberg, director of research & just naturals kamagra. Technology at Medtronic.This research was funded by Medtronic, the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health, and the Minnesota Discovery, Research, and InnoVation Economy (MnDRIVE) Initiative through the State of Minnesota. Additional support was provided by University of Minnesota Interdisciplinary Doctoral Fellowship and Doctoral Dissertation Fellowship awarded to Ghazaleh Haghiashtiani.SOBRE NOTICIAS EN ESPAÑOLNoticias en español es una sección de Kaiser Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que just naturals kamagra vive en los Estados Unidos. Use Nuestro Contenido Este contenido puede usarse de manera gratuita (detalles).

    La temporada de influenza se verá diferente este año, ya just naturals kamagra que los Estados Unidos se enfrentan a una pandemia de erectile dysfunction que ya ha matado a más de 176.000 personas.Muchos estadounidenses son reacios a ir al médico y los funcionarios de salud pública temen que las personas eviten vacunarse. Aunque a veces se considera incorrectamente como un resfriado, la gripe también mata a decenas de miles de personas en el país cada año. Los más vulnerables son los niños pequeños, los adultos mayores y las personas con enfermedades subyacentes just naturals kamagra. Cuando se combina con los efectos de erectile dysfunction treatment, los expertos en salud pública dicen que es más importante que nunca vacunarse contra la gripe.Si una cantidad suficiente de la población se vacuna, más del 45% lo hizo la temporada de gripe pasada, podría ayudar a evitar un escenario de pesadilla este invierno, con hospitales llenos de pacientes con erectile dysfunction treatment y los que sufren los efectos graves de la influenza.Además de la posible carga para los hospitales, existe la posibilidad de que las personas contraigan ambos kamagra y “nadie sabe qué sucede si se contrae influenza y erectile dysfunction treatment simultáneamente porque nunca sucedió antes”, dijo la doctora Rachel Levine, secretaria de Salud de Pennsylvania, a reporteros.En respuesta, este año los fabricantes están produciendo más suministros de vacunas, entre 194 y 198 millones de dosis, unas 20 millones más de las que se distribuyeron la temporada pasada, según los Centros para el Control y Prevención de Enfermedades (CDC).Mientras se acerca la temporada de gripe, aquí hay algunas respuestas a preguntas frecuentes:P. ¿Cuándo debo just naturals kamagra vacunarme contra la gripe?.

    La publicidad ya ha comenzado y algunas farmacias y clínicas ya tienen sus suministros. Pero, debido a que la efectividad de la vacuna puede disminuir con el tiempo, los CDC recomiendan no recibir la dosis en agosto.Muchas farmacias y clínicas comenzarán las inmunizaciones a principios just naturals kamagra de septiembre. Generalmente, los kamagra de la influenza comienzan a circular a mediados o fines de octubre, pero se expanden masivamente más tarde, en el invierno. Se necesitan aproximadamente dos semanas después de recibir la inyección para que los anticuerpos, que circulan en la sangre y frustran las infecciones, just naturals kamagra se acumulen.“Las personas jóvenes y sanas pueden comenzar a vacunarse contra la gripe en septiembre, y las personas mayores y otras poblaciones vulnerables pueden hacerlo en octubre”, dijo el doctor Steve Miller, director clínico de la aseguradora Cigna.Los CDC recomiendan que las personas “se vacunen contra la influenza a fines de octubre”, pero señalaron que se puede recibir la vacuna más tarde porque “aún puede ser beneficiosas y la vacunación debe ofrecerse a lo largo de toda la temporada de influenza”.Aun así, algunos expertos recomiendan no esperar demasiado este año, no solo por erectile dysfunction treatment, sino también en caso de que haya escasez debido a la abrumadora demanda.P. ¿Cuáles son las razones por las que las que debería ofrecer mi brazo para vacunarme?.

    Hay que vacunarse porque just naturals kamagra brinda protección contra la gripe y, por lo tanto, contra la propagación a otras personas, lo que puede ayudar a disminuir la carga para los hospitales y el personal médico.Y hay otro mensaje que puede resonar en estos tiempos extraños.“Le da a la gente la sensación de que hay algunas cosas que pueden controlar”, dijo Eduardo Sánchez, director médico de prevención de la American Heart Association.Si bien una vacuna contra la gripe no evitará erectile dysfunction treatment, recibirla podría ayudar al médico a diferenciar entre las dos enfermedades si se desarrolla algún síntoma (fiebre, tos, dolor de garganta) que ambas infecciones comparten, explicó Sánchez.Y aunque las vacunas contra la gripe no evitarán todos los casos de gripe, vacunarse puede reducir la gravedad si la persona se enferma, dijo.Todas las personas elegibles, especialmente los trabajadores esenciales, los que sufren de afecciones subyacentes y aquellos en mayor riesgo, incluidos los niños muy pequeños y las mujeres embarazadas, deben buscar protección, dijeron los CDC. La entidad recomienda la vacunación a partir de los 6 meses.P. ¿Qué sabemos sobre la efectividad de la vacuna de just naturals kamagra este año?. Se deben producir nuevas vacunas contra la gripe cada año, porque el kamagra muta y la efectividad de la vacuna varía, dependiendo de qué tan bien coincida con el kamagra circulante.Se calculó que la formulación del año pasado tuvo una eficacia de aproximadamente un 45% para prevenir la gripe en general, con una efectividad de aproximadamente un 55% en los niños. Las vacunas disponibles en el país este año tienen como objetivo prevenir al menos tres cepas diferentes del kamagra, y la mayoría cubre cuatro.Todavía no se sabe qué tan bien coincidirá el suministro de este año con las cepas que circularán en los Estados just naturals kamagra Unidos.

    Las primeras indicaciones del hemisferio sur, que atraviesa su temporada de gripe durante nuestro verano, son alentadoras. Allí, las personas practicaron el distanciamiento social, usaron máscaras y se vacunaron en mayor número este año, just naturals kamagra y los niveles mundiales de gripe son más bajos de lo esperado. Sin embargo, expertos advierten que no se debe contar con una temporada igual de suave en los Estados Unidos, en parte porque los esfuerzos por usar mascara facial y de distanciamiento social varían ampliamente.P. ¿Qué están haciendo diferente los seguros y sistemas de salud este año? just naturals kamagra. Las aseguradoras y los sistemas de salud contactados por KHN dicen que seguirán las pautas de los CDC, que exigen limitar y espaciar la cantidad de personas que esperan en las filas y las áreas de vacunación.

    Algunos están programando citas para vacunas contra la gripe para ayudar a controlar el flujo.Health Fitness Concepts, una compañía que trabaja con UnitedHealth Group y otras empresas para establecer clínicas de vacunación contra la gripe en el noreste del país, dijo que está “fomentando eventos más pequeños y frecuentes para apoyar el distanciamiento social” y “exigiendo que se completen todos los formularios y arremangarse las camisas antes de entrar al área de vacunación contra la influenza”.Se requerirá que todos usen máscaras.Además, a nivel nacional, algunos grupos médicos contratados por UnitedHealth instalarán carpas, para que las inyecciones se puedan administrar al aire libre, dijo un vocero.Kaiser Permanente planifica las vacunas directamente en autos en algunos de just naturals kamagra sus centros médicos y está probando los procedimientos de detección y registro sin contacto en algunos lugares.Geisinger Health, un proveedor de salud regional en Pennsylvania y Nueva Jersey, dijo que también tendría programas de vacunación contra la influenza al aire libre en sus instalaciones.Además, “Geisinger exige que todos los empleados reciban la vacuna contra la influenza este año”, dijo Mark Shelly, director de prevención y control de infecciones del sistema. €œAl dar este paso, esperamos transmitir a nuestros vecinos la importancia de la vacuna contra la influenza para todos”.P. Por lo general, me vacunan contra la gripe just naturals kamagra en el trabajo. ¿Seguirá siendo una opción este año?. Con el objetivo de evitar riesgosas reuniones just naturals kamagra en interiores, muchos empleadores se muestran reacios a patrocinar las clínicas de gripe en oficinas como han ofrecido en años anteriores.

    Y con tanta gente que sigue trabajando desde casa, hay menos necesidad de llevar las vacunas contra la gripe al lugar de trabajo. En cambio, muchos empleadores están alentando a los trabajadores a que reciban vacunas de sus just naturals kamagra médicos de atención primaria, en farmacias u otros entornos comunitarios. El seguro generalmente cubrirá el costo de la vacuna.Algunos empleadores están considerando ofrecer cupones para vacunas contra la gripe a sus trabajadores sin seguro o a aquellos que no participan en el plan médico de la compañía, dijo Julie Stone, directora general de salud y beneficios de Willis Towers Watson, una firma consultora.Estos cupones podrían, por ejemplo, permitir a los trabajadores obtener la vacuna en un laboratorio en particular sin costo.Algunos empleadores están comenzando a pensar en cómo podrían usar sus estacionamientos para administrar vacunas contra la gripe enlos autos, dijo el doctor David Zieg, líder de servicios clínicos para el consultor de beneficios Mercer.Aunque la ley federal permite a los empleadores exigir a los empleados que se vacunen contra la gripe, ese paso generalmente lo toman solo los centros de atención médica y algunas universidades donde las personas viven y trabajan en estrecha colaboración, dijo Zieg.Pero sucede. El mes pasado, el sistema de la Universidad de California emitió una orden ejecutiva que requiere que todos los estudiantes, profesores y personal se vacunen contra la gripe antes just naturals kamagra del 1 de noviembre, con limitadas excepciones.P. ¿Qué están haciendo las farmacias para alentar a las personas a vacunarse contra la gripe?.

    Algunas farmacias están haciendo un esfuerzo adicional para salir a la comunidad y ofrecer vacunas contra la gripe.Walgreens, que tiene casi 9,100 farmacias en todo el país, continúa una asociación iniciada en 2015 con organizaciones comunitarias, iglesias y empleadores que ha ofrecido alrededor de 150,000 clínicas de just naturals kamagra gripe móviles hasta la fecha.El programa pone especial énfasis en trabajar con poblaciones vulnerables y en áreas desatendidas, dijo el doctor Kevin Ban, director médico de la cadena de farmacias.Walgreens comenzó a ofrecer vacunas contra la gripe a mediados de agosto y está animando a las personas a no demorar en vacunarse.Tanto Walgreens como CVS están estimulando a las personas a programar citas y hacer trámites en línea este año para minimizar el tiempo que pasan en los locales.En los CVS MinuteClinic, una vez que los pacientes se han registrado para recibir la vacuna contra la gripe, deben esperar afuera o en su automóvil, ya que las áreas de espera interiores ahora están cerradas.“No tenemos un arsenal contra erectile dysfunction treatment”, dijo Ban, de Walgreens. €œPero quitar la presión del sistema de atención médica proporcionando vacunas por adelantado es algo que sí podemos hacer”. Julie just naturals kamagra Appleby. jappleby@kff.org, @Julie_Appleby Michelle Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Noticias En Español Public Health erectile dysfunction treatment Insurers treatmentsThis story was produced in just naturals kamagra partnership with PolitiFact.

    This story can be republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with few participants wearing masks, he touched on a range of topics, including many related to the erectile dysfunction treatment kamagra and health care in general.Throughout, the partisan crowd applauded and chanted “Four more years!. € And, even just naturals kamagra as the nation’s erectile dysfunction treatment death toll exceeded 180,000, Trump was upbeat. €œIn recent months, our nation and the entire planet has been struck by a new and powerful invisible enemy,” he said. €œLike those brave Americans before just naturals kamagra us, we are meeting this challenge.”At the end of the event, there were fireworks.Our partners at PolitiFact did an in-depth fact check on Trump’s entire acceptance speech. Here are the highlights related to the administration’s erectile dysfunction treatment response and other health policy issues:“We developed, from scratch, the largest and most advanced testing system in the world.” This is partially right, but it needs context.It’s accurate that the U.S.

    Developed its erectile dysfunction treatment testing system from scratch, because the government didn’t accept the World Health Organization’s just naturals kamagra testing recipe. But whether the system is the “largest” or “most advanced” is subject to debate.The U.S. Has tested more individuals than any other country just naturals kamagra. But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested. Another useful metric would be the percentage of the population that has been tested.

    The U.S just naturals kamagra. Is one of the most populous countries but has tested a lower percentage of its population than other countries. Don't Miss A Story Subscribe to just naturals kamagra KHN’s free Weekly Edition newsletter. The U.S. Was also slower than other countries in rolling out tests and amping up testing capacity just naturals kamagra.

    Even now, many states are experiencing delays in reporting test results to positive individuals.As for “the most advanced,” Trump may be referring to new testing investments and systems, like Abbott’s recently announced $5, 15-minute rapid antigen test, which the company says will be about the size of a credit card, needs no instrumentation and comes with a phone app through which people can view their results. But Trump’s comment makes it sound as if these testing systems are already in place when they haven’t been distributed to the public.“The United States has among the lowest [erectile dysfunction treatment] case fatality rates just naturals kamagra of any major country in the world. The European Union’s case fatality rate is nearly three times higher than ours.”The case fatality rate measures the known number of cases against the known number of deaths. The European Union has a rate that’s about 2½ times greater than the United States.But the source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a kamagra, the case fatality rate is a poor measure of the mortality risk of the disease.”A better way to measure the threat of just naturals kamagra the kamagra, experts say, is to look at the number of deaths per 100,000 residents. Viewed that way, the U.S.

    Has the 10th-highest death rate in the world.“We will produce a treatment before the end of the year, or maybe even sooner.”It’s far from guaranteed that a erectile dysfunction treatment will just naturals kamagra be ready before the end of the year.While researchers are making rapid strides, it’s not yet known precisely when the treatment will be available to the public, which is what’s most important. Six treatments are in the third phase of testing, which involves thousands of patients. Like earlier phases, this one looks at the safety of a treatment but also examines its effectiveness and collects just naturals kamagra more data on side effects. Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective treatment for erectile dysfunction treatment by January 2021.”And federal health officials and other experts have generally predicted a treatment will be available in early 2021. Federal committees are working on recommendations for just naturals kamagra treatment distribution, including which groups should get it first.

    €œFrom everything we’ve seen now — in the animal data, as well as the human data — we feel cautiously optimistic that we will have a treatment by the end of this year and as we go into 2021,” said Dr. Anthony Fauci, the just naturals kamagra nation’s top infectious diseases expert. €œI don’t think it’s dreaming.”“Last month, I took on Big Pharma. You think that just naturals kamagra is easy?. I signed orders that would massively lower the cost of your prescription drugs.”Quite misleading.

    Trump signed just naturals kamagra four executive orders on July 24 aimed at lowering prescription drug prices. But those orders haven’t taken effect yet — the text of one hasn’t even been made publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for it than others do. In 2017, Trump supported congressional efforts to repeal the ACA just naturals kamagra. The Trump administration is now backing GOP-led efforts to overturn the ACA through a court case. And Trump has also expanded short-term health plans that don’t have to comply with the just naturals kamagra ACA.“Joe Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading.

    During a June 2019 Democratic primary debate, candidates were asked. €œRaise your hand if your government plan would just naturals kamagra provide coverage for undocumented immigrants.” All candidates on stage, including Biden, raised their hands. They were not asked if that coverage would be free or subsidized.Biden supports extending health care access to all immigrants, regardless of immigration status. A task force recommended that he allow immigrants who are in the country illegally to buy health insurance, without federal subsidies.“Joe Biden claims he has empathy for the vulnerable, yet the party he leads supports the extreme late-term abortion of defenseless just naturals kamagra babies right up to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling in Roe v. Wade and related precedents.

    This would just naturals kamagra generally limit abortions to the first 20 to 24 weeks of gestation. States are allowed under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between 24 and 28 weeks from the mother’s last menstrual period — and 43 states do. But the rulings require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds that “every woman should have access to quality reproductive health care services, including safe and legal abortion — regardless of where she lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, Jon just naturals kamagra Greenberg, Louis Jacobson, Noah Y. Kim, Bill McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight contributed to this report. Related Topics just naturals kamagra Elections Health Industry Pharmaceuticals Public Health The Health Law Abortion erectile dysfunction treatment Immigrants KHN &.

    PolitiFact HealthCheck Preexisting Conditions Trump Administration treatmentsThis story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a erectile dysfunction kamagra that has killed more than 172,000 people. Many Americans are reluctant to visit a doctor’s office and public health officials worry people will shy away from being immunized.Although sometimes incorrectly regarded as just another bad cold, just naturals kamagra flu also kills tens of thousands of people in the U.S. Each year, with the very young, the elderly and those with underlying conditions the most vulnerable. When coupled with the effects of erectile dysfunction treatment, public health just naturals kamagra experts say it’s more important than ever to get a flu shot.If enough of the U.S. Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both erectile dysfunction treatment patients and those suffering from severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both kamagraes — and “no one knows what happens if you get influenza and erectile dysfunction treatment [simultaneously] because it’s never happened before,” Dr.

    Rachel Levine, Pennsylvania’s secretary of health, told reporters just naturals kamagra this month.In response, manufacturers are producing more treatment supply this year, between 194 million and 198 million doses, or about 20 million more than they distributed last season, according to the Centers for Disease Control and Prevention. Email Sign-Up Subscribe to KHN’s free Morning Briefing. As flu season approaches, here are some answers to a just naturals kamagra few common questions:Q. When should I get my flu shot?. Advertising has just naturals kamagra already begun, and some pharmacies and clinics have their supplies now.

    But, because the effectiveness of the treatment can wane over time, the CDC recommends against a shot in August.Many pharmacies and clinics will start immunizations in early September. Generally, influenza kamagraes just naturals kamagra start circulating in mid- to late October but become more widespread later, in the winter. It takes about two weeks after getting a shot for antibodies — which circulate in the blood and thwart s — to build up. €œYoung, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations can begin just naturals kamagra in October,” said Dr. Steve Miller, chief clinical officer for insurer Cigna.The CDC has recommended that people “get a flu treatment by the end of October,” but noted it’s not too late to get one after that because shots “can still be beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of erectile dysfunction treatment, but also in case a shortage develops because of overwhelming demand.Q.

    What are the reasons I should roll up my sleeve for just naturals kamagra this?. Get a shot because it protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent erectile dysfunction treatment, he said, getting one could help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get influenza from having a flu treatment.All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said. It recommends that children just naturals kamagra over 6 months old get vaccinated.Q. What do we know about the effectiveness of this year’s treatment?. Flu treatments — which must be developed anew each year because influenza kamagraes mutate — range in effectiveness annually, depending on how well they match the circulating just naturals kamagra kamagra.

    Last year’s formulation was estimated to be about 45% effective in preventing the flu overall, with about a 55% effectiveness in children. The treatments available in the just naturals kamagra U.S. This year are aimed at preventing at least three strains of the kamagra, and most cover four.It isn’t yet known how well this year’s supply will match the strains that will circulate in the U.S. Early indications from the Southern Hemisphere, which just naturals kamagra goes through its flu season during our summer, are encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global flu levels are lower than expected.

    Experts caution, however, not to just naturals kamagra count on a similarly mild season in the U.S., in part because masking and social distancing efforts vary widely.Q. What are insurance plans and health systems doing differently this year?. Insurers and health systems contacted by KHN say they will follow CDC guidelines, just naturals kamagra which call for limiting and spacing out the number of people waiting in lines and vaccination areas. Some are setting appointments for flu shots to help manage the flow.Health Fitness Concepts, a company that works with UnitedHealth Group and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent events to support social distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set up tent areas so shots can be given outdoors, a spokesperson said.Kaiser Permanente plans drive-thru vaccinations at some of its medical facilities and is testing touch-free screening and check-in procedures at some locations. (KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said just naturals kamagra it, too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu treatment this year,” said Mark Shelly, the system’s director of prevention and control.

    €œBy taking this step, we hope to convey to our neighbors the importance of the flu treatment for everyone.”Q. Usually I just naturals kamagra get a flu shot at work. Will that be an option this year?. Aiming to avoid risky indoor just naturals kamagra gatherings, many employers are reluctant to sponsor the on-site flu clinics they’ve offered in years past. And with so many people continuing to work from home, there’s less need to bring flu shots to employees on the job.

    Instead, many employers are encouraging workers to get shots from their primary care doctors, at pharmacies or just naturals kamagra in other community settings. Insurance will generally cover the cost of the treatment.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm. The vouchers could allow workers to get the shot at a particular lab at no cost, for example.Some employers are starting to think about how they might use their parking lots for administering drive-thru flu shots, said Dr. David Zieg, clinical services leader for benefits consultant Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities just naturals kamagra where people live and work closely together, Zieg said.Q. What are pharmacies doing to encourage people to get flu shots?.

    Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered just naturals kamagra about 150,000 off-site and mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr. Kevin Ban, chief medical officer for the drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since the indoor waiting areas are now closed.“We don’t have tons of arrows in our quiver against erectile dysfunction treatment,” Walgreens’ Ban said. €œTaking pressure just naturals kamagra off the health care system by providing treatments in advance is one thing we can do.” Julie Appleby. jappleby@kff.org, @Julie_Appleby Michelle Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Public Health erectile dysfunction treatment Insurers treatmentsUse just naturals kamagra Our Content This story can be republished for free (details). As the smoke thickened near her home in Santa Cruz, California, last week, Amanda Smith kept asking herself the same questions.

    Should we leave?. And where would we just naturals kamagra go?. The wildfire evacuation zone, at the time, ended a few blocks from her house. But she worried just naturals kamagra about what the air quality — which had reached the second-highest warning level, purple for “very unhealthy” — would do to her children’s lungs. Her 4-year-old twins had spent time in the neonatal intensive care unit.

    One was later diagnosed with asthma, and last year was hospitalized with pneumonia.By Tuesday, said Smith, “we all had headaches, the kids were coughing a little bit, and it was just naturals kamagra raining ash.” The family had been conscientiously isolating at home because of the erectile dysfunction treatment kamagra, and leaving meant potential exposures. But on Wednesday, Smith said, “I looked at my partner and said, maybe we should leave.”She called a friend in Orange County, about 380 miles south, who offered her parents’ empty condo. But the next day, just naturals kamagra the friend’s child spiked a fever — a possible case of erectile dysfunction treatment — and the plan fell through amid the distraction.Amanda Smith takes a selfie of herself and her twin children in Santa Cruz, California, in April. (Amanda Smith)So Smith looked on Airbnb, careful to seek out hosts who detailed their erectile dysfunction treatment precautions, and found an apartment in San Bruno, about an hour’s drive north. She stuffed photos and documents into a suitcase, grabbed the go-bags, and her family headed out.“It’s coming out of our savings to stay here,” Smith said just naturals kamagra from the safety of her apartment rental, which runs about $1,150 a week.

    €œIt was a really fraught decision to leave, but as soon as we got over the hill and the sky was blue, I took a big sigh of relief and knew that it had been a good decision.”As the twin disasters of erectile dysfunction treatment and fire season sweep through California, thousands of residents like Smith are weighing difficult options, pitting risk against risk as they decide where to evacuate, whether from imminent flames or the toxic air. Amid a virulent kamagra, which just naturals kamagra is safest?. Doubling up at a friend’s home?. A hotel? just naturals kamagra. An evacuation center?.

    And when do the risks of smoke inhalation outweigh the risk of just naturals kamagra a deadly ?. €œObviously the most important thing is for people to do what they can to protect their lives, not only from the fire, but also from erectile dysfunction treatment,” said Detective Rosemerry Blankswade, public information officer for the San Mateo County Sheriff’s Office, which is helping coordinate response to the massive CZU Lightning Complex fires.“You have to evaluate the big picture here. If fire is your most imminent danger, maybe take just naturals kamagra the erectile dysfunction treatment risk. But if you can avoid both of them, that’s obviously going to be the best option. It’s kind just naturals kamagra of a little bit of triage that we’re asking for people to do in their own lives right now.” Email Sign-Up Subscribe to KHN’s free Morning Briefing.

    In San Mateo, one of two counties where the CZU Lightning Complex fires are blazing, officials are advising people to head to an evacuation center, where county workers will assist them in finding a hotel room. Meanwhile, in neighboring Santa Cruz, where tens of thousands of residents have evacuated and shelters have limited space, officials are asking those under orders to leave to stay with family and friends whenever possible.What’s the right choice when all options pose just naturals kamagra additional risks?. We spoke with several experts to help guide your thought process.You have to evacuate. Where should you just naturals kamagra go?. If your region is under an evacuation order, do not hesitate.

    Leave immediately just naturals kamagra. If you can afford it, booking a room at a hotel or motel outside the evacuation zones may be the best option, said Dr. Michael Wilkes, just naturals kamagra a professor at the University of California-Davis School of Medicine. They almost always have air-conditioning units, which help filter the air from both smoke and kamagra. Many hotels are just naturals kamagra implementing new cleaning processes.

    Ask staffers to detail what they’re doing to sanitize rooms, and consider skipping the daily cleaning service during your stay. You might also check review sites such as TripAdvisor to see what other guests just naturals kamagra report. When possible, avoid the lobby and other shared spaces, and opt for contactless check-in.Amanda Smith at home in Santa Cruz, California, with her twin children. Smith and her family decided to just naturals kamagra voluntarily evacuate their home on Aug. 20, due to heavy smoke in the area from the CZU Lightning Complex fires in the nearby Santa Cruz Mountains.

    (Anna Maria Barry-Jester/KHN)With so many people in just naturals kamagra Northern California fleeing the fires, many hotels are already full, especially in more remote areas. So what about staying with family or friends?. After months of being shut in and avoiding close contact beyond immediate family, moving into just naturals kamagra someone else’s home means a host of potential exposures. Consider whether you or anyone else in the home is at high risk from erectile dysfunction treatment because of age or a preexisting condition.“If so, that’s a reason to think twice before going to someone’s home,” said Dr. Gina Solomon, a program director at the Oakland-based Public Health Institute.Consider, too, what precautions your friends or family just naturals kamagra have been taking.

    Sheltering with someone whose job brings them into frequent contact with other people may not be as safe as sheltering with people who largely have been staying home. Another question is how just naturals kamagra crowded the home is. If you have your own room and, preferably, your own bathroom, that makes staying with friends a better option. If a separate just naturals kamagra bedroom is not available and smoky skies are not a problem, you might consider pitching a tent in their backyard.For those with an RV or tent, camping can present another good option — although, with hundreds of wildfires burning across California, it may be challenging to drive far enough away to avoid fire and smoke. If you do camp, try to find a site away from wooded areas.

    And think just naturals kamagra twice before using group bathrooms.Is an evacuation center safe?. Many counties have implemented new precautions at emergency shelters to prevent the spread of the erectile dysfunction. In Santa Cruz, for example, officials are scaling back the capacity in each shelter to allow for social distancing, providing tents for people just naturals kamagra to use as shielding inside and allowing camping in the parking lots.Still, staying in a shelter should probably not be your first choice. In terms of erectile dysfunction treatment risk, deciding between a hotel and a friend’s house is “nipping at the edges,” said Dr. John Swartzberg, a clinical professor emeritus at the UC-Berkeley School just naturals kamagra of Public Health, while “being in a congregate setting is only better than being completely exposed to the elements.”If an evacuation shelter is your best immediate option, again, do not hesitate.

    €œYou have these standards you want to practice for yourselves,” Swartzberg said, “but when something worse comes along, it trumps how careful we can be with erectile dysfunction treatment because the need for shelter is greater.” You can lower your risk of by wearing a mask, washing hands frequently and sanitizing surfaces.Smith’s partner, Grant Whipple, walks with their children in Big Sur on March 7. That was their last camping trip before the erectile dysfunction treatment kamagra hit, Smith says just naturals kamagra. That area is now under threat from wildfire. (Amanda Smith)If you aren’t in just naturals kamagra a fire zone, should you invite friends and family to stay with you?. Deciding whether to open your home to friends who are evacuating is an intensely personal decision and may depend on whether anyone in your family has a preexisting condition.“I guess it depends on how good a friend they are and how desperate they are,” said Swartzberg.

    It may also depend on how much space you just naturals kamagra have. If your guests can have their own bedroom and bathroom, it might be safer.If you do offer your home, experts advise against simply considering yourself a new pod with your guests. Instead, take steps to lower your chances of .“It might not be pleasant, but wearing a mask anytime you’re not in your own bedroom is the safest way to go,” said Solomon. Stay outside as much as possible, she added, and consider eating meals outdoors or eating in shifts to avoid being maskless with those outside your family unit. Sanitize surfaces and wash hands frequently.

    If air quality permits, keep the windows open to improve airflow.If you’re in a region with hazardous smoke conditions, should you leave?. If your area has dense smoke but no imminent fire risk, the thought of heading somewhere else may be appealing, especially if you have respiratory issues. But in most cases, Wilkes said, it would be safer not to leave your erectile dysfunction treatment bubble. And given the expanse of California’s fires, anywhere you flee could end up having lousy air quality by the time you arrive.“The better part of rationality,” Wilkes said, “would be to stay at home, not exercise [outdoors], stay inside as much as you can, turn on the air conditioning.”California Healthline senior correspondent Anna Maria Barry-Jester contributed to this report. Jenny Gold.

    jgold@kff.org, @JennyAGold Related Topics California Public Health States erectile dysfunction treatment Environmental Health Natural Disasters.

    Researchers from the University of Minnesota, with support from Medtronic, have developed a groundbreaking process for multi-material 3D printing of lifelike models of the heart's aortic valve and the buy kamagra tablets surrounding structures that mimic the exact look and feel of a real patient.These patient-specific organ models, which include 3D-printed soft sensor arrays integrated into the structure, are fabricated using specialized inks and a customized 3D printing process. Such models can be used in preparation for minimally invasive procedures to improve outcomes in thousands of patients worldwide.The research is published in Science Advances, a peer-reviewed scientific journal published by the American Association for the Advancement of Science (AAAS).The researchers 3D printed what is called the aortic root, the section of the aorta closest to and attached to the heart. The aortic buy kamagra tablets root consists of the aortic valve and the openings for the coronary arteries. The aortic valve has three flaps, called leaflets, surrounded by a fibrous ring.

    The model also included part of the left ventricle muscle and the ascending aorta."Our goal with these 3D-printed models is to reduce medical risks and complications by providing patient-specific tools to help doctors understand the exact anatomical structure and mechanical properties of the specific patient's heart," said Michael McAlpine, a University of Minnesota mechanical engineering professor and senior researcher on the buy kamagra tablets study. "Physicians can test and try the valve implants before the actual procedure. The models can also help patients better buy kamagra tablets understand their own anatomy and the procedure itself."This organ model was specifically designed to help doctors prepare for a procedure called a Transcatheter Aortic Valve Replacement (TAVR) in which a new valve is placed inside the patient's native aortic valve. The procedure is used to treat a condition called aortic stenosis that occurs when the heart's aortic valve narrows and prevents the valve from opening fully, which reduces or blocks blood flow from the heart into the main artery.

    Aortic stenosis is one of the most common cardiovascular conditions in the elderly and buy kamagra tablets affects about 2.7 million adults over the age of 75 in North America. The TAVR procedure is less invasive than open heart surgery to repair the damaged valve. advertisement The aortic root models are made by using CT scans of the buy kamagra tablets patient to match the exact shape. They are then 3D printed using specialized silicone-based inks that mechanically match the feel of real heart tissue the researchers obtained from the University of Minnesota's Visible Heart Laboratories.

    Commercial printers currently on the market can 3D print the shape, but use inks that are buy kamagra tablets often too rigid to match the softness of real heart tissue.On the flip side, the specialized 3D printers at the University of Minnesota were able to mimic both the soft tissue components of the model, as well as the hard calcification on the valve flaps by printing an ink similar to spackling paste used in construction to repair drywall and plaster.Physicians can use the models to determine the size and placement of the valve device during the procedure. Integrated sensors that are 3D printed within the model give physicians the electronic pressure feedback that can be used to guide and optimize the selection and positioning of the valve within the patient's anatomy.But McAlpine doesn't see this as the end of the road for these 3D-printed models."As our 3D-printing techniques continue to improve and we discover new ways to integrate electronics to mimic organ function, the models themselves may be used as artificial replacement organs," said McAlpine, who holds the Kuhrmeyer Family Chair Professorship in the University of Minnesota Department of Mechanical Engineering. "Someday maybe these 'bionic' organs can be as good as or better than their biological counterparts."In addition to McAlpine, the team included University of Minnesota researchers buy kamagra tablets Ghazaleh Haghiashtiani, co-first author and a recent mechanical engineering Ph.D. Graduate who now works at Seagate.

    Kaiyan Qiu, another co-first author and buy kamagra tablets a former mechanical engineering postdoctoral researcher who is now an assistant professor at Washington State University. Jorge D. Zhingre Sanchez, buy kamagra tablets a former biomedical engineering Ph.D. Student who worked in the University of Minnesota's Visible Heart Laboratories who is now a senior R&D engineer at Medtronic.

    Zachary J buy kamagra tablets. Fuenning, a mechanical engineering graduate student. Paul A buy kamagra tablets. Iaizzo, a professor of surgery in the Medical School and founding director of the U of M Visible Heart Laboratories.

    Priya Nair, senior scientist buy kamagra tablets at Medtronic. And Sarah E. Ahlberg, director buy kamagra tablets of research &. Technology at Medtronic.This research was funded by Medtronic, the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health, and the Minnesota Discovery, Research, and InnoVation Economy (MnDRIVE) Initiative through the State of Minnesota.

    Additional support was provided by University of Minnesota Interdisciplinary Doctoral Fellowship and Doctoral Dissertation Fellowship awarded to Ghazaleh Haghiashtiani.SOBRE NOTICIAS EN ESPAÑOLNoticias en español es una sección de Kaiser buy kamagra tablets Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en los Estados Unidos. Use Nuestro Contenido Este contenido puede usarse de manera gratuita (detalles). La buy kamagra tablets temporada de influenza se verá diferente este año, ya que los Estados Unidos se enfrentan a una pandemia de erectile dysfunction que ya ha matado a más de 176.000 personas.Muchos estadounidenses son reacios a ir al médico y los funcionarios de salud pública temen que las personas eviten vacunarse. Aunque a veces se considera incorrectamente como un resfriado, la gripe también mata a decenas de miles de personas en el país cada año.

    Los más vulnerables buy kamagra tablets son los niños pequeños, los adultos mayores y las personas con enfermedades subyacentes. Cuando se combina con los efectos de erectile dysfunction treatment, los expertos en salud pública dicen que es más importante que nunca vacunarse contra la gripe.Si una cantidad suficiente de la población se vacuna, más del 45% lo hizo la temporada de gripe pasada, podría ayudar a evitar un escenario de pesadilla este invierno, con hospitales llenos de pacientes con erectile dysfunction treatment y los que sufren los efectos graves de la influenza.Además de la posible carga para los hospitales, existe la posibilidad de que las personas contraigan ambos kamagra y “nadie sabe qué sucede si se contrae influenza y erectile dysfunction treatment simultáneamente porque nunca sucedió antes”, dijo la doctora Rachel Levine, secretaria de Salud de Pennsylvania, a reporteros.En respuesta, este año los fabricantes están produciendo más suministros de vacunas, entre 194 y 198 millones de dosis, unas 20 millones más de las que se distribuyeron la temporada pasada, según los Centros para el Control y Prevención de Enfermedades (CDC).Mientras se acerca la temporada de gripe, aquí hay algunas respuestas a preguntas frecuentes:P. ¿Cuándo debo vacunarme buy kamagra tablets contra la gripe?. La publicidad ya ha comenzado y algunas farmacias y clínicas ya tienen sus suministros.

    Pero, debido a que la efectividad de la vacuna puede disminuir con el tiempo, los CDC recomiendan no recibir la dosis en buy kamagra tablets agosto.Muchas farmacias y clínicas comenzarán las inmunizaciones a principios de septiembre. Generalmente, los kamagra de la influenza comienzan a circular a mediados o fines de octubre, pero se expanden masivamente más tarde, en el invierno. Se necesitan aproximadamente dos semanas después de recibir la inyección para que los anticuerpos, que circulan en la sangre y frustran las infecciones, se acumulen.“Las personas jóvenes y sanas pueden comenzar a vacunarse contra la gripe en septiembre, y las personas mayores y otras poblaciones vulnerables pueden hacerlo buy kamagra tablets en octubre”, dijo el doctor Steve Miller, director clínico de la aseguradora Cigna.Los CDC recomiendan que las personas “se vacunen contra la influenza a fines de octubre”, pero señalaron que se puede recibir la vacuna más tarde porque “aún puede ser beneficiosas y la vacunación debe ofrecerse a lo largo de toda la temporada de influenza”.Aun así, algunos expertos recomiendan no esperar demasiado este año, no solo por erectile dysfunction treatment, sino también en caso de que haya escasez debido a la abrumadora demanda.P. ¿Cuáles son las razones por las que las que debería ofrecer mi brazo para vacunarme?.

    Hay que vacunarse porque brinda protección contra la gripe y, por lo tanto, contra la propagación a otras personas, lo que puede ayudar a disminuir la carga para los hospitales y el personal médico.Y hay otro mensaje que puede resonar en estos tiempos extraños.“Le da a la gente la sensación de que hay algunas cosas que pueden controlar”, dijo Eduardo Sánchez, director médico de prevención de la American Heart Association.Si bien una vacuna contra la gripe no evitará erectile dysfunction treatment, recibirla podría ayudar al médico a diferenciar entre las dos enfermedades si se desarrolla algún síntoma (fiebre, tos, dolor de garganta) que ambas infecciones comparten, explicó Sánchez.Y aunque las vacunas contra la gripe no evitarán todos buy kamagra tablets los casos de gripe, vacunarse puede reducir la gravedad si la persona se enferma, dijo.Todas las personas elegibles, especialmente los trabajadores esenciales, los que sufren de afecciones subyacentes y aquellos en mayor riesgo, incluidos los niños muy pequeños y las mujeres embarazadas, deben buscar protección, dijeron los CDC. La entidad recomienda la vacunación a partir de los 6 meses.P. ¿Qué sabemos sobre la efectividad de la vacuna buy kamagra tablets de este año?. Se deben producir nuevas vacunas contra la gripe cada año, porque el kamagra muta y la efectividad de la vacuna varía, dependiendo de qué tan bien coincida con el kamagra circulante.Se calculó que la formulación del año pasado tuvo una eficacia de aproximadamente un 45% para prevenir la gripe en general, con una efectividad de aproximadamente un 55% en los niños.

    Las vacunas disponibles en el país este año tienen como objetivo prevenir al menos tres cepas diferentes del kamagra, y la mayoría cubre cuatro.Todavía buy kamagra tablets no se sabe qué tan bien coincidirá el suministro de este año con las cepas que circularán en los Estados Unidos. Las primeras indicaciones del hemisferio sur, que atraviesa su temporada de gripe durante nuestro verano, son alentadoras. Allí, las personas practicaron el distanciamiento social, usaron máscaras y se vacunaron en mayor número este buy kamagra tablets año, y los niveles mundiales de gripe son más bajos de lo esperado. Sin embargo, expertos advierten que no se debe contar con una temporada igual de suave en los Estados Unidos, en parte porque los esfuerzos por usar mascara facial y de distanciamiento social varían ampliamente.P.

    ¿Qué están buy kamagra tablets haciendo diferente los seguros y sistemas de salud este año?. Las aseguradoras y los sistemas de salud contactados por KHN dicen que seguirán las pautas de los CDC, que exigen limitar y espaciar la cantidad de personas que esperan en las filas y las áreas de vacunación. Algunos están programando citas para vacunas contra la gripe para ayudar a controlar el flujo.Health Fitness Concepts, una compañía que trabaja con UnitedHealth Group y otras empresas para establecer clínicas de vacunación contra la gripe en el noreste del país, dijo que está “fomentando eventos más pequeños y frecuentes para apoyar el distanciamiento social” y “exigiendo que se completen todos los formularios y arremangarse las camisas antes de entrar al área de vacunación contra la influenza”.Se buy kamagra tablets requerirá que todos usen máscaras.Además, a nivel nacional, algunos grupos médicos contratados por UnitedHealth instalarán carpas, para que las inyecciones se puedan administrar al aire libre, dijo un vocero.Kaiser Permanente planifica las vacunas directamente en autos en algunos de sus centros médicos y está probando los procedimientos de detección y registro sin contacto en algunos lugares.Geisinger Health, un proveedor de salud regional en Pennsylvania y Nueva Jersey, dijo que también tendría programas de vacunación contra la influenza al aire libre en sus instalaciones.Además, “Geisinger exige que todos los empleados reciban la vacuna contra la influenza este año”, dijo Mark Shelly, director de prevención y control de infecciones del sistema. €œAl dar este paso, esperamos transmitir a nuestros vecinos la importancia de la vacuna contra la influenza para todos”.P.

    Por lo general, me vacunan contra la gripe en buy kamagra tablets el trabajo. ¿Seguirá siendo una opción este año?. Con el objetivo de evitar riesgosas reuniones en interiores, muchos empleadores se muestran reacios a patrocinar las clínicas de gripe en oficinas buy kamagra tablets como han ofrecido en años anteriores. Y con tanta gente que sigue trabajando desde casa, hay menos necesidad de llevar las vacunas contra la gripe al lugar de trabajo.

    En cambio, muchos empleadores buy kamagra tablets están alentando a los trabajadores a que reciban vacunas de sus médicos de atención primaria, en farmacias u otros entornos comunitarios. El seguro generalmente cubrirá el costo de la vacuna.Algunos empleadores están considerando ofrecer cupones para vacunas contra la gripe a sus trabajadores sin seguro o a aquellos que no participan en el plan médico de la compañía, dijo Julie Stone, directora general de salud y beneficios de Willis Towers Watson, una firma consultora.Estos cupones podrían, por ejemplo, permitir a los trabajadores obtener la vacuna en un laboratorio en particular sin costo.Algunos empleadores están comenzando a pensar en cómo podrían usar sus estacionamientos para administrar vacunas contra la gripe enlos autos, dijo el doctor David Zieg, líder de servicios clínicos para el consultor de beneficios Mercer.Aunque la ley federal permite a los empleadores exigir a los empleados que se vacunen contra la gripe, ese paso generalmente lo toman solo los centros de atención médica y algunas universidades donde las personas viven y trabajan en estrecha colaboración, dijo Zieg.Pero sucede. El mes pasado, el sistema de la Universidad buy kamagra tablets de California emitió una orden ejecutiva que requiere que todos los estudiantes, profesores y personal se vacunen contra la gripe antes del 1 de noviembre, con limitadas excepciones.P. ¿Qué están haciendo las farmacias para alentar a las personas a vacunarse contra la gripe?.

    Algunas farmacias están haciendo un esfuerzo adicional para salir a la comunidad y ofrecer vacunas contra la gripe.Walgreens, que tiene casi 9,100 farmacias en todo el país, continúa una asociación iniciada en 2015 con organizaciones comunitarias, iglesias y empleadores que ha ofrecido alrededor de 150,000 clínicas de gripe móviles hasta la fecha.El programa pone especial énfasis en trabajar con poblaciones vulnerables y en áreas desatendidas, dijo el doctor Kevin Ban, director médico de la cadena de farmacias.Walgreens comenzó a ofrecer vacunas contra la gripe a mediados de agosto y está animando a las personas a no demorar en vacunarse.Tanto Walgreens como CVS están estimulando a las personas a programar citas y hacer trámites en línea este año para minimizar el tiempo que pasan en los locales.En los CVS MinuteClinic, una vez que los pacientes se han registrado para recibir la vacuna contra la gripe, buy kamagra tablets deben esperar afuera o en su automóvil, ya que las áreas de espera interiores ahora están cerradas.“No tenemos un arsenal contra erectile dysfunction treatment”, dijo Ban, de Walgreens. €œPero quitar la presión del sistema de atención médica proporcionando vacunas por adelantado es algo que sí podemos hacer”. Julie buy kamagra tablets Appleby. jappleby@kff.org, @Julie_Appleby Michelle Andrews.

    andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Noticias En buy kamagra tablets Español Public Health erectile dysfunction treatment Insurers treatmentsThis story was produced in partnership with PolitiFact. This story can be republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with few participants wearing masks, he touched on a range of topics, including many related to the erectile dysfunction treatment kamagra and health care in general.Throughout, the partisan crowd applauded and chanted “Four more years!. € And, even as the nation’s erectile dysfunction treatment death toll exceeded 180,000, buy kamagra tablets Trump was upbeat. €œIn recent months, our nation and the entire planet has been struck by a new and powerful invisible enemy,” he said.

    €œLike those brave Americans before us, we are meeting this challenge.”At buy kamagra tablets the end of the event, there were fireworks.Our partners at PolitiFact did an in-depth fact check on Trump’s entire acceptance speech. Here are the highlights related to the administration’s erectile dysfunction treatment response and other health policy issues:“We developed, from scratch, the largest and most advanced testing system in the world.” This is partially right, but it needs context.It’s accurate that the U.S. Developed its erectile dysfunction treatment testing system from scratch, because the government didn’t accept the World buy kamagra tablets Health Organization’s testing recipe. But whether the system is the “largest” or “most advanced” is subject to debate.The U.S.

    Has tested more individuals buy kamagra tablets than any other country. But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested. Another useful metric would be the percentage of the population that has been tested. The U.S buy kamagra tablets.

    Is one of the most populous countries but has tested a lower percentage of its population than other countries. Don't Miss A buy kamagra tablets Story Subscribe to KHN’s free Weekly Edition newsletter. The U.S. Was also slower than other countries in rolling out tests and amping buy kamagra tablets up testing capacity.

    Even now, many states are experiencing delays in reporting test results to positive individuals.As for “the most advanced,” Trump may be referring to new testing investments and systems, like Abbott’s recently announced $5, 15-minute rapid antigen test, which the company says will be about the size of a credit card, needs no instrumentation and comes with a phone app through which people can view their results. But Trump’s comment buy kamagra tablets makes it sound as if these testing systems are already in place when they haven’t been distributed to the public.“The United States has among the lowest [erectile dysfunction treatment] case fatality rates of any major country in the world. The European Union’s case fatality rate is nearly three times higher than ours.”The case fatality rate measures the known number of cases against the known number of deaths. The European Union has a rate that’s about 2½ times greater than the United States.But the source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a kamagra, the case fatality rate is a poor measure of the mortality buy kamagra tablets risk of the disease.”A better way to measure the threat of the kamagra, experts say, is to look at the number of deaths per 100,000 residents.

    Viewed that way, the U.S. Has the 10th-highest death rate in the world.“We will produce a treatment before the end of the year, or maybe even sooner.”It’s far from guaranteed that a erectile dysfunction treatment will buy kamagra tablets be ready before the end of the year.While researchers are making rapid strides, it’s not yet known precisely when the treatment will be available to the public, which is what’s most important. Six treatments are in the third phase of testing, which involves thousands of patients. Like earlier phases, buy kamagra tablets this one looks at the safety of a treatment but also examines its effectiveness and collects more data on side effects.

    Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective treatment for erectile dysfunction treatment by January 2021.”And federal health officials and other experts have generally predicted a treatment will be available in early 2021. Federal committees are working buy kamagra tablets on recommendations for treatment distribution, including which groups should get it first. €œFrom everything we’ve seen now — in the animal data, as well as the human data — we feel cautiously optimistic that we will have a treatment by the end of this year and as we go into 2021,” said Dr. Anthony Fauci, buy kamagra tablets the nation’s top infectious diseases expert.

    €œI don’t think it’s dreaming.”“Last month, I took on Big Pharma. You think that is buy kamagra tablets easy?. I signed orders that would massively lower the cost of your prescription drugs.”Quite misleading. Trump signed four executive orders on July 24 aimed at lowering prescription buy kamagra tablets drug prices.

    But those orders haven’t taken effect yet — the text of one hasn’t even been made publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for it than others do. In 2017, buy kamagra tablets Trump supported congressional efforts to repeal the ACA. The Trump administration is now backing GOP-led efforts to overturn the ACA through a court case. And Trump has also expanded short-term health plans that don’t buy kamagra tablets have to comply with the ACA.“Joe Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading.

    During a June 2019 Democratic primary debate, candidates were asked. €œRaise your hand if your government plan would provide coverage for undocumented immigrants.” All candidates on stage, including Biden, raised their hands buy kamagra tablets. They were not asked if that coverage would be free or subsidized.Biden supports extending health care access to all immigrants, regardless of immigration status. A task force recommended that he allow immigrants who are in the country illegally to buy health insurance, without federal subsidies.“Joe Biden claims he has empathy for the vulnerable, yet buy kamagra tablets the party he leads supports the extreme late-term abortion of defenseless babies right up to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling in Roe v.

    Wade and related precedents. This would generally limit buy kamagra tablets abortions to the first 20 to 24 weeks of gestation. States are allowed under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between 24 and 28 weeks from the mother’s last menstrual period — and 43 states do. But the rulings require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds buy kamagra tablets that “every woman should have access to quality reproductive health care services, including safe and legal abortion — regardless of where she lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y.

    Kim, Bill McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight contributed to this report. Related Topics buy kamagra tablets Elections Health Industry Pharmaceuticals Public Health The Health Law Abortion erectile dysfunction treatment Immigrants KHN &. PolitiFact HealthCheck Preexisting Conditions Trump Administration treatmentsThis story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a erectile dysfunction kamagra that has killed more than 172,000 people. Many Americans are reluctant to visit a doctor’s office and public health officials worry buy kamagra tablets people will shy away from being immunized.Although sometimes incorrectly regarded as just another bad cold, flu also kills tens of thousands of people in the U.S.

    Each year, with the very young, the elderly and those with underlying conditions the most vulnerable. When coupled with the effects buy kamagra tablets of erectile dysfunction treatment, public health experts say it’s more important than ever to get a flu shot.If enough of the U.S. Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both erectile dysfunction treatment patients and those suffering from severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both kamagraes — and “no one knows what happens if you get influenza and erectile dysfunction treatment [simultaneously] because it’s never happened before,” Dr. Rachel Levine, Pennsylvania’s secretary of health, told reporters this month.In response, manufacturers are producing more treatment supply this year, between 194 million and 198 million doses, or about 20 million more than they distributed last season, according to the Centers for Disease Control buy kamagra tablets and Prevention.

    Email Sign-Up Subscribe to KHN’s free Morning Briefing. As flu season approaches, buy kamagra tablets here are some answers to a few common questions:Q. When should I get my flu shot?. Advertising has already begun, and buy kamagra tablets some pharmacies and clinics have their supplies now.

    But, because the effectiveness of the treatment can wane over time, the CDC recommends against a shot in August.Many pharmacies and clinics will start immunizations in early September. Generally, influenza kamagraes start circulating in mid- to late October but become more widespread buy kamagra tablets later, in the winter. It takes about two weeks after getting a shot for antibodies — which circulate in the blood and thwart s — to build up. €œYoung, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations buy kamagra tablets can begin in October,” said Dr.

    Steve Miller, chief clinical officer for insurer Cigna.The CDC has recommended that people “get a flu treatment by the end of October,” but noted it’s not too late to get one after that because shots “can still be beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of erectile dysfunction treatment, but also in case a shortage develops because of overwhelming demand.Q. What are buy kamagra tablets the reasons I should roll up my sleeve for this?. Get a shot because it protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent erectile dysfunction treatment, he said, getting one could help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get influenza from having a flu treatment.All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said. It recommends buy kamagra tablets that children over 6 months old get vaccinated.Q.

    What do we know about the effectiveness of this year’s treatment?. Flu treatments — which must be developed anew each year because influenza kamagraes mutate — buy kamagra tablets range in effectiveness annually, depending on how well they match the circulating kamagra. Last year’s formulation was estimated to be about 45% effective in preventing the flu overall, with about a 55% effectiveness in children. The treatments available buy kamagra tablets in the U.S.

    This year are aimed at preventing at least three strains of the kamagra, and most cover four.It isn’t yet known how well this year’s supply will match the strains that will circulate in the U.S. Early indications from the Southern Hemisphere, which goes through its flu season during our summer, are buy kamagra tablets encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global flu levels are lower than expected. Experts caution, however, not to count on a similarly mild season in the U.S., in part because masking and social distancing efforts vary buy kamagra tablets widely.Q.

    What are insurance plans and health systems doing differently this year?. Insurers and health systems contacted by KHN say they will follow CDC guidelines, which call for buy kamagra tablets limiting and spacing out the number of people waiting in lines and vaccination areas. Some are setting appointments for flu shots to help manage the flow.Health Fitness Concepts, a company that works with UnitedHealth Group and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent events to support social distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set up tent areas so shots can be given outdoors, a spokesperson said.Kaiser Permanente plans drive-thru vaccinations at some of its medical facilities and is testing touch-free screening and check-in procedures at some locations. (KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said it, buy kamagra tablets too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu treatment this year,” said Mark Shelly, the system’s director of prevention and control.

    €œBy taking this step, we hope to convey to our neighbors the importance of the flu treatment for everyone.”Q. Usually I get a flu shot buy kamagra tablets at work. Will that be an option this year?. Aiming to avoid risky indoor gatherings, many employers are reluctant to sponsor the buy kamagra tablets on-site flu clinics they’ve offered in years past.

    And with so many people continuing to work from home, there’s less need to bring flu shots to employees on the job. Instead, many employers are encouraging workers to get shots from their primary care doctors, at pharmacies or in other community settings buy kamagra tablets. Insurance will generally cover the cost of the treatment.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm. The vouchers could allow workers to get the shot at a particular lab at no cost, for example.Some employers are starting to think about how they might use their parking lots for administering drive-thru flu shots, said Dr.

    David Zieg, clinical services leader for benefits consultant buy kamagra tablets Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities where people live and work closely together, Zieg said.Q. What are pharmacies doing to encourage people to get flu shots?. Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and buy kamagra tablets mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr. Kevin Ban, chief medical officer for the drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since the indoor waiting areas are now closed.“We don’t have tons of arrows in our quiver against erectile dysfunction treatment,” Walgreens’ Ban said.

    €œTaking pressure off the health buy kamagra tablets care system by providing treatments in advance is one thing we can do.” Julie Appleby. jappleby@kff.org, @Julie_Appleby Michelle Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Public Health erectile dysfunction treatment Insurers treatmentsUse buy kamagra tablets Our Content This story can be republished for free (details). As the smoke thickened near her home in Santa Cruz, California, last week, Amanda Smith kept asking herself the same questions. Should we leave?.

    And buy kamagra tablets where would we go?. The wildfire evacuation zone, at the time, ended a few blocks from her house. But she worried about what the air quality — which had reached the second-highest warning level, purple for “very unhealthy” — would do to her children’s lungs buy kamagra tablets. Her 4-year-old twins had spent time in the neonatal intensive care unit.

    One was later diagnosed with asthma, and last year was hospitalized with pneumonia.By Tuesday, said Smith, “we all had headaches, the kids were coughing a buy kamagra tablets little bit, and it was raining ash.” The family had been conscientiously isolating at home because of the erectile dysfunction treatment kamagra, and leaving meant potential exposures. But on Wednesday, Smith said, “I looked at my partner and said, maybe we should leave.”She called a friend in Orange County, about 380 miles south, who offered her parents’ empty condo. But the next day, the friend’s child spiked a fever — a possible case of erectile dysfunction treatment — and the plan buy kamagra tablets fell through amid the distraction.Amanda Smith takes a selfie of herself and her twin children in Santa Cruz, California, in April. (Amanda Smith)So Smith looked on Airbnb, careful to seek out hosts who detailed their erectile dysfunction treatment precautions, and found an apartment in San Bruno, about an hour’s drive north.

    She stuffed photos and documents into a suitcase, grabbed the go-bags, and her family headed out.“It’s coming out of our savings to stay here,” Smith said from the safety of her apartment rental, which runs about $1,150 a buy kamagra tablets week. €œIt was a really fraught decision to leave, but as soon as we got over the hill and the sky was blue, I took a big sigh of relief and knew that it had been a good decision.”As the twin disasters of erectile dysfunction treatment and fire season sweep through California, thousands of residents like Smith are weighing difficult options, pitting risk against risk as they decide where to evacuate, whether from imminent flames or the toxic air. Amid a virulent kamagra, which is safest? buy kamagra tablets. Doubling up at a friend’s home?.

    A hotel? buy kamagra tablets. An evacuation center?. And when do the risks buy kamagra tablets of smoke inhalation outweigh the risk of a deadly ?. €œObviously the most important thing is for people to do what they can to protect their lives, not only from the fire, but also from erectile dysfunction treatment,” said Detective Rosemerry Blankswade, public information officer for the San Mateo County Sheriff’s Office, which is helping coordinate response to the massive CZU Lightning Complex fires.“You have to evaluate the big picture here.

    If fire buy kamagra tablets is your most imminent danger, maybe take the erectile dysfunction treatment risk. But if you can avoid both of them, that’s obviously going to be the best option. It’s kind of buy kamagra tablets a little bit of triage that we’re asking for people to do in their own lives right now.” Email Sign-Up Subscribe to KHN’s free Morning Briefing. In San Mateo, one of two counties where the CZU Lightning Complex fires are blazing, officials are advising people to head to an evacuation center, where county workers will assist them in finding a hotel room.

    Meanwhile, in neighboring Santa Cruz, where tens of thousands of residents have evacuated and shelters have limited space, officials are asking those buy kamagra tablets under orders to leave to stay with family and friends whenever possible.What’s the right choice when all options pose additional risks?. We spoke with several experts to help guide your thought process.You have to evacuate. Where should you go? buy kamagra tablets. If your region is under an evacuation order, do not hesitate.

    Leave immediately buy kamagra tablets. If you can afford it, booking a room at a hotel or motel outside the evacuation zones may be the best option, said Dr. Michael Wilkes, a professor at the University of California-Davis School of buy kamagra tablets Medicine. They almost always have air-conditioning units, which help filter the air from both smoke and kamagra.

    Many hotels are implementing new cleaning buy kamagra tablets processes. Ask staffers to detail what they’re doing to sanitize rooms, and consider skipping the daily cleaning service during your stay. You might also check review buy kamagra tablets sites such as TripAdvisor to see what other guests report. When possible, avoid the lobby and other shared spaces, and opt for contactless check-in.Amanda Smith at home in Santa Cruz, California, with her twin children.

    Smith and her family decided to voluntarily evacuate their home on Aug buy kamagra tablets. 20, due to heavy smoke in the area from the CZU Lightning Complex fires in the nearby Santa Cruz Mountains. (Anna Maria Barry-Jester/KHN)With so many people in Northern California fleeing the fires, many hotels are already full, especially in more remote areas buy kamagra tablets. So what about staying with family or friends?.

    After months of being shut in and avoiding close contact beyond immediate family, moving into someone else’s home means a buy kamagra tablets host of potential exposures. Consider whether you or anyone else in the home is at high risk from erectile dysfunction treatment because of age or a preexisting condition.“If so, that’s a reason to think twice before going to someone’s home,” said Dr. Gina Solomon, a program director at the Oakland-based Public buy kamagra tablets Health Institute.Consider, too, what precautions your friends or family have been taking. Sheltering with someone whose job brings them into frequent contact with other people may not be as safe as sheltering with people who largely have been staying home.

    Another question is how crowded the home is buy kamagra tablets. If you have your own room and, preferably, your own bathroom, that makes staying with friends a better option. If a separate bedroom is not available and smoky skies are not a problem, you might consider pitching a tent in their backyard.For those with an RV or tent, camping can present another good option — although, with hundreds of wildfires burning buy kamagra tablets across California, it may be challenging to drive far enough away to avoid fire and smoke. If you do camp, try to find a site away from wooded areas.

    And think twice before using group bathrooms.Is an evacuation center buy kamagra tablets safe?. Many counties have implemented new precautions at emergency shelters to prevent the spread of the erectile dysfunction. In Santa Cruz, for example, officials are scaling back the capacity buy kamagra tablets in each shelter to allow for social distancing, providing tents for people to use as shielding inside and allowing camping in the parking lots.Still, staying in a shelter should probably not be your first choice. In terms of erectile dysfunction treatment risk, deciding between a hotel and a friend’s house is “nipping at the edges,” said Dr.

    John Swartzberg, a clinical professor emeritus at the UC-Berkeley School of Public Health, while “being in a congregate buy kamagra tablets setting is only better than being completely exposed to the elements.”If an evacuation shelter is your best immediate option, again, do not hesitate. €œYou have these standards you want to practice for yourselves,” Swartzberg said, “but when something worse comes along, it trumps how careful we can be with erectile dysfunction treatment because the need for shelter is greater.” You can lower your risk of by wearing a mask, washing hands frequently and sanitizing surfaces.Smith’s partner, Grant Whipple, walks with their children in Big Sur on March 7. That was their last camping trip before buy kamagra tablets the erectile dysfunction treatment kamagra hit, Smith says. That area is now under threat from wildfire.

    (Amanda Smith)If you aren’t buy kamagra tablets in a fire zone, should you invite friends and family to stay with you?. Deciding whether to open your home to friends who are evacuating is an intensely personal decision and may depend on whether anyone in your family has a preexisting condition.“I guess it depends on how good a friend they are and how desperate they are,” said Swartzberg. It may also depend on how buy kamagra tablets much space you have. If your guests can have their own bedroom and bathroom, it might be safer.If you do offer your home, experts advise against simply considering yourself a new pod with your guests.

    Instead, take steps to lower buy kamagra tablets your chances of .“It might not be pleasant, but wearing a mask anytime you’re not in your own bedroom is the safest way to go,” said Solomon. Stay outside as much as possible, she added, and consider eating meals outdoors or eating in shifts to avoid being maskless with those outside your family unit. Sanitize surfaces and buy kamagra tablets wash hands frequently. If air quality permits, keep the windows open to improve airflow.If you’re in a region with hazardous smoke conditions, should you leave?.

    If your area has dense smoke but no imminent fire risk, the thought of heading somewhere else may be appealing, especially if you have respiratory issues. But in most cases, Wilkes said, it would be safer not to leave your erectile dysfunction treatment bubble. And given the expanse of California’s fires, anywhere you flee could end up having lousy air quality by the time you arrive.“The better part of rationality,” Wilkes said, “would be to stay at home, not exercise [outdoors], stay inside as much as you can, turn on the air conditioning.”California Healthline senior correspondent Anna Maria Barry-Jester contributed to this report. Jenny Gold.

    jgold@kff.org, @JennyAGold Related Topics California Public Health States erectile dysfunction treatment Environmental Health Natural Disasters.

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    High burden of antibiotic-resistant Mycoplasma genitalium in symptomatic cheap kamagra online uk urethritisMycoplasma genitalium is an ajanta kamagra aetiological agent of sexually transmitted urethritis. A cohort study investigated M. Genitalium prevalence, antibiotic resistance and association with previous macrolide exposure among 1816 Chinese men who presented ajanta kamagra with symptomatic urethritis between 2011 and 2015. was diagnosed by PCR, and sequencing was used to detect mutations that confer resistance to macrolides and fluoroquinolones. In 11% ajanta kamagra of men, M.

    Genitalium was the sole pathogen identified. Nearly 90% of s were resistant to macrolides and ajanta kamagra fluoroquinolones. Previous macrolide exposure was associated with higher prevalence of resistance (97%). The findings point to the need for ajanta kamagra routine screening for M. Genitalium in symptomatic men with urethritis.

    Treatment strategies to overcome ajanta kamagra antibiotic resistance in M. Genitalium are needed.Yang L, Xiaohong S, Wenjing L, et al. Mycoplasma genitalium in symptomatic male urethritis ajanta kamagra. Macrolide use is associated with increased resistance. Clin Infect Dis 2020;5:805–10.

    Doi:10.1093/cid/ciz294.A new entry inhibitor offers ajanta kamagra promise for treatment-experienced patients with multidrug-resistant HIVFostemsavir, the prodrug of temsavir, is an attachment inhibitor. By targeting the gp120 protein on the HIV-1 envelope, it prevents viral interaction with the CD4 receptor. No cross-resistance has been described with other ajanta kamagra antiretroviral agents, including those that target viral entry by other modalities. In the phase III BRIGHTE trial, 371 highly treatment-experienced patients who had exhausted ≥4 classes of antiretrovirals received fostemsavir with an optimised regimen. After 48 weeks, 54% of those with 1–2 additional active drugs achieved viral ajanta kamagra load suppression <40 copies/mL.

    Response rates were 38% among patients lacking other active agents. Drug-related adverse events included nausea (4%) ajanta kamagra and diarrhoea (3%). As gp120 substitutions reduced fostemsavir susceptibility in up to 70% of patients with virological failure, fostemsavir offers the most valuable salvage option in partnership with other active drugs.Kozal M, Aberg J, Pialoux G, et al. Fostemsavir in adults with multidrug-resistant HIV-1 ajanta kamagra. N Engl J Med 2020;382:1232–43.

    Doi. 10.1056/NEJMoa1902493Novel tools to aid identification of hepatitis C in primary careHepatitis C can now be cured with oral antiviral treatment, and improving diagnosis is a key element of elimination strategies.1 A cluster randomised controlled trial in South West England tested performance and cost-effectiveness of an electronic algorithm that identified at-risk patients in primary care according to national recommendations,2 coupled with educational activities and interventions to increase patients’ awareness. Outcomes were testing uptake, diagnosis and referral to specialist care. Practices in the intervention arm had an increase in all outcome measures, with adjusted risk ratios of 1.59 (1.21–2.08) for uptake, 2.24 (1.47–3.42) for diagnosis and 5.78 (1.60–21.6) for referral. The intervention was highly cost-effective.

    Electronic algorithms applied to practice systems could enhance testing and diagnosis of hepatitis C in primary care, contributing to global elimination goals.Roberts K, Macleod J, Metcalfe C, et al. Cost-effectiveness of an intervention to increase uptake of hepatitis C kamagra testing and treatment (HepCATT). Cluster randomised controlled trial in primary care. BMJ 2020;368:m322. Doi:10.1136/bmj.m322Low completion rates for antiretroviral postexposure prophylaxis (PEP) after sexual assaultA 4-week course of triple-agent postexposure prophylaxis (PEP) is recommended following a high-risk sexual assault.3 4 A retrospective study in Barcelona identified 1695 victims attending an emergency room (ER) between 2006 and 2015.

    Overall, 883 (52%) started prophylaxis in ER, which was mostly (43%) lopinavir/ritonavir based. Follow-up appointments were arranged for those living in Catalonia (631, 71.5%), and of these, only 183 (29%) completed treatment. Loss to follow-up was more prevalent in those residing outside Barcelona. PEP non-completion was associated with a low perceived risk, previous assaults, a known aggressor and a positive cocaine test. Side effects were common, occurring in up to 65% of those taking lopinavir/ritonavir and accounting for 15% of all discontinuations.

    More tolerable PEP regimens, accessible follow-up and provision of 1-month supply may improve completion rates.Inciarte A, Leal L, Masfarre L, et al. Postexposure prophylaxis for HIV in sexual assault victims. HIV Med 2020;21:43–52. Doi:10.1111/hiv.12797.Effective antiretroviral therapy reduces anal high-risk HPV and cancer riskAmong people with HIV, effective antiretroviral therapy (ART) is expected to improve control of anal with high-risk human papillomakamagra (HR-HPV) and reduce the progression of HPV-associated anal lesions. The magnitude of the effect is not well established.

    By meta-analysis, people on established ART (vs ART-naive) had a 35% lower prevalence of HR-HPV , and those with undetectable viral load (vs detectable viral load) had a 27% and 16% reduced risk of low and high-grade anal lesions, respectively. Sustained virological suppression on ART reduced by 44% the risk of anal cancer. The role of effective ART in reducing anal HR-HPV and cancer risks is especially salient given current limitations in anal cancer screening, high rates of anal lesion recurrence and access to vaccination.Kelly H, Chikandiwa A, Alemany Vilches L, et al. Association of antiretroviral therapy with anal high-risk human papillomakamagra, anal intraepithelial neoplasia and anal cancer in people living with HIV. A systematic review and meta-analysis.

    Lancet HIV. 2020;7:e262–78. Doi:10.1016/S2352-3018(19)30434-5.The impact of sex work laws and stigma on HIV prevention among female sex workersSex work laws and stigma have been established as structural risk factors for HIV acquisition among female sex workers (FSWs). However, individual-level data assessing these relationships are limited. A study examined individual-level data collected in 2011–2018 from 7259 FSWs across 10 sub-Saharan African countries.

    An association emerged between HIV prevalence and increasingly punitive and non-protective laws. HIV prevalence among FSWs was 11.6%, 19.6% and 39.4% in contexts where sex work was partly legalised, not recognised or criminalised, respectively. Stigma measures such as fear of seeking health services, mistreatment in healthcare settings, lack of police protection, blackmail and violence were associated with higher HIV prevalence and more punitive settings. Sex work laws that protect sex workers and reduce structural risks are needed.Lyons CE, Schwartz SR, Murray SM, et al. The role of sex work laws and stigmas in increasing HIV risks among sex workers.

    Nat Commun 2020;11:773. Doi:10.1038/s41467-020-14593-6.BackgroundCumbria Sexual Health Services (CSHS) in collaboration with Cumbria Public Health and local authorities have established a erectile dysfunction treatment contact tracing pathway for Cumbria. The local system was live 10 days prior to the national system on 18 May 2020. It was designed to interface and dovetail with the government’s track and trace programme.Our involvement in this initiative was due to a chance meeting between Professor Matt Phillips, Consultant in Sexual Health and HIV, and the Director of Public Health Cumbria, Colin Cox. Colin knew that Cumbria needed to act fast to prevent the transmission of erectile dysfunction treatment and Matt knew that sexual health had the skills to help.ProcessDespite over 90% of the staff from CSHS being redeployed in March 2020, CSHS maintained urgent sexual healthcare for the county and a phone line for advice and guidance.

    As staff began to return to the service in May 2020 we had capacity to spare seven staff members, whose hours were the equivalent of four full-time staff. We had one system administrator, three healthcare assistants, one nurse, Health Advisor Helen Musker and myself.CSHS were paramount to the speed with which the local system began. Following approval from the Trust’s chief executive officer we had adapted our electronic patient records (EPR) system, developed a standard operating procedure and trained staff, using a stepwise competency model, within just 1 day.In collaboration with the local laboratories we developed methods for the input of positive erectile dysfunction treatment results into our EPR derivative. We ensured that labs would be able to cope with the increase in testing and that testing hubs had additional capacity. Testing sites and occupational health were asked to inform patients that if they tested positive they would be contacted by our teams.This initiative involved a multiagency system including local public health (PH) teams, local authority, North Cumbria and Morecambe Bay CCGs, Public Health England (PHE) and the military.

    If CSHS recognise more than one positive result in the same area/organisation, they flag this with PH at the daily incident management meeting and environmental health officers (EHOs) provide advice and guidance for the organisation. We have had an active role in the contact tracing for clusters in local general practices, providing essential information to PH to enable them to initiate outbreak control and provide accurate advice to the practices. We are an integral part in recognising cases in large organisations and ensuring prompt action is taken to stem the spread of the disease. The team have provided out-of-hours work to ensure timely and efficient action is taken for all contacts.The local contact tracing pilot has evolved and a database was established by local authorities. Our data fed directly into this from the end of May 2020.

    This enables the multiagency team to record data in one place, improving recognition of patterns of transmission.DiscussionCumbria is covered by three National Health Service Trusts, which meant accessing data outside of our Trust was challenging and took more time to establish. There are two CCGs for Cumbria, which meant discussions regarding testing were needed with both North and South CCGs and variations in provision had to be accounted for. There are six boroughs in Cumbria with different teams of EHOs working in each. With so many people involved, not only is there need for large-scale frequent communication across a multisystem team, there is also inevitable duplication of work.Lockdown is easing and sexual health clinics are increasing capacity in a new world of virtual appointments and reduced face-to-face consultations. Staff within the contact tracing team are now balancing their commitments across both teams to maintain their skills and keep abreast of the rapid developments within our service due to erectile dysfunction treatment.

    We are currently applying for funding from PH in order to second staff and backfill posts in sexual health.ConclusionCSHS have been able to lend our skills effectively to the local contact tracing efforts. We have expedited the contact tracing in Cumbria and provided crucial information to help contain outbreaks. It has had a positive effect on staff morale within the service and we have gained national recognition for our work. We have developed excellent relationships with our local PH team, PHE, Cumbria Council, EHOs and both CCGs.Cumbria has the infrastructure to meet the demands of a second wave of erectile dysfunction treatment. The beauty of this model is that if we are faced with a second lockdown, sexual health staff will inevitably be available to help with the increased demand for contact tracing.

    Our ambition is that this model will be replicated nationally..

    High burden of antibiotic-resistant Mycoplasma genitalium in symptomatic http://issihealth.com/features-2/one-click-dummy-data/ urethritisMycoplasma genitalium is an buy kamagra tablets aetiological agent of sexually transmitted urethritis. A cohort study investigated M. Genitalium prevalence, antibiotic resistance and association with previous macrolide exposure among 1816 Chinese men who presented with symptomatic urethritis between 2011 and 2015 buy kamagra tablets. was diagnosed by PCR, and sequencing was used to detect mutations that confer resistance to macrolides and fluoroquinolones. In 11% of men, M buy kamagra tablets.

    Genitalium was the sole pathogen identified. Nearly 90% of s were resistant buy kamagra tablets to macrolides and fluoroquinolones. Previous macrolide exposure was associated with higher prevalence of resistance (97%). The findings point to the need for routine screening for buy kamagra tablets M. Genitalium in symptomatic men with urethritis.

    Treatment strategies to overcome antibiotic buy kamagra tablets resistance in M. Genitalium are needed.Yang L, Xiaohong S, Wenjing L, et al. Mycoplasma genitalium in buy kamagra tablets symptomatic male urethritis. Macrolide use is associated with increased resistance. Clin Infect Dis 2020;5:805–10.

    Doi:10.1093/cid/ciz294.A new entry inhibitor offers promise for treatment-experienced patients with multidrug-resistant HIVFostemsavir, the prodrug of temsavir, is an attachment inhibitor buy kamagra tablets. By targeting the gp120 protein on the HIV-1 envelope, it prevents viral interaction with the CD4 receptor. No cross-resistance has been described buy kamagra tablets with other antiretroviral agents, including those that target viral entry by other modalities. In the phase III BRIGHTE trial, 371 highly treatment-experienced patients who had exhausted ≥4 classes of antiretrovirals received fostemsavir with an optimised regimen. After 48 weeks, 54% of those with 1–2 additional active drugs buy kamagra tablets achieved viral load suppression <40 copies/mL.

    Response rates were 38% among patients lacking other active agents. Drug-related adverse events included nausea (4%) and diarrhoea buy kamagra tablets (3%). As gp120 substitutions reduced fostemsavir susceptibility in up to 70% of patients with virological failure, fostemsavir offers the most valuable salvage option in partnership with other active drugs.Kozal M, Aberg J, Pialoux G, et al. Fostemsavir in buy kamagra tablets adults with multidrug-resistant HIV-1 . N Engl J Med 2020;382:1232–43.

    Doi. 10.1056/NEJMoa1902493Novel tools to aid identification of hepatitis C in primary careHepatitis C can now be cured with oral antiviral treatment, and improving diagnosis is a key element of elimination strategies.1 A cluster randomised controlled trial in South West England tested performance and cost-effectiveness of an electronic algorithm that identified at-risk patients in primary care according to national recommendations,2 coupled with educational activities and interventions to increase patients’ awareness. Outcomes were testing uptake, diagnosis and referral to specialist care. Practices in the intervention arm had an increase in all outcome measures, with adjusted risk ratios of 1.59 (1.21–2.08) for uptake, 2.24 (1.47–3.42) for diagnosis and 5.78 (1.60–21.6) for referral. The intervention was highly cost-effective.

    Electronic algorithms applied to practice systems could enhance testing and diagnosis of hepatitis C in primary care, contributing to global elimination goals.Roberts K, Macleod J, Metcalfe C, et al. Cost-effectiveness of an intervention to increase uptake of hepatitis C kamagra testing and treatment (HepCATT). Cluster randomised controlled trial in primary care. BMJ 2020;368:m322. Doi:10.1136/bmj.m322Low completion rates for antiretroviral postexposure prophylaxis (PEP) after sexual assaultA 4-week course of triple-agent postexposure prophylaxis (PEP) is recommended following a high-risk sexual assault.3 4 A retrospective study in Barcelona identified 1695 victims attending an emergency room (ER) between 2006 and 2015.

    Overall, 883 (52%) started prophylaxis in ER, which was mostly (43%) lopinavir/ritonavir based. Follow-up appointments were arranged for those living in Catalonia (631, 71.5%), and of these, only 183 (29%) completed treatment. Loss to follow-up was more prevalent in those residing outside Barcelona. PEP non-completion was associated with a low perceived risk, previous assaults, a known aggressor and a positive cocaine test. Side effects were common, occurring in up to 65% of those taking lopinavir/ritonavir and accounting for 15% of all discontinuations.

    More tolerable PEP regimens, accessible follow-up and provision of 1-month supply may improve completion rates.Inciarte A, Leal L, Masfarre L, et al. Postexposure prophylaxis for HIV in sexual assault victims. HIV Med 2020;21:43–52. Doi:10.1111/hiv.12797.Effective antiretroviral therapy reduces anal high-risk HPV and cancer riskAmong low cost kamagra people with HIV, effective antiretroviral therapy (ART) is expected to improve control of anal with high-risk human papillomakamagra (HR-HPV) and reduce the progression of HPV-associated anal lesions. The magnitude of the effect is not well established.

    By meta-analysis, people on established ART (vs ART-naive) had a 35% lower prevalence of HR-HPV , and those with undetectable viral load (vs detectable viral load) had a 27% and 16% reduced risk of low and high-grade anal lesions, respectively. Sustained virological suppression on ART reduced by 44% the risk of anal cancer. The role of effective ART in reducing anal HR-HPV and cancer risks is especially salient given current limitations in anal cancer screening, high rates of anal lesion recurrence and access to vaccination.Kelly H, Chikandiwa A, Alemany Vilches L, et al. Association of antiretroviral therapy with anal high-risk human papillomakamagra, anal intraepithelial neoplasia and anal cancer in people living with HIV. A systematic review and meta-analysis.

    Lancet HIV. 2020;7:e262–78. Doi:10.1016/S2352-3018(19)30434-5.The impact of sex work laws and stigma on HIV prevention among female sex workersSex work laws and stigma have been established as structural risk factors for HIV acquisition among female sex workers (FSWs). However, individual-level data assessing these relationships are limited. A study examined individual-level data collected in 2011–2018 from 7259 FSWs across 10 sub-Saharan African countries.

    An association emerged between HIV prevalence and increasingly punitive and non-protective laws. HIV prevalence among FSWs was 11.6%, 19.6% and 39.4% in contexts where sex work was partly legalised, not recognised or criminalised, respectively. Stigma measures such as fear of seeking health services, mistreatment in healthcare settings, lack of police protection, blackmail and violence were associated with higher HIV prevalence and more punitive settings. Sex work laws that protect sex workers and reduce structural risks are needed.Lyons CE, Schwartz SR, Murray SM, et al. The role of sex work laws and stigmas in increasing HIV risks among sex workers.

    Nat Commun 2020;11:773. Doi:10.1038/s41467-020-14593-6.BackgroundCumbria Sexual Health Services (CSHS) in collaboration with Cumbria Public Health and local authorities have established a erectile dysfunction treatment contact tracing pathway for Cumbria. The local system was live 10 days prior to the national system on 18 May 2020. It was designed to interface and dovetail with the government’s track and trace programme.Our involvement in this initiative was due to a chance meeting between Professor Matt Phillips, Consultant in Sexual Health and HIV, and the Director of Public Health Cumbria, Colin Cox. Colin knew that Cumbria needed to act fast to prevent the transmission of erectile dysfunction treatment and Matt knew that sexual health had the skills to help.ProcessDespite over 90% of the staff from CSHS being redeployed in March 2020, CSHS maintained urgent sexual healthcare for the county and a phone line for advice and guidance.

    As staff began to return to the service in May 2020 we had capacity to spare seven staff members, whose hours were the equivalent of four full-time staff. We had one system administrator, three healthcare assistants, one nurse, Health Advisor Helen Musker and myself.CSHS were paramount to the speed with which the local system began. Following approval from the Trust’s chief executive officer we had adapted our electronic patient records (EPR) system, developed a standard operating procedure and trained staff, using a stepwise competency model, within just 1 day.In collaboration with the local laboratories we developed methods for the input of positive erectile dysfunction treatment results into our EPR derivative. We ensured that labs would be able to cope with the increase in testing and that testing hubs had additional capacity. Testing sites and occupational health were asked to inform patients that if they tested positive they would be contacted by our teams.This initiative involved a multiagency system including local public health (PH) teams, local authority, North Cumbria and Morecambe Bay CCGs, Public Health England (PHE) and the military.

    If CSHS recognise more than one positive result in the same area/organisation, they flag this with PH at the daily incident management meeting and environmental health officers (EHOs) provide advice and guidance for the organisation. We have had an active role in the contact tracing for clusters in local general practices, providing essential information to PH to enable them to initiate outbreak control and provide accurate advice to the practices. We are an integral part in recognising cases in large organisations and ensuring prompt action is taken to stem the spread of the disease. The team have provided out-of-hours work to ensure timely and efficient action is taken for all contacts.The local contact tracing pilot has evolved and a database was established by local authorities. Our data fed directly into this from the end of May 2020.

    This enables the multiagency team to record data in one place, improving recognition of patterns of transmission.DiscussionCumbria is covered by three National Health Service Trusts, which meant accessing data outside of our Trust was challenging and took more time to establish. There are two CCGs for Cumbria, which meant discussions regarding testing were needed with both North and South CCGs and variations in provision had to be accounted for. There are six boroughs in Cumbria with different teams of EHOs working in each. With so many people involved, not only is there need for large-scale frequent communication across a multisystem team, there is also inevitable duplication of work.Lockdown is easing and sexual health clinics are increasing capacity in a new world of virtual appointments and reduced face-to-face consultations. Staff within the contact tracing team are now balancing their commitments across both teams to maintain their skills and keep abreast of the rapid developments within our service due to erectile dysfunction treatment.

    We are currently applying for funding from PH in order to second staff and backfill posts in sexual health.ConclusionCSHS have been able to lend our skills effectively to the local contact tracing efforts. We have expedited the contact tracing in Cumbria and provided crucial information to help contain outbreaks. It has had a positive effect on staff morale within the service and we have gained national recognition for our work. We have developed excellent relationships with our local PH team, PHE, Cumbria Council, EHOs and both CCGs.Cumbria has the infrastructure to meet the demands of a second wave of erectile dysfunction treatment. The beauty of this model is that if we are faced with a second lockdown, sexual health staff will inevitably be available to help with the increased demand for contact tracing.

    Our ambition is that this model will be replicated nationally..

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