Study of 670,450 American Women Shows Almost Half of Them Are Receiving the Wrong UTI Treatment

Many American healthcare professionals are still prescribing incorrect antibiotics treatments for too long of a duration.

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Across the United States, in both rural and urban settings, most women with private health insurance are receiving inappropriate treatment for their urinary tract infections (UTIs), according to a new study. 

Of the 670,450 women included in this research, all of whom had been diagnosed with uncomplicated UTIs between the ages of 18 and 44, nearly half received the wrong antibiotics and over three quarters were prescribed the medicine for too long. (A UTI is declared ‘uncomplicated’ when the patient has no abnormality or disease that could predispose them to more frequent infections.)

The results are largely consistent from location to location, although patients in more rural settings were more likely to be prescribed antibiotics for longer. 

Over the course of the study, from 2011 to 2015, there was only a slight improvement in proper antibiotic prescriptions based on current clinical guidelines.

“Inappropriate antibiotic prescriptions for uncomplicated urinary tract infections are prevalent and come with serious patient- and society-level consequences,” says epidemiologist Anne Mobley Butler from the Washington University School of Medicine, St. Louis.

“Our study findings underscore the need for antimicrobial stewardship interventions to improve outpatient antibiotic prescribing, particularly in rural settings.” 

The research was funded in part by several pharmaceutical companies, including Sanofi Pasteur, Pfizer, and Merck. The results were peer-reviewed and fall largely in line with the findings of previous studies, which suggest up to 60 percent of antibiotics prescribed in intensive care units are “unnecessary, inappropriate, or suboptimal”.

Nor is this just a problem in the US. Around the world, UTIs are one of the most common infections leading to emergency room visits. In the United Kingdom, it’s the second most common reason for prescribing antibiotics. 

Not only does taking the wrong antibiotic have worse outcomes for the individual patient, longer prescriptions are not necessarily better and can cause bacteria to grow resistant, making recurrence more likely and future infections harder to treat. 

Today, it’s estimated one in three uncomplicated UTIs in women are resistant to the popular combined antibiotic drug Bactrim (sulfamethoxazole and trimethoprim), and one in five are resistant to five other common antibiotics. 

An estimate of the number of deaths related to antibiotic-resistant UTIs is hard to establish due to a lack of research and monitoring, but some studies suggest that in US hospitals alone it could be around 13,000 lives lost per year. And some people suffer recurrent, resistant infections for years on end with little to no relief.

In light of these emerging concerns, in 2010 the Infectious Diseases Society of America (IDSA) and the European Society for Microbiology and Infectious Diseases updated their clinical practice guidelines. Based on results from various studies, they now recommend several first-line antibiotic agents and durations to best treat UTIs while minimizing the risk of antibiotic resistance.

That advice, however, is clearly not getting through to physicians and healthcare professionals. Many are still prescribing non-recommended antibiotics for improper durations.

Figuring out where the most inappropriate prescriptions are happening could help us target areas where we need to improve adherence to antibiotic guidelines. In the US, rural areas experience numerous health disparities compared to more urban areas, and yet this is the first large-scale study to evaluate how that impacts UTI treatment.

The authors are not sure why longer antibiotic treatments for UTIs are especially prevalent in rural areas, but suggest it could have to do with access to care and physician awareness. In rural areas, women may be given longer prescriptions to avoid future travel if that treatment fails.

Studies also show late-career physicians are more prevalent in rural locations and are more likely to prescribe antibiotics for longer, possibly because they have not heard of updated guidelines. 

“Accumulating evidence suggests that patients have better outcomes when we change prescribing from broad-acting to narrow-spectrum antibiotics and from longer to shorter durations,” explains Butler.

“Promoting optimal antimicrobial use benefits the patient and society by preventing avoidable adverse events, microbiome disruption, and antibiotic-resistant infections.”

When up to 60 percent of women can suffer from a UTI at some point in their life, it’s clearly vital that guidelines for treatment are better enforced, especially as antibiotic resistance increases.

This particular study was only based on commercially insured individuals, which means those who are uninsured or who receive public insurance were not considered. Rural areas were also loosely defined, including small towns as well as ‘exurbs’ on the edges of urban areas, and men, who also suffer from UTIs (albeit at a lower rate), were not included. 

Future research should focus on filling these gaps, but in the meantime, the trend reinforces the idea that clinicians need to periodically review clinical practice guidelines, even for common conditions that they have been treating for years.

“In recent years, little effective progress has been achieved to reduce inappropriate antibiotic prescribing for uncomplicated UTI,” the new paper concludes

“Given the large quantity of inappropriate prescriptions annually in the United States, as well as the negative patient- and society-level consequences of unnecessary exposure to antibiotics, antimicrobial stewardship interventions are needed to improve outpatient UTI antibiotic prescribing, particularly in rural settings.”

The study was published in Infection Control & Hospital Epidemiology.

Abortion Reversal — The Dangerous Practice You’ve Probably Never Heard Of

In the United States, many more laws have been implemented that restrict or ban a woman’s ability to have an abortion. Abortion reversal is a new technique that hasn’t undergone much medical testing since the one test on it showed significant harm to the women.

Several states now require women who seek medication abortions to be provided with dubious information that the procedure could be stopped, allowing a pregnancy to continue.

But when researchers attempted to carry out a legitimate study of whether these “abortion reversal” treatments were effective and safe, they had to stop almost immediately – because some of the women who participated in the study experienced dangerous hemorrhaging that sent them to the hospital.

By passing these abortion reversal laws, “states are encouraging women to participate in an unmonitored experiment,” Creinin said.

Creinin and his colleagues detailed their concerns in a commentary in the journal Contraception, and they will publish their study in January’s edition of Obstetrics and Gynecology.

Medication abortions, which are used up to 10 weeks into a pregnancy, consist of taking two pills in sequence. The first pill in the regimen, mifepristone, loosens the pregnancy’s attachment to the uterus. The second pill, misoprostol, forces the uterus to contract to push out the pregnancy. The pills must be taken consecutively to complete the abortion, and there’s a chance the pregnancy will continue if the second pill is not taken.

A total of 862,320 abortions were provided in clinical settings in 2017, according to the Guttmacher Institute, about 39 percent of which were medication abortions. Research has shown that using these drugs is a safe way to end a pregnancy.

Some antiabortion activists and legislators claim that not taking the second pill, or giving a woman high doses of the hormone progesterone after taking mifepristone, can help stop, or “reverse,” a medical abortion.

The American College of Obstetricians and Gynecologists firmly states that “claims regarding abortion ‘reversal’ treatment are not based on science and do not meet clinical standards” and say the purported studies that underpin these antiabortion arguments lack scientific rigor and ethics.

Despite this, the claims made in these discredited studies have worked their way to antiabortion lawmakers, who in turn have put them into abortion reversal legislation that was signed by governors in North Dakota, Idaho, Utah, South Dakota, Kentucky, NebraskaOklahoma and Arkansas. The laws are currently blocked or enjoined in Oklahoma and North Dakota.

Because reliable research on these treatments is nonexistent, earlier this year, Creinin and his colleagues designed a legitimate double-blind, placebo-controlled, randomized trial that aimed to observe 40 volunteers who had already elected to have a surgical abortion.

Their goal was to see if giving progesterone to women who took the first pill in the prescribed regimen would effectively and safely halt an abortion.

After the women took the first pill in the abortion protocol, mifepristone, rather than take the second pill, misoprostol, they were either given a placebo or a dose of progesterone.

Researchers only enrolled 12 women before they had to stop the study.

Bleeding is normal during a medication abortion. But three of the women who enrolled in the UC-Davis study experienced far more serious bleeding than anyone could have anticipated when the second pill was not administered.

One woman “was so scared she called an ambulance,” while another woman startled by the amount of blood “called 911 and crawled into her bathtub”, Creinin said. A third woman who went to the emergency room needed a transfusion. One of the women had received a placebo, while two others had taken the progesterone.

Creinin and his colleagues halted the study as soon as it became clear that they could not proceed safely.

“I feel really horrible that I couldn’t finish the study. I feel really horrible that the women … had to go through all this,” Creinin said. Because the study ended prematurely, the researchers could not establish any evidence that progesterone was an effective way to stop a medication abortion.

“What the results do show, though, is that there’s a very significant safety signal” when it comes to disrupting the approved medication abortion protocol, Creinin said.

In their upcoming paper in Obstetrics and Gynecology, the researchers warn that “patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage.”

Medical experts are so concerned about abortion reversal laws that the American Medical Association joined a lawsuit against North Dakota’s abortion reversal law, which was blocked by a federal judge in September.

The North Dakota abortion reversal law, signed by Gov. Doug Burgum (R) in March, instructed health-care providers to tell a woman “that it may be possible to reverse the effects of an abortion-inducing drug if she changes her mind, but time is of the essence” and to provide a woman with literature on how to do this. The law fails to specify what that literature would include, or what such a treatment might entail.

Study Finds Women Feel Less Pain When Holding the Hand of Someone They Love

There’s real evidence of the positive effects of caring human touch. Society is pained by many problems that it shouldn’t have, and an approach such as this one that isn’t opiate-based (seeing what that approach has done to society) should therefore be encouraged more.

A small team of researchers from the University of Colorado, the University of Haifa and University Paris Diderot has found that women sense less pain when holding the hand of a person they love. In their paper published in the Proceedings of the National Academy of Sciences, the group describes the experiments they conducted in which women were exposed to some degree of pain and were then asked to report how painful it felt under different conditions.

In modern times, it has become common in some countries for husbands (or other loved ones) to be invited into the to offer comfort as a woman experiences the pain of childbirth. But does such hand-holding actually offer any benefits to the woman in pain? To test for that possibility, the researchers enlisted the assistance of 20 couples willing to undergo several experiments.

The experiments consisted of having the women hold onto a tube through which could be pumped to induce pain. Then the women and their significant others were placed in different sorts of situations. In some, the man held the woman’s hand as the hot water was applied; in others, the man sat nearby but did not offer a hand. In others, the man sat in a nearby room. In all of the cases, both volunteers were asked to rate the degree of pain the woman was experiencing.

In looking at the results of their experiments, the researchers found that the women reported on average experiencing less than half as much pain when they were holding their loved one’s hand. And it went both ways—the men in the group were most accurate in matching the reported by the women when they were holding her hand during her painful experience. The team also found that couples whose EEG printout was most similar coincided with the lowest reports of pain by the women.

The researchers suggest that hand holding can offer two types of benefits to a person in pain. The first is that touching or being touched releases chemicals in the brain that make pain easier to bear. The second is that there appeared to be some sort of synchronizing going on in the brains of the couples that offered an analgesic-like effect, some of which, they note, might have an empathetic component.

Icelandic Law Now Punishes Companies for Paying Women Less Than Men

Punishing gender discrimination is good news out of Iceland, and it serves as a model for other countries.

Iceland began the new year by becoming the first country in the world to mandate that all its companies must pay men and women equally. Following years of passing legislation promoting equal pay, employers that fail to ensure pay parity will now be subject to fines, thanks to a law passed last spring that went into effect Monday.

“We have had legislation saying that pay should be equal for men and women for decades now but we still have a pay gap,” Dagny Osk Aradottir Pind of the Icelandic Women’s Rights Association told Al Jazeera. “We have managed to raise awareness, and we have managed to get to the point that people realize that the legislation we have had in place is not working, and we need to do something more.”

Under the new law, companies that employ more than 25 people will have to prove to the government that they’re paying men and women equally. Officials hope the move will help Iceland to completely close its gender wage gap by 2020.

Iceland has long been admired by progressives as a model of gender equality, filling nearly 50 percent of its parliament seats with women. Supporters of the new law say it couldn’t have been put into action without the strong presence of female lawmakers.

For the past nine years, the small island country has been the world’s highest-ranking nation in terms of gender equality according to the World Economic Forum’s (WEF) Global Gender Gap Report. Iceland has managed to close its gender gap by about 10 percent since the report was first compiled in 2006, according to the WEF’s markers which include political empowerment, economic opportunity, and education access as well as compensation.

As Iceland makes strides in its gender equality goals, the United States’ gender wage gap has been narrowing slowly, with women earning 83 percent of men’s salaries. The U.S. ranks at number 49 on the WEF’s list; less than 20 percent of members of Congress are women.

According to the American Association of University Women, at the wage gap’s current rate of narrowing, American women would have to wait until 2119 to be paid equally to their male counterparts. The Trump administration has shown little interest in improving the gap, with the president suspending an Obama-era rule which required employers to provide the government with pay equity data.

Supporters congratulated Iceland on its new system while lamenting the United States’ failure to take similar steps.

Surveys Reveal Pervasive Sexual Harassment of Women Across Industries

This is largely out of the spotlight, and that makes it all the more important. The discrimination against women also manifests itself in a gap in pay — in the U.S., that means women are often payed 80 cents instead of the $1 a male would probably earn. Women want the whole damn dollar, and they should receive it.

Amid a wave of new sexual harassment and assault allegations in politics and news media this week, two polls released Tuesday illustrate how pervasive such behavior is in many other industries across America, with 35-40 percent of women reporting they have been harassed at work.

A survey (pdf) conducted in mid-November by PBS NewsHour, NPR, and Marist found that 35 percent of women and 9 percent of men have “experienced sexual harassment or abuse from someone in the workplace.” A Quinnipiac University poll, also conducted in mid-November, found that 60 percent of women have been sexual harassed generally, and 69 percent of those women said it happened at work; it also found 20 percent of men have experienced sexual harassment, the majority of which also took place at work.

The results follow a series of reports in recent weeks that have highlighted how women working in service industries, such as hotels and restaurants, are especially susceptible to sexual harassment and assault. Other reports have examined how immigrants, particularly those who are undocumented, often experience abuse. Although such findings have been well documented for several years, these issues have received heightened attention lately, as several high-profile people have been publicly accused of sexual misconduct, and survivors have turned to social media with the hashtag #MeToo to share their stories.