Does Oral Sex Protect Against HIV?

A new study from Sweden suggests that repeated exposure to HIV via oral sex may trigger neutralizing antibodies that protect against the virus.[1]

Some HIV-negative men in long term relationships with HIV-positive men have an antibody response in saliva which may inhibit HIV infection, report Swedish researchers in an article published online ahead of print in AIDS. This is the first time that such a response has been described in saliva, and may help explain why infection through oral sex is somewhat infrequently reported even in serodiscordant couples.

While it is well established that while HIV infection during fellatio and other types of oral sex can and does happen, the number of infections that can be attributed to oral sex is relatively small in comparison with the number of times that unprotected oral sex is practiced. One reason is that saliva contains enzymes which partially inhibit HIV infection.

Klara Hasselrot and colleagues from the Karolinska Institutet in Stockholm wished to investigate whether in long term relationships where one partner has HIV, the HIV-negative partner develops IgA1 antibodies in saliva that would help inhibit HIV infection during oral sex.

They recruited 25 HIV-negative men who were in a relationship of at least six months duration with an HIV-positive man. In addition, 22 HIV-negative men who were not in a serodiscordant relationship were recruited at a blood donor clinic to act as controls.

Analysis of the medical records of the HIV-positive partners showed that whilst most were on treatment at the time of the study, only two had been on antiretroviral treatment with undetectable viral loads for the entire length of their relationship. The researchers judge that this means that, with two exceptions, all HIV-negative partners have probably been exposed to HIV at some point.

[1] Hasselrot K et al. Oral HIV-exposure elicits mucosal HIV-neutralizing antibodies in uninfected men who have sex with men. AIDS (online edition), 2009.

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Insurers Accused Of HIV Bias

Two HIV advocacy groups filed a federal complaint yesterday against 4 insurance companies that have placed anti-retroviral medications in their highest payment tiers. The complaint asserts that the four insurers — CoventryOne, Cigna, Humana and Preferred Medical Plan — placed H.I.V. drugs on the highest payment tier for midlevel, or silver, plans on the federal health insurance exchange in Florida. CoventryOne, for example, placed every H.I.V. drug, including generics, on the most restrictive tier, which meant consumers were required to exhaust a $1,000 deductible and were then asked to contribute 40 percent toward the cost of their drugs, the groups said. There were similar complaints against Humana and Cigna.  The Wall Street Journal reported in December that HIV organizations believed some health insurers had found other ways to discourage people infected with HIV from signing up for their plans, such as requiring higher copayments for HIV drugs than they would for other prescriptions. The two patient advocacy organizations are trying to challenge that practice by using another provision in the health law that bars any health program that receives federal funds from discriminating on the basis of “race, color, national origin, sex, age, or disability.”

Alzheimer’s Disease: A 2012 Financial Update

The article Yearly Cost of Alzheimer’s Tops $200 Billion published by CNN on March 8, 2012 was a good way to refresh our memory about the toll Alzheimer disease take on us. From patient and family suffering to challenges for health care professionals, the effects of this disease affecting an estimated 5.4 million Americans is not only medical in nature, it’s also an economic.  The Alzheimer’s Association’s “2012 Alzheimer’s Disease Facts and Figures” finds that the cost of caring for patients with Alzheimer’s and other dementias will total $200 billion this year and is projected to increase to $1.1 trillion a year by 2050.

Medicare and Medicaid currently pay roughly 70% of the costs associated with caring for Alzheimer’s patients, which adds up to $140 billion.  But those costs do not include treating the many other chronic conditions these patients often have, some of which can be exacerbated by having this form of dementia. For example, the report says a senior with Alzheimer’s and diabetes costs Medicare 81% more than a senior citizen who only has diabetes.

Dementia can also inhibit a person’s ability to manage their other conditions and that additional complication can also drive up related costs. Compounding that, the Alzheimer’s Association estimates that one of every seven patients, or 800,000 people, who have Alzheimer’s lives alone and up to half of them don’t have an identifiable caregiver. At the same time, the number of caregivers is equally staggering. According to the report, there are 15.2 million family members and friends of Alzheimer’s patients caring for more than 4 million people with the disease.  Those caregivers provide 17.4 billion hours of unpaid care valued at more than $200 billion dollars.

Of the ten most common causes of death in the United States, Alzheimer’s is the only one for which there is no cure or means of prevention.  The Alzheimer’s Association says someone is diagnosed with the disease every 68 seconds. At NHI we believe healthcare professionals can play a determinant role to educate their patients on ways to prevent this disease. While there is no definitive evidence that brain games and mental stimulation can protect the brain from Alzheimer’s, Dr. Gary Small, Director of UCLA’s Longevity Center, says there are non-genetic factors that may influence whether someone develops dementia. Nothing to loose and a lot to gain by encouraging your patient to play Sudoku!

Did You Know How Rare You Are?

Decades long cyclical shortages of nurses is now affecting patient care

There are many reasons for the decrease in available nurses in 2012.  Nurses are aging, some are leaving the profession because they feel overworked and underpaid and demand is growing.  With the passage of the Affordable Health Care Act in 2010 (commonly referred to as Obamacare) over 32 million Americans are now able to receive health care that was previously denied to them due to their economic and/or employment status.  While not all of them are rushing to doctors and hospitals for check-ups; it’s obvious there will be an exponential increase in the number of trained medical professionals.

On the scholastic side of things, budget shortages and cutbacks have created a catch-22 where many educational institutions simply don’t have sufficient class space for all the people who want to enter the medical field.  And yet contrary to this dilemma, the Bureau of Labor Statistics is projecting a need for well over half a million new nurses between now and 2018 – a 22% increase in employment that has the numbers, but not the bodies.

As more jobs are needed and there are less nurses to fill them – nurses are working harder than ever, experiencing high turnover to different facilities in an attempt to increase their pay and the people suffering more than the beleaguered nurse are the patients.  In short, inadequate levels of nurses who are happy at their place of employment is translating into a potential health care crisis that isn’t going to go away soon.  The New England Journal of Medicine relates low nurse staffing rates directly to patient mortality while Medical Care reports that higher numbers of nurses on staff was proven to be associated with fewer deaths, lower rates of infection and shorter hospital stays for patients.

At NIH we’re here to assist you with ongoing professional development programs to ensure that you increase your worth and value – check out some of our many programs!

Stop Cleaning – That Soap Will Kill You!

The exponential growth of drug resistant bacteria. . .

The title’s a catcher, isn’t it! Well let’s be honest – using soap isn’t going to kill you and can you ever be too clean?  Nursing practitioners in a health care setting know they have to wash their hands with soap and anti-bacterial often; usually after contact with each and every patient –the danger of spreading germs in hospital settings isn’t just the fodder for science fiction novels and movies after all.

But the last thirty years has seen a rise in the food industry in our animals that are raised to be slaughtered – ingesting large batches of anti-bacterial.  Today, so many cattle, poultry and pigs are packed together, they can easily sicken from the build-up of feces and other germs that surround slaughter houses.  Anti-bacterial in animal feed means no dead beasts and more burgers to sell. Yet studies are showing that these anti-bacterials in our food combined with a more sedentary lifestyle (more American children are sacrificing recess and time outdoors for better grades so schools can keep their funding.

Children who don’t play outside don’t acquire immunities that were more common ten and twenty years ago), and the addition of anti-bacterials in our own soaps and hand washes means that newer hybrid bacteria can literally be drug resistant.

The time has not yet come, but might – when a super drug is going to be resistant to medications we have on hand and the human race could be looking globally at just being one flux away from a violent virile epidemic.  Right now science is working on ways to use a multi-form of drugs to combat illnesses and to keep a larger tragedy at bay.  It’s incumbent on nurses to be aware of the dangers that potentially exist – and hey – let your kids go outdoors and play; sometimes it’s the not clean fun that’s also good for you!

For more information check our Essentials of Antibacterial Therapy course!

Medical Billing Fraud – As Serious As It Sounds

As nursing and health care professionals we at NIH take medical billing fraud seriously, and you should too.

In 2007 Americans spent over $2 trillion on health care; and over 3% of those funds went to medical billing fraud.  Some organizations say the figure may be as high as 10%!

What types of medical fraud is out there:  (a) bill for unprovided services; (b) billing for a higher level of service than the patient received (called “upcoding”); (c) the provision of unnecessary services and procedures; and a host of others from “unbundling” to “balance billing” – whatever name they go by the result is the same; insurance companies are bilked out of money.

In addition to the burden on an overwhelmed tax system and the dangers to our own budgets, fraudulent billing which documents misrepresentations in a patient’s chart may lead to wrong treatment, errors in our Medical Information Bureau records, and even medical identity theft.

In an example of a local cause of medical billing fraud and its consequences; one Miami medical billing company executed a scheme to submit fraudulent claims to Medicare over a seven year period, for reimbursement for durable medical equipment (DME) and related services.  They were indicted for $80 million in false claims .  The claims were allegedly fraudulent in that the equipment had not been ordered by a physician and/or had never been delivered to a Medicare patient.  As a result of the submission of the fraudulent claims, Medicare paid the DME companies approximately $56 million.

Because healthcare fraud is so prevalent and expensive, it is often considered part of the discussion of healthcare reform today in the United States.

Interested in learning more about medical billing? Then our Medical Office Insurance and Billing Certificate Program could be the solution for you!

PAY FOR PERFORMANCE – IS IT RIGHT FOR NURSES?

When we say the healthcare industry is always changing, at National Healthcare Institute we know we’re preaching to the choir.  One of today’s biggest challenges is the dichotomy of the need for more nurses, and yet the desire of top notch institutions to cut costs every which way they can – including nurses salaries.

One up and coming idea is the pay-for performance (also called “variable pay” or “profit-sharing” among other monikers) concept that is becoming more than just a trend.  The general idea is that nurses receive bonuses or pay increases if they can produce more effectively and increase patient satisfaction; in short your first have to do more for less.  The big question:  should nurses be subjected to compensatory salaries based on achievement?  Nursing is about healthcare first; the patient isn’t always going to be satisfied and as we know – the patient isn’t always going to get well.

What is clear – there are legal ramifications; nurses are obligated to follow the professional obligations of their healthcare institutions and what’s written in their state licensure requirements.  Pay for performance can also have a practical and ethical impact on your adherence to your code of ethics.  For example, an incentive to make more money should not imply you cut corners in patient care or try to “force” wellness on someone through possibly illegal practices (i.e., additional administration of undiagnosed medications).

If you work for an institution that is starting a pay for performance program, you may need to know your rights – contact a representative of your state labor board or speak with a legal employment professional about how such changes in your job would square with the NLRA (National Labor Relations Act).  At NHI we’d like to hear from you if you’ve been having concerns about such programs or even participate in one – give us your pros and cons.