Understanding Shingles — the Basics

Understanding Shingles — the Basics

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Shingles (herpes zoster) results from a reactivation of the varicella-zoster virus that also causes chickenpox. With shingles, usually the first thing you may notice is a tingling sensation or burning pain on one side of your body or face. Within days, tiny clusters of red bumps quickly evolve into a group of painful blisters which can pop and get crusty with pus. Unless you are immunocompromised, the rash almost never crosses the midline of your body (it’s unilateral) because it is localized to one nerve root.

The area can be very painful, itchy, and tender. After one to two weeks, the blisters heal and form scabs.

Up to 15% of people with herpes zoster develop deep pain called postherpetic neuralgia that follows after the infection has run its course. It can continue for months or even years, especially in older people. The incidence of shingles and of postherpetic neuralgia rises with increasing age. In fact, more than 50% of cases occur in people over age 60.В

Shingles usually occurs only once, although it has been known to recur, usually in people with weakened immune systems.В

What Causes Shingles?

Shingles arises from varicella-zoster, the same virus that causes chickenpox. Following a bout of chickenpox, the virus lies dormant in the spinal nerve cells. But it can be reactivated years later when the immune system is suppressed by:

  • Physical or emotional trauma
  • A serious illness
  • Certain medications, like steroids

Medical science doesn’t understand why the virus becomes reactivated in some people and not in others.

Sources

National Institute of Neurologic Disorders and Stroke: «Shingles. Seek Early Treatment.»

Mayo Clinic Health Letter, June 2002.

Oxman M. New England Journal of Medicine, June 2, 2005.

Douglas M. Drug Safety, В 2004.

WebMD Health News: «Shingles Vaccine to Be Routine at 60.»

FDA: «FDA Licenses New Vaccine to Reduce Older Americans’ Risk of Shingles.»

www.webmd.com

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2018 Eastern Democratic Republic of the Congo Outbreak (ongoing)

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Rosalind Carter, an epidemiologist and vaccine expert, has packed her bags and taken off 12 times so far, making her the response’s most frequent flyer.

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On August 1, 2018, the Ministry of Health of the Democratic Republic of Congo (DRC) reported an outbreak of Ebola virus disease in North Kivu Province external icon . Cases have also been reported in Ituri and South Kivu provinces. Confirmed and probable cases have been reported in twenty-nine health zones of North Kivu, South Kivu, and Ituri provinces of DRC.

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The Journal of Rural Health

Edited By: Tyrone Borders Ph.D., F.A.C.E.

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Susceptibility of Southwestern American Indian Tribes to Coronavirus Disease 2019 (COVID‐19)

  • Monika Kakol MD
  • Dona Upson MD, MA
  • Akshay Sood MD, MPH
  • First Published: &nbsp18 April 2020

Navigating Nonessential Research Trials During COVID19: The Push We Needed For Using Digital Technology To Increase Access For Rural Participants?

  • Devon Noonan PhD, MPH, FNP‐BC
  • Leigh Ann Simmons PhD, MFT
  • First Published: &nbsp13 April 2020

Ethical and Legal Challenges During the COVID‐19 Pandemic – Are We Thinking About Rural Hospitals?

  • Love Patel MD
  • Amy Elliott MD
  • Erik Storlie MD, FHM
  • Rajesh Kethireddy MD
  • Kim Goodman M.Div
  • William Dickey MD
  • First Published: &nbsp13 April 2020

Preventing Suicide in Rural Communities During the COVID‐19 Pandemic

  • Lindsey L. Monteith PhD
  • Ryan Holliday PhD
  • Talia L. Brown PhD
  • Lisa A. Brenner PhD
  • Nathaniel V. Mohatt PhD
  • First Published: &nbsp13 April 2020

Flattening the Curve by Getting Ahead of It: How the VA Healthcare System Is Leveraging Telehealth to Provide Continued Access to Care for Rural Veterans

  • Ursula S. Myers PhD
  • Anna Birks PsyD
  • Anouk L. Grubaugh PhD
  • R. Neal Axon MD, MSCR
  • First Published: &nbsp13 April 2020

The following is a list of the most cited articles published in 2017 and 2018 in The Journal of Rural Health.

Cancer Disparities in Rural Appalachia: Incidence, Early Detection, and Survivorship

  • Nengliang Yao PhD
  • Héctor E. Alcalá PhD
  • Roger Anderson PhD
  • Rajesh Balkrishnan PhD
  • The Journal of Rural Health
  • Pages: &nbsp375-381
  • DOI: &nbsp10.1111/jrh.12213

Task‐Sharing Approaches to Improve Mental Health Care in Rural and Other Low‐Resource Settings: A Systematic Review

Rural and Appalachian Disparities in Neonatal Abstinence Syndrome Incidence and Access to Opioid Abuse Treatment

A Closer Look at Rural‐Urban Health Disparities: Associations Between Obesity and Rurality Vary by Geospatial and Sociodemographic Factors

  • Steven A. Cohen DrPH, MPH
  • Sarah K. Cook MPH
  • Lauren Kelley MPH
  • Julia D. Foutz MPH
  • Trisha A. Sando DPT, MSc, CWS
  • The Journal of Rural Health
  • Pages: &nbsp167-179
  • DOI: &nbsp10.1111/jrh.12207

Long‐Term Trends in Black and White Mortality in the Rural United States: Evidence of a Race‐Specific Rural Mortality Penalty

Top Cited Articles in 2017 and 2018

Rural Healthy People 2020: New Decade, Same Challenges
Bolin, Jane N.; Bellamy, Gail R.; Ferdinand, Alva O.; Vuong, Ann M.; Kash, Bita A.; Schulze, Avery; Helduser, Janet W.

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The Journal of Rural Health Recognizes 2018 Article of the Year

The Journal of Rural Health (JRH) will recognize its 2018 article of the year at the National Rural Health Association’s (NRHA) Annual Rural Health Conference May 9 in Atlanta, Ga. The JRH Editorial Board selected the winner from all JRH articles published last year.

The 2018 article of the year is “Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations” by John C. Fortney, Richard C. Veith, Amy M. Bauer, Paul N. Pfeiffer, Marcia Valenstein, Jeffrey M. Pyne, Gregory W. Dalack, Teresa L. Kramer, Lori J. Ferro, Karla Metzger, Jay H. Shore, Andrew D. Carlo, Sara Coates, Susan Ward-Jones, Ed Larkins, Erin Hafer, Stephanie Shushan, Donald L. Weaver, and Jurgen Unutzer.

Drawing on their collective experience launching telemental health (TMH) partnerships, the study’s authors make recommendations to state medical schools and federally qualified health centers about how to overcome existing barriers to TMH partnerships. They also suggest policy changes that would mitigate the impact of these barriers.

The article was published online Oct. 4, and a print version will be published in the summer issue. Selection criteria included average downloads per month and evaluation by the JRH Editorial Board regarding methodology and importance.

“Both the editor and editorial board of the Journal of Rural Health see this article as addressing an important issue and offering practical and actionable recommendations for improving access to telemental health services,” says Carrie Henning-Smith, Editorial Board chair. “This article can make a positive difference in the effort to address widespread barriers to mental health care in rural areas. We applaud the authors for their work and are pleased to disseminate this work through the Journal.

“Our rural research community serves a key role in the development of good public policy,” says NRHA CEO Alan Morgan. “NRHA is proud to select this vital and timely research as our article of the year.”

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Understanding MPNs

An Overview of MPNs

Myeloproliferative neoplasms (MPNs) are a closely related group of progressive blood cancers in which the bone marrow typically overproduces one of the mature blood elements. Other shared features include tendencies toward blood clotting/bleeding, organ enlargement, bone marrow scarring (fibrosis) and a possibility of transformation. Although MPNs can strike anyone at any age, most patients are afflicted in the sixth decade of life or later.

Stem cell transplants may offer a cure for some myelofibrosis sufferers. But there are no known cures for most MPNs. However, patients can experience few or no symptoms for extended periods of time and many people who suffer from MPNs can enjoy longevity with proper monitoring and treatment. The identification of the JAK2 gene marker in 2005 and the CALR gene marker in 2013 have led to significant advances in the diagnosis, understanding of disease processes and treatment of MPNs.

At the MPN Research Foundation, we’re committed to funding researchers in their quest to treat and ultimately cure MPNs. But even more importantly, we’re committed to providing patients, their families and the entire MPN community with advocacy, education, and resources. Working together, we can change the prognosis and create a brighter future for people whose lives are affected by this group of diseases.

Types of MPNs

There are three blood cancer types that are categorized as “classic” MPNs: Primary Myelofibrosis (MF), Essential Thrombocythemia (ET) and Polycythemia Vera (PV):

  • Primary Myelofibrosis (MF) – Most commonly seen in men and women over the age of 60, MF is a chronic blood cancer in which the bone marrow function is impacted by scarring. Patients often have associated symptoms and an enlarged spleen. MF can occur in patients with no prior history of an MPN (primary MF) or as a progression of PV or ET.
  • Essential Thrombocythemia (ET) – ET is a blood malignancy that is typically characterized by an elevation of platelets in the blood. It is most prevalent in women over the age of 50 and common symptoms include blood clotting and bleeding. ET patients have a later risk of progression to MF.
  • Polycythemia Vera (PV) – Characterized by an elevation of red blood cells, PV is most commonly diagnosed in men over the age of 60. PV patients often exhibit elevated white blood cell and platelet counts as well as an enlarged spleen.

Mutations

What are genetic mutations?

Many MPNs are characterized by the abnormal growth of white blood cells, red blood cells, and platelets – events that can be caused by genetic mutations.

In 2005, researchers discovered an important genetic mutation associated with the MPNs. Since then researchers have discovered additional mutations including the JAK2, CALR, TET2, and MPL gene markers.

Genetic Mutations and MPN Treatments

The discovery of genetic mutations has led to significant developments in the treatment of MPNs. For example, in the wake of identifying the JAK2 mutation, researchers and physicians have been able to inhibit the JAK2 gene with a variety of compounds including a JAK inhibitor which has been approved by the FDA as well as other drugs still being tested in clinical trials.

Research is ongoing to identify and explain genetic underpinnings for the cause of the MPNs. At the MPN Research Fund, our commitment to funding leading-edge research in the area of MPN genetic mutations and gene therapies is just one of the ways that we drive improved patient outcomes and carry out our mission to work tirelessly to change the prognosis for MPN patients and their families.

Treatments

Treatments for MPNs
If you or someone you care about has been diagnosed with an MPN, it’s important to know that blood cancer treatments have come a long way over the past decade, significantly improving the quality of life for MPN patients and their families. At the MPN Research Foundation, we’re proud to fund research that is leading to advances in treatment and ultimately, a cure for myelofibrosis (MF), essential thrombocythemia (ET) and polycythemia vera (PV). But just as importantly, we’re committed to helping patients and their families understand MPN treatments as well as the novel therapies, clinical trials and emerging treatments that are shaping the way we approach MPNs going forward.

Available Treatments
There are a wide variety of treatments available for MPN sufferers based on the type of disease, the severity of symptoms and other variables:

Clinical Trials
Learn more about current clinical trials for the latest drugs to treat MPN symptoms.

Drug Reimbursements
Discover how to navigate drug reimbursements and the use of off-label prescriptions for blood cancer treatment.

Treatment Facilities
Find a treatment facility that is right for you and can provide the appropriate treatment for your MPN symptoms.

prevalence

How Prevalent Are MPNs?

If you or someone you love has been diagnosed with an MPN, it’s important to know that you’re not alone.

While incidence rates refer to the number of new patients diagnosed with an MPN each year, prevalence rates indicate the total number of patients living with an MPN at any given time. And with earlier diagnoses and better tracking, the numbers appear to be growing.

MPN Prevalence in the U.S.

Recently, researchers from the Mayo Clinic, Boston University School of Public Health and the pharmaceutical company Sanofi’s department of Global Evidence & Value Development, concluded a study of the prevalence of the myeloproliferative neoplasms in the U.S. Their findings were reported at the American Society of Hematology annual meeting in 2012 and in a recent scientific publication.

Age-Adjusted Prevalence (per 100,000) for MPN Subgroups of Interest for Two Large U.S. Health Plans, 2008-2010.

*unique patients only MF=Myelofibrosis; PV=Polycythemia vera; ET=Essential thrombocythemia

Based on MarketScan database estimates from 2010 (which were lower than the Impact database estimates), the projected prevalence for MPNs in the U.S. on December 31, 2010 was:

The study results suggest that MPN prevalence is much higher than previously reported.

MPN Prevalence Rates and You

For patients, the key takeaway from MPN prevalence rates is that you don’t have to walk through this difficult period of your life alone. Although reported MPN prevalence rates are increasing, it could be due to better tracking of these diseases as well as earlier diagnosis. The good news is that there is a vibrant MPN community comprised of researchers, healthcare practitioners and other patients on hand to provide information and emotional support.

At the MPN Research Foundation, we’re proud to play an important role in the MPN community by supporting patients and families through research, advocacy and education. Working in tandem with the healthcare and research communities, we’re dedicated to changing your prognosis and helping you identify a path toward a brighter future.

the environment and MPNs

A frequent question for someone diagnosed with an MPN is «how did I get this?» Very often newly diagnosed patients wonder about exposure to chemicals. There is some evidence that exposure to chemicals plays a role in the onset of an MPN. More research is needed to confirm the role and extent that environment plays.

Here is a collection of the known information about the exposure to chemicals and MPN:

News on the Polycythemia Vera cluster found in Pennsylvania

www.mpnresearchfoundation.org

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