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Rats are extremely playful creatures. They love playing chase, and they literally jump for joy when tickled. Central to this playfulness, a new study finds, are cells in a specific region of rats’ brains.
Neurons in the periaqueductal gray, or PAG, are active in rats during different kinds of play, scientists report July 28 in Neuron. And blocking the activity of those neurons makes the rodents much less playful.
The results give insight into a poorly understood behavior, particularly in terms of how play is controlled in the brain. “There are prejudices that it’s childish and not important, but play is an underrated behavior,” says Michael Brecht, a neuroscientist at Humboldt University in Berlin.
Scientists think play helps animals develop resilience. Some even relate it to optimal functioning. “When you’re playing, you’re being your most creative, thoughtful, interactive self,” says Jeffrey Burgdorf, a neuroscientist at Northwestern University in Evanston, Ill., who was not involved in the new study. This is the opposite of depressive states, and Burgdorf’s own research aims to turn understanding the neuroscience of play into new therapies for mood disorders.
For the new study, Brecht and colleagues got rats used to lab life and being tickled and played with in a game of chase-the-hand. When rats play, they squeal with glee at a frequency of 50 kilohertz, which humans can’t hear. The researchers recorded these ultrasonic giggles as a way of measuring when the rats were having fun.
Brecht and colleagues suspected the PAG — a deep, midbrain region connecting the forebrain to the lower brainstem that’s involved in many automatic functions and instinctual responses — might be involved in play behavior, partly because it controls these vocalizations. If your playmate stops laughing, it is time to stop play-fighting.
The team recorded activity from individual cells in rats’ PAGs while they played chase-the-hand or were tickled. Cells located in two columns down the sides of the PAG were active during play, the researchers found. “These cells really go crazy, especially in response to tickling,” Brecht says. Importantly, the same cells were active during both chasing and tickling. “This was where we thought: These are the cells,” Brecht says. “They’re not about moving, or touch. They’re about fun.”
Making the rats anxious by putting them on an elevated, brightly lit platform suppressed playfulness and giggles, and reduced activity in these “fun” cells.
The researchers then genetically altered the cells so they could be turned off using light. Blocking activity in just these cells caused the rats to play much less and become less ticklish, as shown by an absence of giggles, the team found.
These results suggest that the PAG is required for play, probably as part of a circuit. Brecht and colleagues have previously found play-responsive neurons in the somatosensory cortex, a brain region responsible for perceiving touch (SN: 11/10/16). However, other research has shown that animals without a cortex still play. Brecht doesn’t think the same will be true for animals lacking the play-associated part of the PAG. “We think it’s a control structure for playfulness.”
Understanding this circuitry better may help researchers improve their knowledge of depression in people (SN: 2/12/23). “The people that really, really need help are the ones that can’t play,” Burgdorf says. The new study is a step toward understanding what that looks like in the brain, which could one day help clinicians choose the best treatments for different patients, Burgdorf says.
The team plans to study this region in other animals to see how it might differ across species and to see if it helps explain why some animals are more playful than others, Brecht says. One of the first things Brecht did after realizing its importance in rats was look at the region in humans. “And guess what? It’s very large,” he says. “That’s not a coincidence: No animal plays as many games as we do.” | Mental Health Treatments |
Without other pandemic precautions, hospital mask rules didn’t stop COVID spread, study finds
In a world moving on from the COVID-19 pandemic, hospitals and medical offices have been the last bastions of mandatory masking. But new research finds that in communities where pandemic precautions have been largely abandoned, mask mandates in healthcare settings do little to prevent coronavirus infections among patients.
The findings, presented on Thursday at the European Congress of Clinical Microbiology & Infectious Diseases in Copenhagen, suggest that hospitals, nursing homes and clinics could adopt “mask optional” policies without putting their patients at increased risk.
The study’s findings come almost a year after most European governments decided to let the virus spread unimpeded among their highly vaccinated populations. But with some of the last masking requirements now being dismantled in the United States, many here continue to debate the wisdom of declaring an end to the public health emergency.
The U.S. Centers for Disease Control and Prevention continue to recommend indoor masking for all in communities where new infections, hospitalizations and local hospital capacity combine to push COVID-19 into a “high” risk level, and for people who may become severely ill with COVID-19 if they live in communities where the risk level is “medium.” But for the 96% of counties where the risk is deemed “low,” masks are neither recommended nor discouraged.
This week, California health officials lifted the general masking order for healthcare settings throughout the state while allowing individual hospitals, doctor’s offices and other facilities to set their own requirements.
Los Angeles and San Francisco counties have lifted their masking orders for patients and visitors. But under new local orders, doctors, nurses and other employees will be required to wear masks while providing patient care or working in patient areas at hospitals, clinics, skilled nursing facilities, dialysis centers and the like.
The end of COVID-19 emergency declarations in L.A. County brings new guidance on when to mask, quarantine or isolate and the reporting of new cases.
L.A. County rules also require continued masking by janitors, security officers, secretaries and volunteers who work in patient-care areas, as well as by firefighters, emergency medical technicians and police officers who enter such places.
The British authors of the new study appeared to question the value of such broad masking policies, both in the absence of masking outside of hospital walls and in light of evidence that the pandemic virus has become less likely to kill than it was three years ago.
“A low-tech, low-cost intervention without well-established benefit was reasonable in the context of the early pandemic,” wrote the authors of the new study, referring to the widespread use of face-coverings. “However, with a reduction in the severity of COVID-19 disease, in later variants, the risk-benefit balance becomes more questionable.”
Dr. Aodhan Breathnach, an infectious disease physician with the National Health Service Foundation Trust and one of the study’s authors, said many hospitals “have retained masking at significant financial and environmental cost and despite the substantial barrier to communication.” He expressed hope that the study’s findings “can help inform a rational and proportionate mask policy in health services.”
In the United Kingdom as in the United States, continuing mask mandates “became politicized,” Breathnach said. “Rather than people just flocking to their political tribe, we said, ‘Let’s see how much they actually work.’ The data were just sitting there.”
Breathnach and his colleagues in the U.K.’s National Health Service set out to test whether changes in masking policies for hospital visitors and staff resulted in changed infection rates among patients on the wards of St. George’s Hospital in southwest London. They focused on a 40-week period that began in December 2021, when the Omicron variant had established itself as the dominant coronavirus strain.
It’s 2023 and you just tested positive for COVID-19. Now what? The latest CDC protocols, isolation recommendations, ways to treat it and ways to prevent long COVID.
In the first 26 weeks, masking was required of all hospital visitors and healthcare workers. The researchers captured rates of infection among patients upon admission and rates of hospital-acquired coronavirus infections during that time. In-hospital infection rates were much lower that those detected at admission, but the two tracked up and down largely in tandem.
On June 2, 2022, masking became optional for healthcare workers and visitors in most wards of St. George’s. However, on cancer wards, in dialysis suites and intensive care units, and at medical admissions, the mask mandate stayed in place. That allowed those areas of the hospital to serve as the study’s control group.
For the next 14 weeks, researchers found that patients admitted to wards where masks were optional were no more likely to become infected inside the hospital than were patients in units where masking remained mandatory.
For both sets of patients, the relationship between infections at admission and hospital-acquired infections followed the patterns established in the first 26 weeks of the study. That held up even in July 2022, when London experienced a huge Omicron surge: Infections among newly admitted patients rose dramatically, and throughout the hospital, rates of in-hospital infection continued their customary pattern of rising less dramatically.
Breathnach said the stability of the group’s findings, even as a surge swept through London, gave them confidence that universal masking in hospitals had become hard to defend. Still, he said he understands why demands for continued masking would be the final fall-back for many people.
“There’s a certain psychological aspect to masking: it’s the most visible control measure, and you feel you have control over it. And other public health measures, like social distancing, are so much harder to do,” he said. But when virtually all other strictures have gone by the boards and only hospital workers are wearing masks, their face coverings barely make a difference.
“They have a marginal ability to protect against a disease that’s increasingly less severe,” Breathnach said.
A new study examines the factors that caused some states to have COVID-19 mortality rates that were four times higher than others.
At the Copenhagen meeting of microbiologists, experts continued to debate how much less severe COVID-19 has become. Another study presented Thursday assessed the virus’s power in the context of another widespread respiratory disease, influenza.
While the Omicron variant appears to have rendered the coronavirus less virulent, research from Israel affirms that it remains deadlier than flu.
Scientists compared the characteristics and outcomes of 167 Israeli hospital patients admitted with COVID-19 between December 2021 and January 2022 to those of 221 admitted with a flu infection during the same period.
The COVID-19 patients, half of whom were older than 71, were more likely to require oxygen support, to be put on a ventilator and to die than were the slightly younger patients with influenza. Of the 167 patients hospitalized for COVID-19, 26% died within 30 days of admission. By contrast, 9% of the 221 flu patients died in that timespan.
In order to move through a world where the coronavirus is endemic, we need a reliable way to assess our individual level of immunity. Here’s how we can.
That jibes with a study published Thursday in JAMA Network Open, which found that among people 65 and over treated in U.S. Veterans Affairs hospitals, the death rate for patients with COVID-19 (6%) was nearly twice as high as for patients with the flu (3.75%).
The Israeli research underscored that COVID-19 is increasingly a disease that exacts its greatest toll on older, sicker patients. Most patients hospitalized with flu had asthma, whereas those hospitalized for COVID-19 more frequently had diabetes and high blood pressure, and needed more assistance with daily activities.
Both studies were peer reviewed by a panel of the European Congress of Clinical Microbiology & Infectious Diseases, and have been submitted to medical journals for publication.
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Introduction
Diabetes and hypertension are two chronic conditions that affect millions of people worldwide. They require careful management, especially when it comes to making healthy food choices. However, navigating the world of food can be challenging, especially during holidays or family gatherings where social pressure and cultural traditions often dictate meals.
In this comprehensive guide, we will explore the dietary recommendations provided by renowned organizations such as the American Diabetes Association, American Heart Association, National Institutes of Health, and the Center for Disease Control and Prevention. We will discuss strategies to say no to unhealthy foods, offer tips on how to adapt meals to suit your dietary needs, and address the cultural influences that may impact your food choices. By understanding the principles of a healthy diet and learning how to navigate social situations, you can effectively manage diabetes and hypertension while still enjoying a fulfilling and delicious meal.
Understanding Diabetes and Hypertension
To make informed choices about what food to eat, it’s important to understand the underlying conditions of diabetes and hypertension.
Diabetes is a condition characterized by high blood sugar levels due to either insufficient insulin production or ineffective use of insulin by the body. It requires careful management of carbohydrate intake to maintain blood sugar levels within a target range. On the other hand, hypertension refers to high blood pressure, which can increase the risk of heart disease and stroke. Individuals with hypertension need to limit their intake of sodium (salt) and monitor their blood pressure regularly.
By understanding these conditions, you can make more informed choices when it comes to your food intake. In the next section, we will delve deeper into the dietary recommendations for diabetes and hypertension and explore specific food groups that are beneficial for managing these conditions. Stay tuned!
The Importance of Healthy Food Choices
When it comes to managing diabetes and hypertension, healthy food choices play a crucial role in maintaining overall well-being. Not only can the right foods help prevent complications, but they can also improve the effectiveness of medication and aid in weight management.
For individuals with diabetes, a balanced diet focused on whole grains, lean proteins, and healthy fats can help regulate blood sugar levels. Incorporating foods rich in fiber, such as fruits, vegetables, and legumes, can also slow down the absorption of sugar into the bloodstream, making it easier to maintain stable glucose levels.
Similarly, for those with hypertension, a diet low in sodium can help control blood pressure. Opting for fresh, unprocessed foods and avoiding high-sodium packaged snacks and processed meats is key. Instead, choosing foods rich in potassium, such as bananas, avocados, and leafy greens, can help counterbalance the effects of sodium on blood pressure.
In the next section, we will explore the specific food groups that are beneficial for managing diabetes and hypertension. By incorporating these foods into your daily diet, you can take proactive steps towards better health and well-being. Stay tuned!
Planning Your Meals
Now that we understand the importance of healthy food choices for managing diabetes and hypertension, let’s dive into the specifics of planning your meals. By organizing your meals in advance, you can ensure that your diet is both nutritious and enjoyable.
Start by creating a meal plan that includes a good balance of carbohydrates, proteins, and fats, while keeping in mind the specific dietary needs of diabetes and hypertension. Aim to include a variety of fruits and vegetables, whole grains, lean proteins, and healthy fats in each meal.
It can also be helpful to prepare your meals in advance, especially if you have a busy schedule. Consider cooking larger batches of healthy dishes that can be portioned and stored in the refrigerator or freezer for later use. This way, you’ll have convenient and wholesome options readily available when you’re strapped for time.
In the following sections, we will provide you with meal ideas and recipes tailored to managing diabetes and hypertension. With proper planning and preparation, you can take control of your diet and successfully manage these conditions. Stay tuned for more helpful tips and recipes to support your health journey!
Making Informed Food Choices
Now that you have a meal plan in place, let’s talk about making informed food choices when it comes to managing diabetes and hypertension. It’s important to understand how different foods impact your blood sugar levels and blood pressure.
First, let’s focus on carbohydrates. As a diabetic, it’s crucial to choose carbohydrates that have a low glycemic index (GI). Foods with a low GI release glucose into your bloodstream slowly, preventing sudden spikes in your blood sugar levels. Opt for whole grains like quinoa, brown rice, and whole wheat bread, as well as legumes like lentils and chickpeas.
Next, let’s talk about proteins. Incorporating lean protein sources into your meals can help stabilize your blood sugar levels and promote satiety. Some excellent choices include skinless chicken breast, turkey, fish, tofu, and Greek yogurt.
Now, let’s discuss fats. While it’s essential to limit saturated and trans fats, incorporating healthy fats into your diet can be beneficial. Opt for sources like avocados, nuts, seeds, and fatty fish like salmon. These foods are rich in omega-3 fatty acids, which have been shown to reduce inflammation and improve heart health.
Lastly, be mindful of your sodium intake. Too much sodium can raise your blood pressure. Limit processed and packaged foods, which tend to be high in sodium, and instead, season your meals with herbs and spices for flavor.
By making informed food choices and incorporating these guidelines into your meal planning, you can effectively manage your diabetes and hypertension while enjoying a varied and delicious diet. Stay tuned for our next section, where we’ll provide you with some tasty and diabetes-friendly recipes to try out!
Managing Portion Sizes
In addition to making informed food choices, managing portion sizes is key when it comes to maintaining a healthy diet for patients with diabetes and hypertension. It’s important to remember that even healthy foods can have an impact on your blood sugar levels and blood pressure if consumed in excessive amounts.
One helpful strategy is to use measuring cups or a food scale to accurately portion out your meals. This ensures that you are consuming the right amount of carbohydrates, proteins, and fats as recommended by your healthcare provider.
Another helpful tip is to fill half of your plate with non-starchy vegetables like leafy greens, broccoli, and bell peppers. These vegetables are low in carbohydrates and calories, while providing essential vitamins and minerals.
When it comes to carbohydrates, it’s crucial to be mindful of portion sizes. A general guideline is to aim for around 45-60 grams of carbohydrates per meal. This can be achieved by measuring out servings of whole grains, starchy vegetables, or fruits.
For proteins, aim for a palm-sized portion of lean protein sources like chicken, fish, or tofu. These provide essential nutrients without adding excessive calories or unhealthy fats.
Remember, portion control is a vital component of managing your blood sugar levels and blood pressure. By being mindful of portion sizes and following the recommended guidelines, you can maintain a healthy and balanced diet.
Incorporating Physical Activity
Alongside making healthy food choices and managing portion sizes, incorporating regular physical activity into your routine is essential for maintaining overall health and managing diabetes and hypertension. Engaging in physical activity can help improve insulin sensitivity, control blood sugar levels, manage weight, and lower blood pressure.
Aim for at least 150 minutes of moderate-intensity aerobic activity, such as brisk walking, cycling, or swimming, per week. This can be broken down into 30 minutes of activity on most days of the week.
In addition to aerobic exercise, including strength training exercises at least two days a week can help build lean muscle mass, improve metabolism, and enhance overall physical function.
Before starting any exercise program, it’s important to consult with your healthcare provider to ensure it is safe and appropriate for you. They can provide guidance on the type and intensity of exercise that will best suit your needs.
Remember, incorporating physical activity into your routine can bring numerous benefits. It not only helps manage diabetes and hypertension but also boosts your overall well-being and quality of life.
Seeking Professional Guidance
While this comprehensive guide provides valuable information on healthy food choices and physical activity for patients with diabetes and hypertension, it is crucial to seek professional guidance from a healthcare provider or registered dietitian.
They can assess your specific needs and medical history, and provide personalized recommendations tailored to your individual circumstances. They can help you create a meal plan that takes into account your dietary restrictions, preferences, and goals.
Professional guidance can also ensure that your exercise routine is safe and effective. Your healthcare provider can monitor your progress, adjust your medications if necessary, and provide ongoing support and motivation.
Remember, managing diabetes and hypertension requires a holistic approach, and the guidance and expertise of healthcare professionals are invaluable resources on your journey to optimal health. Take advantage of their knowledge and expertise to ensure you are making the best choices for your individual needs.
Navigating the Holidays
The holiday season can be a challenging time for anyone trying to maintain a healthy diet, especially for patients with diabetes and hypertension. However, with careful planning and mindful choices, it is possible to enjoy the festivities without compromising your health.
One key strategy is to prioritize portion control. It can be tempting to indulge in all the delicious treats and hearty meals, but remember that moderation is critical. Choose smaller portions and savor each bite to fully enjoy the flavors.
Additionally, be mindful of your beverage choices. Alcoholic drinks and sugary beverages can quickly add up in calories and negatively impact blood sugar and blood pressure levels. Instead, stick to healthier options like water, herbal tea, or sparkling water with a splash of citrus.
Another tactic is to bring your own healthy dish to holiday gatherings. This ensures that you have a nutritious option that fits within your dietary restrictions. Look for recipes that are low in sodium, sugar, and unhealthy fats, but still delicious and festive.
Lastly, don’t forget to stay active during the holiday season. Physical activity can help manage blood sugar levels and reduce stress. Taking a walk after a big meal or finding fun ways to stay active with family and friends can be a great way to incorporate exercise into your holiday routine.
Remember, with proper planning, mindful choices, and the support of healthcare professionals, you can navigate the holiday season while maintaining your healthy eating habits and managing your diabetes and hypertension effectively.
Final Thoughts
Maintaining a healthy diet is crucial for patients with diabetes and hypertension. The holiday season can present challenges, but with the strategies discussed in this guide, it is possible to make mindful choices and enjoy the festivities without compromising your health.
Remember, portion control is important. Opt for smaller portions and savor each bite to fully enjoy the flavors without overindulging. Be mindful of your beverage choices and stick to healthier options like water and herbal tea.
Bringing your own healthy dish to holiday gatherings ensures that you have a nutritious option that fits within your dietary restrictions. Look for recipes that are low in sodium, sugar, and unhealthy fats.
Lastly, don’t forget to stay active during the holidays. Incorporate physical activity into your holiday routine to manage blood sugar levels and reduce stress.
By following these guidelines and seeking support from healthcare professionals, you can maintain your healthy eating habits while effectively managing your diabetes and hypertension. Here’s to a happy and healthy holiday season! | Nutrition Research |
Surgeons in New York say they have performed the world's first complete eye transplant on a man, although it is not certain he will regain vision.
Aaron James, who survived a high-voltage electrical accident, underwent 21 hours of surgery that replaced half of his face.
Surgeons have been able to transplant corneas successfully for years.
Experts have called the breakthrough a pivotal moment in the quest to restore sight to millions of people.
Mr James, a high-voltage utility line worker from Arkansas, lost most of his face when it accidentally touched a 7,200-volt live wire in 2021.
On 27 May this year, he underwent a rare partial face transplant in addition to the eye transplant - which involved more than 140 healthcare professionals.
Surgeons at NYU Langone Health, who performed the complicated surgery, said on Thursday that Mr James, 46, was recovering well from the dual transplant and the donated eye looked remarkably healthy. His right eye still works.
"The mere fact that we've accomplished the first successful whole-eye transplant with a face is a tremendous feat many have long thought was not possible," said Dr Eduardo Rodriguez, one of the leading surgeons on the team. "We've made one major step forward and have paved the way for the next chapter to restore vision."
Doctors say James' surgery offers scientists an unprecedented window into how the human eye tries to heal.
"We're not claiming that we are going to restore sight," Dr Rodriguez told ABC News. "But there's no doubt in my mind we are one step closer."
Doctors said there was direct blood flow to the retina - the part of the eye that sends images to the brain. While there is no certainty Mr James will regain vision in his new eye, doctors do not rule out the possibility either.
"If I can see out of it, that's great," Mr James said in an interview. "But if it'll kick-start the next path in the medical field, then I'm all for it."
Mr James, a military veteran, will continue to be monitored by doctors, but the progress they have seen with the eye is "exceptional" says Bruce E. Gelb, MD, a transplant surgeon at New York University.
The donated face and eye came from a single male donor in his 30s. During the surgery, doctors injected adult stem cells from the donor's bone marrow into the optic nerve to encourage its repair.
Mr James is only the 19th person in the US to undergo a face transplant.
His wife of 20 years, Meagan James, told CNN seeing him after the surgery "was a crazy, great, weird, strange, ecstatic, happy feeling".
"I was just happy he made it through, and everything was good in the moment."
After the accident, Mr James had to have his left eye removed because of the pain and has undergone numerous surgeries, including one for a prosthetic arm.
He has called the eye transplant "life changing" and says he is "grateful beyond words" to the donor and their family for making the surgery possible.
"I just look like a normal person walking down the street," he told NBC News. | Medical Innovations |
The disgraced former Health Secretary decided only to make it mandatory to test those entering care homes from hospital but not those coming from the community.
He said he did not think committing to testing those from the community - including care home staff - added anything and “muddies the waters”.
This was despite guidance from his Chief Medical Officer Chris Whitty telling him there should be testing for “all going into care homes” in April 2020.
It puts into question the Government’s insistence that it was always “following the science”.
A backlash is expected to come from families who lost beloved relatives in care homes - and have already accused the Government of neglecting their loved ones.
More than 45,000 people living in care homes died with Covid in England and Wales during the first two years of the pandemic.
In 2021, Mr Hancock told the health and social care select committee that “the strongest route of the virus into care homes, unfortunately, is community transmission, so it was staff testing that was most important thing for keeping people safe in care homes”.
The revelations were reported last night by The Telegraph, which has obtained more than 100,000 WhatsApp messages sent between the then health secretary and other ministers and officials during the pandemic.
They contain 2.3million words and are expected to include more controversial details about major decisions made by officials.
The messages are said to show the often casual approach that officials took in huge decisions including to close classrooms, introduce face masks in schools, as well as provide testing in care homes.
The key messages relating to the first bombshell revelation are between Mr Hancock and one of his aides, Allan Nixon.
On April 14 2020, at almost 6.30pm, Mr Nixon sent a message saying: “Just to check: officials are saying your steer is to remove the commitment to testing on admission to care homes from the community, but keep commitment to testing on admission to care homes from hospital. Is that right?”
Twenty-five minutes later, he messaged again: “Update: we can say in the doc that it’s our ambition to test everyone going into a care home from the community where care homes want (‘in the comings weeks’ is the suggested timeframe I’ve been told).”
Mr Hancock responded: “Tell me if I’m wrong but I would rather leave it out and just commit to test & isolate ALL going into care from hospital. I do not think the community commitment adds anything and it muddies the waters.”
The WhatsApp messages were leaked to The Telegraph by Isabel Oakeshott, a journalist who was given copies of them while working on Mr Hancock’s Pandemic Diaries memoir.
Referring to the Covid-19 public inquiry, of which a lot of the findings could take years to be released, she told the newspaper she wanted to make the information public as “we absolutely cannot wait any longer for answers”.
Meanwhile, the MP denied what was called the “distorted account” with a spokesman alleging the leaked messages have been “spun to fit an anti-lockdown agenda”.
Mr Hancock was said to be "considering all options" in response to the leak, with a source close to him saying: "She's broken a legal NDA (non-disclosure agreement). Her behaviour is outrageous."
The spokesman for Mr Hancock said "instead of spinning and leaks we need the full, comprehensive inquiry".
"It is outrageous that this distorted account of the pandemic is being pushed with partial leaks, spun to fit an anti-lockdown agenda, which would have cost hundreds of thousands of lives if followed. What the messages do show is a lot of people working hard to save lives," the spokesman said.
"The story spun on care homes is completely wrong. What the messages show is that Mr Hancock pushed for testing of those going into care homes when that testing was available.
"The full documents have already all been made available to the inquiry, which is the proper place for an objective assessment, so true lessons can be learned." | Epidemics & Outbreaks |
By Kristen Shifflett, OT, as told to Keri Wiginton
âWill I go completely blind from this?âÂ
Thatâs the question everyone with age-related macular degeneration (AMD) always asks. And they melt upon themselves with calmness when I say, no, youâll just need to do some things differently.
If you have geographic atrophy (GA), an advanced form of dry AMD, you may lose some or all of your central vision. Thatâs the part of your eye you use to look directly at things, like peopleâs faces or the words in this sentence.
Your medical team may give you shots or other interventions to keep your eyesight as close as possible to where it is now. But no matter how GA affects your vision, lifestyle changes and low vision aids can help you adapt.
Keep in mind that some solutions may seem impractical at first. For instance, you may feel like youâre interrogating someone if you shine a flashlight directly on their face. But isnât a little awkwardness worth it to see your loved ones a little more clearly?
Here are some tips for how to stay safe, connected, and independent with low vision.Â
Work With a Low Vision Therapist
Iâm an occupational therapist who specializes in low vision rehabilitation. I help people with vision loss learn how to do daily activities on their own. No task is too small to tackle. Everything from the moment you get up to the moment you go to bed is technically in our realm.Â
A conversation with someone like me early on can help you find ways to make life easier and safer at every stage of vision loss.
I treat many folks with vision impairment who tell me they're functioning well. Maybe they have trouble seeing numbers on their bank statement or kitchen appliances. But those little things can add up.
For example, people often say they press 20 minutes on the microwave when they mean 2. If you tend to set the timer and walk away, a simple bump or locator dot on the button could save you from a house fire.Â
Low vision therapists donât just consider your vision problems. We look at whatâs going on with your whole body because you may need to tap into your other senses to make up for a loss of sight.Â
Take reading, for example. If you have trouble seeing fine print, there are many other ways to get information from a book or newspaper, including someone reading to you. But to reach your goal, we may also need to address things like:Â
- Hearing problems
- Dementia or memory challenges
- Arthritis or other medical conditionsÂ
I also get a feel for how comfortable someone is with technology. Some interventions can be a little intense, but I can make the solution as simple or complicated as you can handle.Â
Create a New Normal
The first thing people want is a new prescription. And while your low vision eye doctor should certainly fit you for the best corrective lenses, ânormalâ glasses arenât the end-all, be-all when it comes to improving eyesight for people with low vision.Â
From reading the mail to doing computer work, external devices may help you see better for everyday tasks. Some examples of low vision assistive aids are:Â
- Stand or hand-held magnifiersÂ
- Desktop or portable video magnifier (CCTV)Â
- Stronger reading glasses
- Devices that talk out loud
- Low vision cooking toolsÂ
Youâll also want to take advantage of any accessibility features on your smartphone or computer, including tools to make text bigger or boost contrast. Ask a low vision specialist if youâre not sure how to do this.Â
Once you find a tool or strategy that works for you, practice using it daily. Youâll feel more confident when you complete tasks accurately, like reading and paying your bills, even if using an assistive device takes a little longer.
Control Lighting
If you have GA, you want to boost brightness without adding glare. Here are some things to consider when it comes to low vision lighting: Â
Use task lighting. These desk or floor lamps are a must for any tabletop activity, whether thatâs reading, seeing food on your plate, or working on a jigsaw puzzle. One of my favorites is the Stella Go, a portable task lamp that lets you change the color of light and adjust brightness depending on what you need. Â
Put your light in the best place. Youâll want to position the light low and in between you and the activity, not behind you or over your shoulder. That may cast a shadow and make it harder to read or see whatever youâre doing. Anything with a gooseneck can help you achieve this. Â Â
Use dimmer switches. A simple on or off may make the room too bright or dark. Dimmers give you more flexibility with light, and I suggest people with low vision install them throughout the home.Â
Tips for Social Situations
Itâs common for people with low vision to shy away from social events. But there are steps you can take to see better and feel more comfortable when youâre out and about. Ask your low vision therapist for more tips, but here are a few I suggest.Â
Find a good spot. When you go to a party or restaurant, try to get close to a window. And stand or sit with your back to it. The added sunlight may help you see details better, including peopleâs faces or the menu.
Bring a buddy. If youâre in a big group situation, like a wedding or party, you might want to have a friend or partner with you to identify folks or guide you through the crowd.Â
Say hello first. I usually tell people with low vision to extend their hand when they meet someone. Youâre less likely to misalign a handshake if you let them come to you.Â
Tell people about your vision impairment. I know a few people who wear a button that says I have low vision. If someone doesnât know what that means, at least itâll give you a new topic of conversation.Â
Education and Awareness
People are resilient. And you may learn to work around your vision problems so that people can't notice your vision loss. But it's important to take your tools with you everywhere once you feel confident with lifestyle changes or devices at home.Â
I encourage people to use assistive devices in the real world for many reasons. First, they give you the confidence and ability to do what you need. But they also normalize the use of low vision aids in public.
The larger community doesn't understand the spectrum of vision loss. Most folks think youâre either sighted or blind. But that can change if society starts to understand the diverse needs of those with vision impairment.
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Photo Credit: iStock / Getty Images Plus / Getty Images
SOURCES:Â
Kristen Shifflett, licensed occupational therapist and certified low vision therapist with a specialty certification in low vision, Wilmer Eye Institute, Johns Hopkins University School of Medicine. | Medical Innovations |
Weight management is a sensitive topic. Nevertheless, the measurement is often used as a marker to inform medical decisions or for someone's personal interest. But for many wheelchair users, accessing scales has proved near impossible.
"The last time I was weighed was about 22 years ago, " Lizzie tells the BBC podcast, Access All. "I think I was about 15."
As a result, now aged 37, Lizzie has been through three successful pregnancies, all without knowing how her body was adapting or how her baby was growing.
Based in Devon, she has a degenerative muscle-related impairment and uses a wheelchair. This makes weighing herself on traditional bathroom scales, which require you to stand still and independently on a small platform, a challenge - although she has given it a go.
It involves "sitting down really quickly, lifting my feet up, which is like a ridiculous yoga pose, and trying to balance," Lizzie says. Unsurprisingly, the reading is never accurate.
LISTEN: You can hear more from Lizzie, Dr Georgie Budd and Gillian on the latest episode of Access All.
There is equipment out there to help wheelchair users, like Lizzie. Chair scales enable someone to sit on a seat which records their weight and there are similar bed and hoist versions too. There are also wheel-on scales which are very large and involve subtracting the weight of the chair afterwards.
But none of these seem widely available.
It's not just in medical settings. Over the past 13 years and after serving 100,000 customers, Ability Superstore, which calls itself the "home of mobility aids" in the UK, said it had never been asked for accessible scales. It believes that comes down to cost - with accessible versions often retailing for hundreds of pounds.
Comparatively, your average, everyday scales, can be bought for as little as £9.99.
It means many disabled people are going without this benchmark a lot of the population take for granted.
Dr Georgie Budd, who is based in Merthyr Tydfil, says this worries her. A wheelchair user herself she appreciates how difficult it can be for people to access scales.
"There's a lot of things that we use weight for in health - anaesthetics and drug dosing - and just to keep an eye on it as well for someone's general health. During pregnancy for example, if someone was losing weight I, as a GP, would actually be really quite concerned," she says.
Although people can keep across their weight by feeling how their clothes fit, Georgie says this can be inaccurate, especially when clothes are rarely tailored with wheelchair users in mind.
But Dr Georgie says weight management can be crucial, especially for those who use wheelchairs.
"You're not using your big leg muscles anymore so you're not burning as many calories and access to actually exercising as a disabled person is less than I would like it to be."
She says another key factor that is lost due to inaccessibility is motivation.
Gillian Morphy knows about that. She had her right leg amputated a year ago due to dystonia, which causes uncontrolled and sometimes painful muscle movements. She is trying to lose weight, but was last weighed at her local amputee clinic six months ago.
"Every [medical] appointment you go to you're told 'you've got to lose weight'. But we're not helped, nobody's telling me how," she says.
Gillian says losing weight has become even more important to her since the amputation. "I don't want to be putting so much weight through my left leg because I don't want to cause any problems there."
She says she would like to be weighed weekly to "know which direction I'm heading in".
Gillian can get weighed at the amputee clinic, but it's not somewhere she can just drop into plus she relies on patient transport which can involve a lot of waiting around. "For two minutes on the scales, that could take me six hours," she says.
More generally, there seems to be little information out there on how Gillian, Lizzie and their medical teams can measure weight and access scales.
Neither NHS England nor the government have guidance for doctors nor advice on what equipment to use and no figures are kept on how many hospitals have access to such equipment and where they are.
The National Institute for Health and Care Excellence (NICE) previously considered the issue in 2014 and requested more research be carried out. But so far nothing has been started.
Lizzie's healthcare trust - Devon Integrated Care Board, which covers Devon, Torbay and Plymouth - says it does have equipment which enables weight to be measured "safely and with dignity". But Lizzie is yet to have been offered the use of it.
Gillian wonders if more simple solutions could be found, such as doctor surgeries clubbing together to buy accessible scales for the local area.
Her next appointment at the amputee clinic is fast approaching and, unlike many people, she's looking forward to getting on the scales and seeing what progress she has made with losing weight.
"After that it won't be until Christmas that I get weighed, and then it could be another six months." | Nutrition Research |
Keeping track of everything you eat and drink in a day is a tedious task that is tough to keep up with over time. Unfortunately, dutiful tracking is a vital component for successful weight loss, however, a new study in Obesity finds that perfect tracking is not needed to achieve significant weight loss.
Researchers from UConn, the University of Florida, and the University of Pennsylvania tracked 153 weight loss program participants for six months where users self-reported their food intake using a commercial digital weight loss program. The researchers wanted to see what the optimal thresholds were for diet tracking to predict 3%, 5%, and 10% weight loss after six months.
"We partnered with WeightWatchers, who was planning on releasing a new Personal Points program, and they wanted to get empirical data via our clinical trial," says co-author and Department of Allied Health Sciences Professor Sherry Pagoto.
Pagoto explains that the new program takes a personalized approach to assigning points including a list of zero-point foods to eliminate the need for calculating calories for everything,
"Dietary tracking is a cornerstone of all weight loss interventions, and it tends to be the biggest predictor of outcomes. This program lowers the burden of that task by allowing zero-point foods, which do not need to be tracked."
Researchers and developers are seeking ways to make the tracking process less burdensome, because as Pagoto says, for a lot of programs, users may feel like they need to count calories for the rest of their lives: "That's just not sustainable. Do users need to track everything every single day or not necessarily?"
With six months of data, Assistant Professor in the Department of Allied Health Sciences Ran Xu was interested to see if there was a way to predict outcomes based on how much diet tracking participants did. Ran Xu and Allied Health Sciences Ph.D. student Richard Bannor analyzed the data to see if there were patterns associated with weight loss success from a data science perspective. Using a method called receiver operating characteristics (ROC) curve analysis they found how many days people need to track their food to reach clinically significant weight loss.
"It turns out, you don't need to track 100% each day to be successful," says Xu. "Specifically in this trial, we find that people only need to track around 30% of the days to lose more than 3% weight and 40% of the days to lose more than 5% weight, or almost 70% of days to lose more than 10% weight. The key point here is that you don't need to track every day to lose a clinically significant amount of weight."
This is promising since Pagoto points out that the goal for a six-month weight loss program is typically 5% to 10%, a range where health benefits have been seen in clinical trials.
"A lot of times people feel like they need to lose 50 pounds to get healthier, but actually we start to see changes in things like blood pressure, lipids, cardiovascular disease risk, and diabetes risk when people lose about 5-to-10% of their weight," says Pagoto. "That can be accomplished if participants lose about one to two pounds a week, which is considered a healthy pace of weight loss."
Xu then looked at trajectories of diet tracking over the six months of the program.
The researchers found three distinct trajectories. One they call high trackers, or super users, who tracked food on most days of the week throughout six months, and on average lost around 10% of their weight.
However, many participants belonged to a second group that started tracking regularly, before their tracking gradually declined over time to, by the four-month mark, only about one day per week. They still lost about 5% of their weight.
A third group, called the low trackers, started tracking only three days a week, and dropped to zero by three months, where they stayed for the rest of the intervention. On average this group lost only 2% of their weight.
"One thing that is interesting about this data is, oftentimes in the literature, researchers just look at whether there is a correlation between tracking and overall weight loss outcomes. Ran took a data science approach to the data and found there is more to the story," Pagoto says. "Now we're seeing different patterns of tracking. This will help us identify when to provide extra assistance and who will need it the most."
The patterns could help inform future programs which could be tailored to help improve user tracking based on which group they fall into. Future studies will dig deeper into these patterns to understand why they arise and hopefully develop interventions to improve outcomes.
"For me, what's exciting about these digital programs is that we have a digital footprint of participant behavior," says Xu. "We can drill down to the nitty-gritty of what people do during these programs. The data can inform precision medicine approaches, where we can take this data science perspective, identify patterns of behavior, and design a targeted approach."
Digitally delivered health programs give researchers multitudes of data they never had before which can yield new insights, but this science requires a multidisciplinary approach.
"Before, it felt like we were flying in the dark or just going by anecdotes or self-reported measures, but it's different now that we have so much user data. We need data science to make sense of all these data. This is where team science is so important because clinical and data scientists think about the problem from very different perspectives, but together, we can produce insights that neither of us could do on our own. This must be the future of this work," says Pagoto.
Xu agrees: "From a data science perspective, machine learning is exciting but if we just have machine learning, we only know what people do, but we don't know why or what to do with this information. That's where we need clinical scientists like Sherry to make sense of these results. That's why team science is so important."
No longer flying in the dark, these multi-disciplinary teams of researchers now have the tools needed to start tailoring programs even further to help people achieve their desired outcomes. For now, users of these apps can be assured that they can still get significant results, even if they miss some entries.
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The NHS is 'not serving its purpose' and needs to 'cooperate with private sector', says Tony Blair
The NHS is 'not serving its purpose' and needs to 'cooperate with private sector', says Tony Blair The former PM told Sky News the health service needed to do things "completely differently" if it was going to improve its service.
Tony Blair has said that the NHS is "not serving its purpose" in an exclusive interview with Sky News.
Speaking to Sophy Ridge on Sunday, the former PM didn't mince his words when addressing the current state of the UK's health service.
Asked if he thought the NHS was providing a good standard of service, Mr Blair replied: "No, at the moment. In some respects the staff do a great job in difficult circumstances.
"And I think the general experience of people is if you're in really acute difficulty, then then it still does provide very good care.
"But a lot of the waiting lists are terrible, COVID, of course, has made it a lot worse.
"The truth is, you're not going to have a lot more money to spend, but you do have to think how do we do things completely differently."
He went on to say that he felt there should be more private sector involvement in the NHS, saying there should be "complete cooperation between the public and private sector".
Mr Blair said: "The problem always with the public sector, and this is what I learned in government, is the tough thing is to get it to innovate.
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"Because in the private sector, if you don't innovate, you go out of business, but it doesn't happen in the public sector."
He added that "private" shouldn't be considered a "dirty word" and went on to say that the NHS, in its current state, was not serving its purpose, despite employing more people than ever before.
The former prime minister said: "The NHS is a great institution and we should keep its principles. But the truth? I mean, you don't have to be a genius to look at it and say it's not, it's not serving its purpose."
The full interview with Tony Blair will be on the Sophy Ridge on Sunday programme on Sky News from 8.30am this morning. | Health Policy |
Entrepreneur and bestselling author Peter Diamandis today announced a new XPRIZE—a $101 million global competition for technologies that combat aging and extend health span.
Diamandis, founder of the XPRIZE Foundation, which creates incentives for technological and health innovation, introduced the first competition of its scale for reducing biological age at the Global Healthspan Summit in Saudi Arabia sponsored by Hevolution, a nonprofit investing in aging research.
“I hope we will see breakthroughs for extended life and health span,” says Diamandis, calling for researchers, technologists, physicians, and AI experts, among others, to participate.
The multimillion-dollar competition will ask teams to test and verify therapeutics that can restore a decade of muscle, immune, and cognitive functioning for people age 65 to 80 in one year or less. Judges will assess participants’ muscle, immune, and cognitive function before and after the therapeutic.
“The team has got to deliver a minimum of a 10-year restoration of function with a target of 20 years,” Diamandis tells Fortune. “We’re talking about the potential for therapeutics to have a massive impact on humanity.” A 2021 study found that one extra year of life expectancy due to slowed aging equates to $38 trillion in economic gain.
The goal of the competition is to extend health span, the number of years people live healthy and free of disease. Experts have estimated that the health span and life span gap is about a decade or more—meaning people live the last of their lives disabled and in pain.
“Regaining muscle function is one of the key elements because it gives you mobility and the ability to navigate and enjoy life,” Diamandis says.
He adds, “The two most powerful capabilities are the universal human brain and the human immune system.”
Diamandis predicts teams will use gene therapies, epigenetic reprogramming, stem cell therapies—or a combination—to deliver results.
“We’ve extended [life expectancy] over the last century from antibiotics, better sanitation, pasteurization, all kinds of things like that,” he says. As the number of people 65 and older will more than double in the next 40 years, and more people have an extra third tacked onto their later years, Diamandis feels there’s no better XPRIZE for the current moment. “I think it is science that’s going to enable us to continue to extend it.”
The future of longevity
More entrepreneurs, physicians, and researchers are getting into the $26 billion business of longevity to find ways to reduce biological age and extend health span. The proven lifestyle interventions for extending health span and living longer include routine exercise, stress management, a balanced diet, and connecting with others. Some are arguing, though, that more is on the horizon.
“If I’m 62 right now, my mission is to do everything I can to give myself those extra decades to intercept those technologies coming our way,” Diamandis says.
Chip Wilson, founder of Lululemon, is one of the major investors in the competition. He was recently diagnosed with a rare form of muscular dystrophy, which causes muscle loss and weakness, and founded and a non-profit called SOLVE FSHD. He is adding a bonus of $10 million to any team that can target his specific condition, Diamandis says. Dr. Andrea Maier, director of the Centre for Healthy Longevity at the National University of Singapore, and George Church, the cofounder of Eugit Therapeutics, plan to compete thus far.
While expensive novel treatments for aging are not widely accessible, Diamandis hopes the findings of XPRIZE will eventually scale for the masses.
“You’re going to have this extra decade or two in your life. Do you go back and start a company? Do you go back to school? See the world?” Diamandis says. “What do we do with this extra chapter of life that’s coming?” | Longevity |
No matter how old you are, it's never too late to start eating in a way that gives you the best possible chance of staving off dementia as you age and making sure that you feel focused and sharp every day.As a nutritional psychiatrist, faculty member at Harvard Medical School and author of "This Is Your Brain on Food," I study how our gut bacteria can trigger metabolic processes and brain inflammation that impact memory. Existing studies point to the idea that we may be able to reduce the possibility of dementia by avoiding foods that can compromise our gut bacteria and weaken our memory and focus.Here are the foods I try to avoid or cut back on to fight inflammation and promote brain health, sharp thinking and good decision-making:1. Added sugarsPhoto: Berntsen | Twenty20The brain uses energy in the form of glucose, a form of sugar, to fuel cellular activities. However, a high-sugar diet can lead to excess glucose in the brain, which studies have linked to memory impairments and less plasticity of the hippocampus — the part of the brain controlling memory.Consuming unhealthy processed foods like baked goods and soda, which are often loaded with refined and added sugars — often in the form of high-fructose corn syrup — floods the brain with too much glucose.Although each body has different needs, the American Heart Association recommends that women consume no more than 25 grams of added sugar per day, and men stay under 36 grams added sugar per day. (To figure out if a packaged food contains added sugars, and how much, check the "added sugars" line in the Nutrition Facts panel.)2. Fried foodsPhoto: Ingrid Nagy | Twenty20French fries, tempura, samosas, fish and chips and chicken-fried steak. Is your mouth watering? I get it.Still, when it comes to brain health, it pays to reduce the amount of fried foods you eat. In fact, one study including 18,080 people found that a diet high in fried foods was linked to lower scores in learning and memory. The likely reason: These guilty pleasures cause inflammation, which can damage the blood vessels that supply the brain with blood.Another study looked at 715 people and measured their levels of depression and mental resilience. It also documented their level of fried food consumption. Sure enough, researchers found that those who consumed more fried foods were more likely to develop depression in their lifetime.If you're eating fried foods daily, switch to weekly. If it's a weekly habit, try enjoying them just once a month. If you don't eat fried foods, you're already on your way to happier times!3. High-glycemic-load carbohydratesPhoto: Rita Savenkova | Twenty20Even if high-carbohydrate foods — for example, bread, pasta, and anything else made from refined flour — don't taste sweet, your body still processes them in much the same way it does with sugar.That means they can also raise your risk for depression. Don't panic, I'm not going to suggest eliminating carbs from your diet completely! But the quality of the carbs you eat matters.In 2018, researchers sought to evaluate which particular carbohydrates, if any, had an association with depression. They administered a questionnaire called the "carbohydrate-quality index" to 15,546 participants."Better-quality" carbohydrates were defined as whole grains, foods high in fiber, and those ranked low on the glycemic index (GI). The GI is a measure of how quickly foods convert to glucose when broken down during digestion; the faster a food turns into glucose in the body, the higher its GI ranking.Researchers discovered that people who had the highest score on the carbohydrate-quality index, meaning they were eating better-quality carbs, were 30% less likely to develop depression than those who were eating high-GI carbs.High-GI carbs include potatoes, white bread and white rice. Honey, orange juice and whole-meal breads are medium-GI foods. Low-GI foods include green vegetables, most fruits, raw carrots, kidney beans, chickpeas and lentils.4. AlcoholPhoto: Studioomg | Twenty20I often encounter people in my practice who live stressful lives. The "work hard, play hard" mindset often leads to heavy drinking on weekends as a way to relieve stress. While drinking might make them relax in the moment, they pay for it the next morning, when they wake up jittery with brain fog.Archana Singh-Manoux, a research professor and director at the French Institute of Health and Medical Research, and her colleagues followed 9,087 people over 23 years to see how alcohol related to the incidence of dementia.In 2018, in the British Medical Journal, they reported that people who had abstained from alcohol completely or who consumed more than 14 drinks per week had a higher risk of dementia compared to those who drank alcohol in moderation.In general, men who consume more than 14 drinks per week or more than four drinks in a single day at least once a month are considered to be heavy drinkers, as are women who drink more than seven drinks per week or three drinks per day. But different people (and their brains) respond differently to alcohol abuse.When I work with anxious patients who drink, I always ask them to consider the contexts in which they might be using alcohol in an unhealthy way — for instance, using drinking as a means of coping with something they are trying to avoid — and to consider moderating the amount they drink.5. NitratesPhoto: Loreke76 | Twenty20Used as a preservative and to enhance color in deli slices and cured meats like bacon, salami and sausage, nitrates may be connected with depression.One recent study even suggests that nitrates can alter gut bacteria in such a way as to tip the scales toward bipolar disorder.If you simply can't live without salami and sausages, seek out those containing buckwheat flour, which is used as a filler. Buckwheat flour contains important antioxidants that can counter some of the negative health effects of these meats.Dr. Uma Naidoo is a nutritional psychiatrist, brain expert, and faculty member at Harvard Medical School. She is also the Director of Nutritional & Lifestyle Psychiatry at Massachusetts General Hospital and author of the best-selling book "This Is Your Brain on Food: An Indispensible Guide to the Surprising Foods that Fight Depression, Anxiety, PTSD, OCD, ADHD, and More." Follow her on Twitter @DrUmaNaidoo.Don't miss:A Harvard nutritionist and brain expert shares the 5 foods she eats every day to sharpen her memory and focusA longevity expert shares the diet, exercise and sleep rules he lives by for a longer, stronger life: These are 'non-negotiable'A neuroscientist shares the 6 exercises she does every day to build resilience and mental strength | Nutrition Research |
A school principal has told a committee of MPs that a quarter of her students are estimated to be vaping, with older pupils apparently bulk buying to sell to younger children.
Laranya Caslin, from St George's Academy in Sleaford, Lincolnshire, said lessons are being disrupted as alarms are set off in the toilets by pupils topping up on nicotine "on a really regular basis".
She explained to members of the Health and Social Care Committee that one parent handed in five vapes they had found in their child's bedroom, which they believe they intended to sell on to other pupils.
"The police had those analysed and the chemicals that were contained within, there was very little nicotine. In one there was only hydraulic oil and anti-freeze," she said.
"In five vapes there were nine extremely concerning chemicals."
The scrutiny by MPs follows a recent Sky News investigation which revealed a growing number of school children are being admitted to hospital - with vaping cited as a reason for their illness.
In the past year, 15 of those who required hospital care were aged nine or under.
Mrs Caslin also spoke of her concern about the pressure to fit in.
"Many of these lovely, lovely students - who I don't think would ever dream of smoking - going and having a sneaky cigarette - have been drawn into vaping much more easily because it is perceived to be safe and because of the chat around the flavours...
"To be part of the peer-to-peer conversation you have to be in that crowd."
She said some of the flavours "read like a sweet shop" with names such as Gummy Bear, Slushy and Unicorn Milk.
The MPs also heard from Deborah Arnott, from the charity Action on Smoking and Health (ASH).
She said ASH wanted to see a full ban on disposable vapes and that the charity has three top measures it wants to see enforced: a £5 tax on vapes to make them less affordable; a ban on branding that appeals to children; and for vapes to be put out of sight and out of reach of young people.
Two representatives of the vaping industry were also questioned by the committee of MPs.
John Dunne, from the UK Vaping Industry Association, reiterated tougher regulation is needed with £10,000 fines for those selling to children.
He outlined how a court recently fined a retailer just £26 for selling a 14-year-old a vape.
"We are not in any way trying to get young people to use our products at all," Mr Dunne said.
"We have a lot of wonderful laws in this country but unless they are enforced - unless there is a financial penalty for breaking those rules - you can make all the laws you want but they won't be followed.
"And that's why we are looking at punitive charges on those retailers and distributors and brands that are flouting the law."
Meanwhile, Marcus Saxton, of the Independent British Vape Trade Association, argued the industry was not breeding a new generation of nicotine addicts.
"Anyone that's using names that simulate food and drink should be targeted and prosecuted," he said.
"Having said that, the role of flavours, if any of you have been a smoker, is absolutely critical to enable a successful quit attempt."
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Mr Saxton also pointed out that around two-thirds of the estimated £4bn vape industry in the UK is black market or illicit.
"It's really important to understand the negative consequences of putting in the wrong regulation," he said, adding that there's a danger of allowing that underground market "to thrive".
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He also defended the use of advertising and sponsorship, such as the naming of St Helen's RFC Totally Wicked Stadium after the vape brand.
He said: "We believe that everyone we can drive awareness to about the relative safety of vaping versus smoking is someone who is going to benefit from that." | Epidemics & Outbreaks |
As the COVID-19 pandemic raged around the country in the summer of 2021, another virus—an endemic one spread by mosquitoes—thrashed residents of one Arizona county, causing a record-shattering outbreak that left 101 people dead, according to a study published today by Arizona health officials.
The virus is West Nile, which constantly lurks in hundreds of bird species in the US and spreads to humans via mosquito bites. Most people infected—about 8 out of 10—will have no symptoms. But the unlucky remainder will develop a nondescript illness with fever, headache, body aches, joint pains, vomiting, diarrhea, or rash. Fatigue and weakness from a symptomatic case can linger for weeks to months. A small fraction of the symptomatic cases will develop a serious, life-threatening neuroinvasive case, such as meningitis or encephalitis.
West Nile Virus (WNV) was discovered in the US in 1999 and first detected in Arizona in 2003, when just 12 cases were recorded. Since then, the state's yearly totals have often been around 100 cases, with Maricopa County always claiming the lion's share. The outbreak record was set in 2004, quickly after its discovery. That year, the state saw 391 cases, 355 of which were from Maricopa.
But, in the shadow of the coronavirus Delta wave in the summer of 2021, Maricopa's WNV outbreak totaled a whopping 1,487 symptomatic cases—breaking the 2004 record by more than fourfold. It is the largest WNV outbreak recorded from any county in the country ever. Yet, the recorded number in Maricopa is likely a severe undercount.
Coinciding outbreaks
Of the 1,487 sickened, 1,014 (68 percent) were hospitalized and 956 (64 percent) developed neuroinvasive disease. All of the 101 deaths occurred in those with neuroinvasive disease. The median age of all cases was 66, and the median age of those who died was 79. There were an additional 78 asymptomatic infections found in routine blood-donation screening.
The huge share of neuroinvasive cases in the outbreak suggests that a massive number of cases went unrecorded. Previous case estimates indicate that for every one neuroinvasive case, there are between 30 to 70 non-neuroinvasive symptomatic cases. That would put the true case total between 28,700 and 67,000 in the county, which has a population of around 4.5 million.
It's unclear what spurred the massive outbreak. But it's likely to be explained by a confluence of factors. Arizona health officials speculate it could be related to increased rain, increasing temperatures that prolong WNV season in Arizona, recent population growth and housing development in Maricopa, and changes in health care-seeking behavior during the COVID-19 pandemic.
But awareness of WNV and the outbreak—among both residents and health care providers—appeared to be troublingly inadequate, indicating that officials have more outreach and awareness work to do. This is particularly important in times of multiple outbreaks. While the COVID-19 pandemic appeared to exacerbate the WNV outbreak, the WNV also exacerbated COVID-19 responses, sending 1,014 people to already overwhelmed hospitals. Health facilities anecdotally reported to officials that there were times when intensive care units hit capacity, half full with COVID-19 cases and the other half with WNV. Overall, though, WNV's burden paled in comparison to that from COVID-19 in the county, which saw over 19,600 COVID-19 hospitalizations in the same span of 2021.
With both viruses here to stay, Arizona officials are working on ways to improve responses. "Analyses are underway to identify data thresholds for increased public and provider messaging on prevention, diagnosis, and testing," they wrote. "Timely and coordinated mosquito and human case surveillance are critical to identifying outbreaks and guiding prevention efforts." | Epidemics & Outbreaks |
More than 20% of American adults say they "rarely or never" wake up feeling well-rested, according to a new survey from U.S. News & World Report.
Nearly half (43%) of survey respondents said they have experienced insomnia in 2023, and 17% said they've suffered from sleep apnea.
The survey, which polled 1,200 adults about their sleep habits and quality, revealed some of the biggest sources of sleep struggles.
Here's the state of slumber.
What’s keeping people up at night
The survey identified the biggest concerns that are hindering Americans’ sleep:
- The increase in cost of living
- The COVID-19 pandemic
- Gun violence
- Climate change
- The 2024 presidential election
These results were virtually identical to last year, except for No. 5, which was the Russia-Ukraine war.
(The survey was conducted before the onset of the Israel-Hamas war.)
"In addition to these general worries, there are also specific concerns that may keep Americans up at night depending on their individual circumstances, such as relationship problems or work stress," Dr. Shelby Harris, the New York-based director of sleep health at Sleepopolis, who was not involved in the survey, told Fox News Digital.
Americans’ worst sleep habits
Survey respondents shared these top five habits that are detrimental to their sleep:
- Going to bed at inconsistent times
- Accessing screens in bed
- Eating too much before bed
- Falling asleep with the television on
- Staying up all night
A previous poll by the National Sleep Foundation found that 89% of adults and 75% of children have at least one electronic device in their bedrooms.
"By allowing each partner to regulate their own temperature and choose bedding that meets their personal preferences and needs, the method can significantly reduce sleep disruptions and improve comfort."
"Other common sleep habits that can negatively affect sleep quality include consuming caffeine or alcohol close to bed, napping for too long or too late in the day, not getting enough sunlight in the morning/afternoon, sleeping in a hot or uncomfortable environment and not having a relaxing bedtime routine," said Harris of Sleepopolis.
Impact of partners on sleep
One in three adult respondents said they do not sleep in the same bed as their partners due to differing sleep preferences, a trend known as "sleep divorce."
Dr. Brandy Smith, an Alabama-based psychologist with the virtual health care company Thriveworks, who was not involved in the survey, previously told Fox News Digital that the most common reasons for sleep divorce include snoring, frequent movements that keep one partner awake or wake them too often throughout the sleep cycle, mismatched sleep/wake cycles — and schedule differences.
Another sleep trend revealed in the survey is "Scandinavian sleeping."
This is when couples share the same bed but use individual comforters or duvets instead of sharing bedding.
"While most surveyed U.S. adults (59%) prefer sharing a comforter with their partner at night, the remainder (41%) would rather sleep with their own blanket at night, which is commonly referred to as the Scandinavian sleeping method," Haniya Rae, a New York-based sleep feature editor at U.S. News & World Report, told Fox News Digital.
"The Danes, Icelanders, etc. prefer sleeping with their own duvet with no top sheet to fight over," she noted.
"This means both you and your partner can each have your own individual, preferred sleep space in the same bed. No more tugging at the sheets or dealing with a blanket hog."
Harris agreed that the Scandinavian sleep method can have several potential benefits for sleep quality and overall well-being.
"By allowing each partner to regulate their own temperature and choose bedding that meets their personal preferences and needs, the method can significantly reduce sleep disruptions and improve comfort," she told Fox News Digital.
"Getting better sleep can also help to reduce stress levels and lead to a healthier relationship."
Essentials for a good night’s sleep
In the survey, adults were asked to rate which items are most critical for quality sleep. In order from most to least important, they noted the following:
- High-quality mattress
- Memory foam pillows
- High thread-count sheets
- Down comforter
- Weighted blanket
Nearly 40% of respondents also said they use white noise to help them fall asleep.
The National Sleep Foundation recommends that adults between 18 and 64 years of age get seven to nine hours of sleep each night. | Stress and Wellness |
Laura Winham: Council failed to follow up on police concerns for vulnerable woman who lay dead in flat for years, says family
Laura Winham's remains were found by her brother in her flat in Woking, Surrey, in May 2021 - three-and-a-half years after her death.
Monday 30 January 2023 17:12, UK
A 38-year-old vulnerable woman, whose body was found three years after her death, was "abandoned and left to die" by social and mental health services, according to her family.
Laura Winham's remains were found by her brother in her flat in Woking, Surrey, in May 2021, after she died in November 2017.
A pre-inquest review at Surrey Coroner's Court heard the county council failed to follow up on police concerns.
Kate O'Raghallaigh, representing the Winham family at the review, said Surrey police officers visited the woman's flat when she was still alive in October 2017.
She said the police reported concerns, that she had been neglecting herself and had little access to food, to Surrey County Council.
"There was a risk to Laura of malnutrition and self-neglect in October 2017 when she was observed by police," Ms O'Raghallaigh said.
But the council failed to follow up on these concerns, the hearing was told.
The inquest heard that the exact date of death is unknown - a calendar in Ms Winham's flat had dates crossed off until November 2017.
Her body was found in May 2021 - three-and-a-half years after her death - when Ms Winham's family said they asked police to break into her home after they grew concerned for her safety.
A cause of death has yet to be determined, which Ms O'Raghallaigh described as a "very unusual factor in this case".
Katie Ayers, representing the county council, said the authority accepts a care assessment for Ms Winham should have been done after the police visit.
"What Surrey County Council has accepted is that a section nine check should have been completed but it was not," she said.
Ms Ayers added: "There may have been a risk in relation to malnutrition. At this stage that would seem to be speculative."
Ms O'Raghallaigh asked assistant coroner Dr Karen Henderson to engage a forensic anthropologist to investigate whether Ms Winham's death was caused by malnutrition and establish a window of time in which she may have died.
Dr Henderson said she will provide a written decision on the matter in the coming weeks.
She scheduled another pre-inquest review for 15 March and set a provisional full hearing date for 3 April.
The review previously heard that Ms Winham was found in a "mummified almost skeletal state".
Her sister Nicky Winham said the family was unable to maintain contact with her as years of schizophrenia had led her to believe they would harm her. | Mental Health Treatments |
A new organoid model of the dopaminergic system sheds lights on its intricate functionality and potential implications for Parkinson's disease. The model, developed by the group of Jürgen Knoblich at the Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences, replicates the dopaminergic system's structure, connectivity, and functionality. The study, published on December 5 in Nature Methods, also uncovers the enduring effects of chronic cocaine exposure on the dopaminergic circuit, even after withdrawal.
A completed run, the early morning hit of caffeine, the smell of cookies in the oven -- these rewarding moments are all due to a hit of the neurotransmitter dopamine, released by neurons in a neural network in our brain, called the "dopaminergic reward pathway." Apart from mediating the feeling of "reward," dopaminergic neurons also play a crucial role in fine motor control, which is lost in diseases such as Parkinson's disease. Despite dopamine's importance, key features of the system are not yet understood, and no cure for Parkinson's disease exists. In their new study, the group of Jürgen Knoblich at IMBA developed an organoid model of the dopaminergic system, which not only recapitulates the system's morphology and nerve projections, but also its functionality.
A model of Parkinson's disease
Tremor and a loss of motor control are characteristic symptoms of Parkinson's disease and are due to a loss of neurons that release the neurotransmitter dopamine, called dopaminergic neurons. When dopaminergic neurons die, fine motor control is lost and patients develop tremors and uncontrollable movements. Although the loss of dopaminergic neurons is crucial in the development of Parkinson's disease, the mechanisms how this happens, and how we can prevent -- or even repair -- the dopaminergic system is not yet understood.
Animal models for Parkinson's disease have provided some insight into Parkinsons disease, however as rodents do not naturally develop Parkinson's disease, animal studies proved unsatisfactory in recapitulating hallmark features of the disease. In addition, the human brain contains many more dopaminergic neurons, which also wire up differently within the human brain, sending projections to the striatum and the cortex. "We sought to develop an in vitro model that recapitulates these human features in so called brain organoids," explains Daniel Reumann, previously a PhD student in the lab of Jürgen Knoblich at IMBA, and first author of the paper. "Brain organoids are human stem cell derived three-dimensional structures, which can be used to understand both human brain development, as well as function," he explains further.
The team first developed organoid models of the so-called ventral midbrain, striatum and cortex -- the regions linked by neurons in the dopaminergic system -- and then developed a method for fusing these organoids together. As happens in the human brain, the dopaminergic neurons of the midbrain organoid send out projections to the striatum and the cortex organoids. "Somewhat surprisingly, we observed a high level of dopaminergic innervation, as well as synapses forming between dopaminergic neurons and neurons in striatum and cortex," Reumann recalls.
To assess whether these neurons and synapses are functional, the team collaborated with Cedric Bardy's group at SAHMRI and Flinders University, Australia, to investigate if neurons in this system would start to form functional neural networks. And indeed, when the researchers stimulated the midbrain which contains dopaminergic neurons, neurons in the striatum and cortex responded to the stimulation. "We successfully modelled the dopaminergic circuit in vitro, as the cells not only wire correctly, but also function together," Reumann sums up.
The organoid model of the dopaminergic system could be used to improve cell therapies for Parkinson's disease. In first clinical studies, researchers have injected precursors of dopaminergic neurons into the striatum, to try and make up for the lost natural innervation. However, these studies have had mixed success. In collaboration with the lab of Malin Parmar at Lund University, Sweden, the team demonstrated that dopaminergic progenitor cells injected into the dopaminergic organoid model mature into neurons and extend neuronal projections within the organoid. "Our organoid system could serve as a platform to test conditions for cell therapies, allowing us to observe how precursor cells behave in a three-dimensional human environment," Jürgen Knoblich, the study's corresponding author, explains. "This allows researchers to study how progenitors can be differentiated more efficiently and provides a platform which allows to study how to recruit dopaminergic axons to target regions, all in a high-throughput manner."
Insights into the reward system
Dopaminergic neurons also fire whenever we feel rewarded, thus forming the basis of the "reward pathway" in our brains. But what happens when dopaminergic signaling is perturbed, such as in addiction? To investigate this question, the researchers made use of a well-known dopamine reuptake inhibitor, cocaine. When the organoids were exposed to cocaine chronically, over 80 days, the dopaminergic circuit changed functionally, morphologically and transcriptionally. These changes persisted, even when cocaine exposure was stopped 25 days before the end of the experiment, which simulated the withdrawal condition. "Even after almost a month after stopping cocaine exposure, the effects of cocaine on the dopaminergic circuit were still visible, which means that we can now investigate what the long-term effects of dopaminergic overstimulation are in a human-specific in vitro system," Reumann summarizes.
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Materials provided by IMBA- Institute of Molecular Biotechnology of the Austrian Academy of Sciences. Note: Content may be edited for style and length.
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Ministers tried to remove the head of the NHS just five days after the first Covid-19 case was detected in the UK.
The Lockdown Files reveal the animosity shown towards Lord Stevens of Birmingham, the chief executive of NHS England.
Six months into the pandemic, Matt Hancock, the then health secretary, declared “removing SS [Simon Stevens] will be a massive improvement”.
On another occasion, Mr Hancock was so visibly angered by the NHS chief that his own advisers warned him: “Simon needs a kick... don’t make yourself look bad in the process”.
The messages between ministers and officials disclose the lack of regard both in Downing Street and the Department of Health for Lord Stevens, despite widespread praise of his stewardship of the NHS for seven years.
The private messages also appear at odds with the Government’s support for the NHS during Covid, while belittling its boss behind the scenes.
Lord Stevens finally retired from the post in July 2021 and was made a life peer in recognition of his services to the NHS.
But the messages reveal that Mr Hancock and Dominic Cummings, Boris Johnson’s chief adviser, were conspiring to get rid of him for at least 18 months before he finally stepped down.
Nine days after Chinese authorities first shared the genetic sequence of Covid-19, Mr Hancock messaged Mr Cummings explaining he was approaching Lord Ara Darzi, an eminent professor of surgery, to “persuade” Lord Stevens to quit.
Then on Feb 3, just days after the first two Covid cases were detected in the UK and after the World Health Organisation declared a global health emergency, Mr Cummings again messaged Mr Hancock:
But although that never happened and Lord Stevens remained in post, the briefings against him continued.
In April 2020, Mr Hancock criticised Lord Stevens in a Downing Street meeting, during which he was so visibly angered that his special adviser Allan Nixon remarked by WhatsApp: “You look like you’re losing grip in front of No 10 by having a go at Simon like that. Simon needs a kick but don’t make yourself look bad in the process.”
Mr Hancock responded: “It's ok - he needs to know he is massively fucking up. And I'll tell the room what happened once the video is off.”
Mr Nixon replied: “Ok but be aware from afar it looks like you’re cracking under pressure.”
It’s unclear precisely why Lord Stevens irritated Mr Hancock so much, but when he quit, NHS sources said his successor was likely to be someone “less outspoken and less willing to challenge Government”.
Lord Stevens had clashed with successive Tory administrations over NHS funding, and The Lockdown Files also show clashes over tackling the virus and the rolling out of the vaccines.
By the end of May, Mr Hancock was again furious with Lord Stevens, this time over the NHS chief executive’s issuing of guidance allowing dentists to reopen in June. Mr Johnson complained he had not been aware of the guidance being changed.
The files also contain text messages between Mr Hancock and Lord Stevens, in which they argue over whether the NHS chief executive had permission to make the announcement on dentists reopening, which the Government had wanted held back for its televised press conference.
Again in August, Mr Hancock pressed Mr Cummings for a new NHS Bill to push through reforms that would give ministers more powers over the health service.
The pair rowed again over the vaccine introduction.
Lord Stevens was angered in December 2020 about a claim being briefed to the media that millions of people were due to receive the jab by Christmas.
Lord Stevens posted a message on a WhatsApp group that included Mr Hancock and senior health officials and advisers:
Even after Lord Stevens announced that he was stepping down, Mr Hancock continued to be irked by him.
The three health secretaries he had served alongside – Mr Hancock, Jeremy Hunt and Sajid Javid – had jointly signed a letter praising Lord Stevens.
The letter included a statement saying his “tireless efforts to improve patient safety, and secure access to innovative medicines like Orkambi, have had a huge impact on the lives of so many”.
But after he was shown the letter, Mr Hancock – who had by then been forced to resign over an affair in his office – asked for the reference to the drug Orkambi to be removed.
The drug, now available on the NHS, is used to treat cystic fibrosis patients. | Health Policy |
Hospitals in Wales "didn't want to know" about the additional needs of disabled staff, according to a doctor who was looking for work after being paralysed in a car crash.
"They wanted someone that could easily and quickly fill the post without them having to do anything," Dr Georgina Budd, who qualified as an A&E medic.
She ended up becoming a GP at a surgery that could accommodate her needs.
Health boards said they were committed to creating inclusive environments.
"There shouldn't be a limit because of my disability," said Dr Budd, known as Georgie, who spent three years as a clinical fellow in the A&E department at Glangwili Hospital in Carmarthenshire as part of her medical training.
"I've been in situations where I've had to deal with a medical emergency and I'm no less effective for being in the wheelchair."
But when the time came to find a full-time job, she said she faced barriers.
"I've had colleagues say: 'You're going to need to think about your career and how you tailor it to your disability'," said Georgie.
"I shouldn't have to. I should be able to work in the specialty that I want to."
Georgie said for one job application, a hospital asked her to do an unpaid "trial shift".
"It was all dressed up in language of 'so we can see how we can help you'," she said.
"What really came across was 'so we can see how many adjustments you would need so we can see if it's financially viable for us to change things around for you'."
She added: "You would think that hospitals are set up for disabled people because they are a big part of our service, but they're not".
Most hospital cupboards are out of a reach for a wheelchair user, she explained, and some buildings were still inaccessible.
"Life has been built around able-bodied people. It is not built for me and it's not built for the rest of the disabled community," she said.
Working hours is another barrier.
"It does take me a longer time to get ready and out of the house in the mornings," she said.
"Without getting up at a ridiculous hour, I might not be able to be on shift at 8am like some doctors.
"That was a problem at first because ward rounds happen in the morning.
"We are looking for reasonable adjustments, but it's very difficult to get those changes made and to get people thinking differently about disability and about a disabled doctor."
Originally from Downton in Wiltshire, Georgie started at Cardiff Medical School in 2009.
On her way to a shift at Glangwili Hospital in 2017, she lost control after a tyre on her car punctured. To avoid oncoming traffic, she swerved into a pole at 50mph (80km/h).
At the age of 30 she was paralysed from the waist down and she thought her career was over.
But she fought to complete her doctor training.
"It is not the end of the world. It's hard and there are challenges, but I kept telling myself 'my life isn't over'," she said.
She recalled her first time seeing a patient as a doctor in wheelchair: "She looked at me and... was like, 'oh, hello, love. Are you one of the patients?'
"'No, I'm your doctor today'."
Georgie completed her doctor training at Glangwili Hospital in August, but after failing to find a job she changed her specialty and is now a general practice trainee.
Working as a GP at Tŷ Calon Lân surgery in Mountain Ash, Rhondda Cynon Taf, means more sociable hours and more flexibility.
Her typical day starts with a carer coming to her home in Merthyr Tydfil at around 8am.
"I could probably just about do it myself... but I was slipping because I was so exhausted," she said.
"Having [a carer] in just sort of makes the morning run smoother, allowing me to conserve my energy and put it into things that I really want to do."
She is co-chairwoman for junior doctors at the British Medical Association in Wales, and is currently doing research with Swansea University on the mental health needs of medical students.
"GP gives me the opportunity to be more active in medical politics and in research and still see my patients and have a good impact on them," she said.
"In an ideal world any child that wanted to grow up to be a doctor and had a disability wouldn't feel that's off limits to them," she said.
That would require a "perspective change in society" she said.
"It's understanding that disability isn't inability," she said. "Being in a wheelchair doesn't limit my ability as a doctor."
She said she wants to see full accessibility as the standard in all health buildings so no-one feels left out.
"I want more disabled kids to know that this kind of opportunity is open to them," she said.
"That it doesn't matter if their legs don't work. I know a consultant who's got one arm... he still takes blood and is an effective doctor and why shouldn't he be?"
"A lot of what a doctor does is up here," she added, touching her temple.
"I've put chest drains in, I've sutured people... all kinds of crazy stuff.
"I adapt it for me but I can still do it. It's just doing it a different way."
Georgie spent months in hospital recovering from her accident, an experience she said gives her more empathy for her patients.
"I think that knowledge is something that can really help the medical community," she said.
"Having more doctors that have gone through poor health experiences, chronic illness, disability is important to widening doctors' understanding of what their patients are going through."
She said more understanding of disability was needed in society more generally, recalling upsetting comments she overheard after her friends had to carry her into a non-accessible café.
"We were sat there and this young woman said really loudly: 'Why would she even come here, it's clearly not disabled accessible. Does she not realise that she's just a nuisance'."
Comments like that could be "hard", Georgie admitted, but said they made her more determined to "normalise" disability.
"I can spend the next 60 years miserable because I can't stand up, or I can do something about this," she said.
Several health boards in Wales said they follow an all-Wales recruitment process designed to ensure "fair and equal opportunities for all" and that disabled candidates who meet the minimum standard were guaranteed an interview.
"Only when shortlisting is complete will a candidate's self-declaration [of a disability] be visible, alerting the appointing manager that reasonable adjustments may be required," said Lisa Gostling, from Hywel Dda health board.
Aneurin Bevan health board said it offered disabled staff access to work assessments, aiming to "create an inclusive environment for our staff and patients".
Powys health board said "tailored adjustments will be made, where possible, to roles and/or workplaces through discussion between the manager and the employee".
Betsi Cadwaladr heath board said it "welcomes applications from individuals with disabilities and value all staff".
A Welsh government spokesperson said it expected "all NHS organisations to comply with the Equality Act 2010, and to follow best practice regarding the recruitment and retention of staff". | Health Policy |
The UK’s top civil servant vented that Boris Johnson “cannot lead” amid pandemic-era frustration with the prime minister’s leadership, according to WhatsApp messages shared with the Covid-19 inquiry.
Simon Case, who remains Cabinet Secretary, told Mr Johnson’s then-chief adviser Dominic Cummings that the prime minister was making government “impossible”.
The private correspondence, which took place as the Government grappled with the spread of Covid, came during the appearance of former top aide Martin Reynolds at Lady Hallett’s probe.
Mr Case, who has temporarily stepped back from his role due to a “private medical matter”, told Mr Cummings that the PM “cannot lead and we cannot support him in leading with this approach”.
In the message, read at the hearing, Mr Case said: “I am at the end of my tether.
Martin Reynolds has now concluded his evidence.
Our second witness today, Imran Shafi (Former Private Secretary to the Prime Minister, Public Services) has now been sworn in and begins his evidence.
He is being questioned by Lead Counsel to the Inquiry Hugo Keith KC.
— UK Covid-19 Inquiry (@covidinquiryuk) October 30, 2023
“He changes strategic direction every day (Monday we were all about fear of virus returning as per Europe, March etc – today we’re in ‘let it rip’ mode cos (sic) the UK is pathetic, needs a cold shower etc).
“The team captain cannot change the call on the big plays every day.
“The team can’t deliver anything under these circumstances.
“Decide and set direction – deliver – explain.
“Gov’t isn’t actually that hard but this guy is really making it impossible.”
It is not the first time that private concerns by Mr Case have made public.
Recently disclosed WhatsApp messages saw him describe the Government as looking like a “terrible, tragic joke”, while Mr Johnson’s wife Carrie was “the real person in charge”.
Mr Case, who was made Cabinet Secretary in September 2020 having been permanent secretary in Number 10, had been expected to give evidence to the Covid inquiry in the coming weeks.
Mr Johnson’s handling of the early days of the pandemic came in for particular scrutiny, as the inquiry launched a major week of hearings that will see Mr Cummings and former Number 10 director of communications Lee Cain appear on Tuesday.
The then-leader, according to a note read from the diary of a former private secretary, asked why the economy was being destroyed “for people who will die anyway soon”, in the days before the country went into lockdown.
The diary note from Imran Shafi, which he attributed to Mr Johnson, stated: “We’re killing the patient to tackle the tumour. Large ppl (taken to mean large numbers of people) who will die, why are we destroying economy for people who will die anyway soon.”
Elsewhere Mr Reynolds, dubbed “Party Marty” due to his role in the partygate scandal, said that Mr Johnson did “blow hot and cold” on various issues while at another he acknowledged concerns about “macho behaviour” and “misogyny” in the top-level management of the crisis.
The former principal private secretary also pointed to a “systemic failure” to prepare for the pandemic as he appeared to acknowledge that the realisation of the scale of the disaster had come “late”.
Taking questions from Hugo Keith KC, lead counsel to the UK Covid-19 Inquiry, he was asked about a 10-day spell in February 2020 where there “were no communications by email, by Cobra, by boxed notes, with the prime minister during that 10-day period on coronavirus”.
Mr Reynolds, who initially said that he could not recall whether there was any “urgent business” during that period, was told by Mr Keith it was half-term.
The senior civil servant faced repeated questions about whether Downing Street and the Cabinet Office were slow to respond to the impending crisis, as scenes and reports of overwhelmed Italian hospitals began to be broadcast in the UK.
“The fact we got into that position is a result of a systemic failure and a failure of the people who are really tracking the situation most closely,” he said.
He accepted that Government protocols were “inadequate” and “grossly deficient”, while also pointing to the “unusual dynamic” in Downing Street during that period and the influence of Dominic Cummings.
Mr Reynolds offered a picture of a Government that, after Mr Johnson’s 2019 general election, was “very different” and acknowledged that there had been a “bedding down of new working arrangements”.
It also emerged that Mr Case, in a WhatsApp exchange with Mr Reynolds, said Mr Johnson was “mad” if he did not believe his private WhatsApp messages would become public as part of the Covid inquiry.
The extent and nature of decision-making through the messaging app has become a key plank of Baroness Heather Hallett’s probe, with the comments about Mr Johnson made in exchanges between Mr Case and Mr Reynolds.
It also emerged that Sir Patrick Vallance believed senior officials in Number 10 had tried to “strong arm” himself and Professor Sir Chris Whitty into appearing at a press conference around the time it was revealed Mr Cummings had gone to Barnard Castle during the first lockdown.
The former chief scientist’s notebooks also described Mr Cummings’ Downing Street rose garden statement to the media as a “car crash” and “rambling”, and said neither he nor Sir Chris wanted to do a press conference with Mr Johnson afterwards.
Mr Reynolds denied being involved in strong-arming the top health experts, while also using the hearing to acknowledge his own concerns about management at the top of Government.
He was asked about a report he and deputy cabinet secretary Helen MacNamara helped write in May 2020, amid concerns about “discipline”, “macho behaviour” and “misogyny”.
Mr Reynolds agreed with counsel Mr Keith who said that the report showed “dysfunctionality, lack of discipline, chaos and a significant degree of misogyny”.
The then-senior official also suggested that he had turned on the “disappearing message function” on the WhatsApp group titled “PM Updates” on April 15 2021 because of concerns about potential leaks.
Downing Street on Monday said that the use of disappearing WhatsApp messages is permitted as civil servants and ministerial private offices are required to record and log official decisions for the official record.
Mr Shafi, in his afternoon evidence session, also said that be believed there was “too much focus on excess-death management and not enough focus on preventing those deaths in the first place”.
Campaigners from the Covid-19 Bereaved Families for Justice UK group said it had been “hard to keep up with the number of horrific revelations” which emerged from Monday’s hearing.
Charlie Williams, spokesman for the group, said: “Whilst we were desperately doing everything we could to protect our loved ones, even if it meant not being with them at their final moments, the Government was failing to take decisive action and pretending everything was fine, repeating their many, many mistakes, partying and breaking their own lockdown rules.
“Like so many others, we’re left having to live with the devastation caused by their failures and chaos for the rest of our lives.” | Epidemics & Outbreaks |
I started pole dancing in 2015. It’s my happy place, and makes me feel free and empowered. But the sport I adore so much nearly cost me my life.I was learning a new move in 2016, an upside down arch that is just about as hard as it sounds. It involves hanging, inverted, with your hands above your head; only the back of one thigh is holding you on the pole.I wanted to document my progress. I gave my sister my phone to take a picture, and prepared to hold the move. I suddenly lost my grip, and before I knew it, I landed on my neck and was on the floor. I panicked. I couldn’t feel a thing from the neck down – I knew immediately that I was paralysed.My sister called for an ambulance and I was rushed to the nearby hospital in Johannesburg, where they confirmed a spinal injury. The fall had burst a vertebra in my neck. I was in total disbelief. I kept thinking I was in a dream, and that I needed to shake myself out of it. The rest of my family met us at the hospital. They were terrified.The hospital couldn’t get hold of the neurosurgeon within the limited time needed to operate, so I was airlifted to a second hospital, also in the city, with a dedicated team of neurosurgeons.I was bed-bound. They had to remove the fragmented pieces of the broken vertebra in my neck and replace it with metal. My family and I were warned that they didn’t know what the outcome would be, and permanent paralysis from the neck down was possible.I learned later that they had taken my family aside before the operation and told them there was a significant risk that I wouldn’t survive. As the spine injury was so high up, the anaesthetic could affect my diaphragm – meaning I’d be unable to breathe.After waking from the surgery, I was placed in the ICU for a week and my brain went into overdrive. It was my 19th birthday week, too. They had physios assess me. My motion was extremely limited. I needed to relearn everything: walking, feeding myself, drinking from a bottle, using my phone, brushing my hair and teeth. I was mostly confined to my bed.After seven days, I was taken to a rehabilitation facility. I was given a wheelchair and my family was taught how to help me in and out of it, but I was not able to move around by myself. After working with a team of physiotherapists and occupational therapists, I slowly began to regain movement.They would fetch me from my room daily and take me down to the gym. In the afternoons, there would be a group physio session with all the patients in the spinal cord unit. Sometimes we would do sports such as wheelchair basketball or games.I felt overwhelmed, but the people around me were so supportive. My mum, dad and sister visited me every day, bringing home-cooked food. My dance studio held a fundraiser to help pay for some of the medical bills.It might sound crazy, but I was determined to get back on the pole. I’d come so far in the sport and refused to let this injury stop me. About three and a half months later, the seemingly impossible happened. I regained enough movement and was able to go home and recover as an outpatient.I have now managed to recover sufficiently to continue my dream. I perform as a ParaPole dancer, which is pole sports for people with disabilities. I was excited but nervous about getting back into it: I had lost a lot of strength and knew it would be difficult to build it up again. But mostly I was just happy to be back.What happened to me is very rare – broken toes and grazes are common in the sport but this extent of injury isn’t a regular occurrence, so I wouldn’t want to put other people off. I haven’t tried the original move that caused the injury. Physically, it remains too difficult, but I also don’t feel mentally ready to try it.My experience has made me more resilient; if I can get through that, nothing else can compare. Last year, at the World Pole and Aerial Championships, I won gold and my score broke the world record for ParaPole dancing. I had been working towards that for so long, and I am really proud of myself – it took a lot of hard work and dedication to get this far. As told to Elizabeth McCafferty Do you have an experience to share? Email [email protected] on this piece are premoderated to ensure the discussion remains on the topics raised by the article. Please be aware that there may be a short delay in comments appearing on the site. | Medical Innovations |
When predicting the function of microbial communities, simpler may be better
As biologists learn more about how microbial communities work together, a major goal is understanding how their composition determines function. What combination of strains and species makes the best team for breaking down pollutants, for example, or fighting off infections? For years, scientists attempted to crack this problem with calculations about how microbial species interact with each other, but the nearly endless potential combinations of microbes in each community render these calculations nearly impossible.
A new study by researchers from the University of Chicago, Yale University, and Washington University in St. Louis shows that taking a simpler approach may be better. In a paper published in Nature Ecology & Evolution on October 2, 2023, they demonstrate a statistical model that can accurately predict functions of a microbial community just by considering the presence or absence of different species and not the details of their interactions.
This approach worked across a variety of datasets from different ecological systems, suggesting that it could be useful for designing microbial communities with a specific function for many different applications.
"Predictions using the standard approaches are themselves very challenging and require a lot of data," said Seppe Kuehn, Ph.D., Assistant Professor of Ecology and Evolution at UChicago and co-senior author of the study. "In some cases that approach has been successful. But what's quite surprising in our paper is that we're just as successful if we ignore all of that."
The researchers used a concept borrowed from genetics. The way in which genetic mutations impact an organism's fitness, or ability to survive and pass genetic material to offspring, is commonly depicted as a "fitness landscape." In this picture, different combinations of mutations are conceptualized as points on an abstract "map" of possible organisms; the height of the landscape above each point corresponds to the fitness of that organism. The result looks like a topographical map with peaks and valleys representing high- and low-fitness organisms.
In the new study, instead of fitness landscapes, the researchers considered an analogous landscape of community function, where adding or removing species is akin to "mutations," and the topographical peaks represent communities with, say, a high production rate of some compound.
In principle, the shape of such landscapes could be arbitrarily complex, or "rugged," with many peaks and valleys. But testing this approach on six different datasets from different labs, the team discovered that the landscapes were surprisingly smooth. This smoothness meant the shape of the landscape could be approximated with relatively little data, allowing the researchers to predict community function just as well as the more complicated approaches that account for species dynamics and abundance.
The simplicity of the approach may contribute to its robustness. "The model worked well compared to other statistical approaches, but more importantly, it seems to work consistently well across different datasets that have very different microbes for different functions," said Abby Skwara, the lead author of the study, who was an undergraduate at UChicago and is now a graduate student at Yale University.
Among the six examples tested by the researchers, one measured the ability of microbial communities to produce butyrate, a short-chain fatty acid that is important for healthy digestion. Another dataset measured the breakdown of starch.
The researchers hope that this new landscape model can provide a tool to help design microbial communities for a specific purpose, like breaking down environmental contaminants in soil, or producing the right metabolites to help restore healthy digestive systems. In the process, it could also lead to a greater understanding of how microbial communities function in the first place.
"The success of this simple approach is intriguing in that it contradicts our intuition about ecological complexity," said Mikhail Tikhonov, Ph.D., Assistant Professor of Physics at WashU and co-senior author. "Here, the communities are complex, yet the landscapes of their function are not. Understanding why this is the case is an exciting question for theory."
More information: Abigail Skwara et al, Statistically learning the functional landscape of microbial communities, Nature Ecology & Evolution (2023). DOI: 10.1038/s41559-023-02197-4
Journal information: Nature Ecology & Evolution
Provided by University of Chicago | Disease Research |
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This is the third in a three-part series on the obesity crisis. Part one asks a complicated question: Why has the obesity rate continued to rise despite our efforts to stop it? Part two examines whether new weight loss drugs will finally end the crisis.Â
July 5, 2023 â After Mia OâMalley gave birth in 2018, she retained fluid in her legs â a common occurrence after giving birth. The swelling made walking, sitting, and caring for her newborn painful and uncomfortable. She went in for a check-up, and her doctor told her it would eventually go away with regular movement and elevating her legs.Â
Months passed and the painful swelling wouldnât subside, so she saw a different primary care doctor. OâMalley said the second doctor didnât examine her legs, but instead implored her to focus on one thing: losing weight. She left with information on which calorie-counting apps to download.Â
As time went by and the swelling persisted, she went back to the second doctor and asked for a water pill to flush out the fluids â something she had seen other new parents discuss online. The doctor obliged, and within days, OâMalleyâs swelling was gone. She realized she could have avoided 6 months of potential health risks and pushing through pain if only her doctor had seen her as a person, not just a bigger body.Â
Weight bias, unfortunately, is nothing new. Many studies over decades have shown that doctors sometimes look down on patients with obesity, and can have a hazy understanding of the condition overall. This makes it harder for bigger patients to receive proper care and achieve positive health outcomes, with previous negative experiences deterring some from seeing doctors at all. And so the cycle continues.Â
âThere are a lot of things that happen in my body that I feel like I have to educate my [health care] providers on,â OâMalley said. âI wish that was different.â
Weight Stigma in Health Care Runs Deep
In some cases, like O'Malley's, patients don't feel heard because they doubt their doctors can see past their obesity. At the same time, the weight loss advice that doctors tend to give â eat less, move more â often doesn't work. While some doctors do specialize in obesity treatment â obesity medicine has been growing since the field was established in 2011 â most receive little training in how to talk about and treat obesity.
Then there's the fact that doctors are human and not immune to bias. Previous studies have shown weight stigma in patient-provider encounters, with a 2021 PLOS One study of nearly 14,000 people across six countries showing two-thirds of those who have experienced weight stigma also experienced it with doctors. The result: They perceived less listening and respect from doctors, more judgment due to body weight, and lower quality of health care.
Thereâs more. The negativity of weight stigma can lead to more unhealthy behavior, including disordered eating, more weight gain, and alcohol use, and it has been linked to higher suicide risk.
All this is bad news for people and for public health, as it leaves people living with obesity reluctant to seek help for any health issue, much less for weight management. In a country with skyrocketing obesity rates, that's not good.Â
Obesity medicine specialist Fatima Stanford, MD, MPH, an educator and doctor at Harvard Medical School and Massachusetts General Hospital, sees patients from as young as 2 years old to upwards of 90. Among her diverse pool of patients emerges one common theme.Â
âPatients with obesity have been devalued and belittled,â she said. âThey often seek treatment under cloak of secrecy. They donât want people to know theyâre being treated for obesity because it must be a sign of failure or of their inadequacy of not doing things the âhardâ or the ârightâ way.âÂ
When It Becomes Easier to Simply Not Go to the DoctorÂ
For many larger-bodied patients, itâs common to go years without seeing a doctor. Studies have shown that people with obesity are less likely to be screened for certain cancers and more likely to delay care, in large part due to the negative attitudes they experience in health care settings.Â
Research also shows that overweight patients shop for doctors 23% more often than their lower-weight counterparts. For patients with obesity, that jumps to 52%, showing just how hard it is for those patients to find a compassionate provider and stick with them.Â
âItâs not just about hurt feelings,â OâMalley said. âItâs about people avoiding preventative care appointments, avoiding getting injuries treated, avoiding their health issues because they donât want to be shamed.âÂ
This rings true for Jen McLellan, a plus-sized childbirth educator and author.Â
âEven though this is what I teach full-time, I didnât go to the doctor for over 2 years, and during that time I gained weight already existing in a larger body,â she said. âI gained an additional 60 pounds, and it really affected my mental health.âÂ
The long hiatus began pre-pandemic, after McLellan saw a doctor when she had a hard time breathing. A month before her appointment, she had completed a 5K and was in good health. She asked her provider for an inhaler but was told that would âhurt her heart.â The doctor ordered an EKG, which showed no abnormalities, but still refused to give McLellan a prescription for an inhaler.Â
As she was driving home, she nearly blacked out from lack of air. She ended up going to urgent care for an inhaler and was told she just had a restricted airway that needed help opening up after a bout with strep throat.Â
âIâve basically had to say [to doctors]: Look at me, the human sitting in front of you that has been mistreated by the health care system,â McLellan said. âI am a person. I am not a BMI or a number on the scale. Treat me with dignity.âÂ
A New Path to Better ResultsÂ
Kristal Hartman, 45, is a member of the Obesity Action Coalition and has sought treatment for obesity throughout her life. She ultimately had bariatric surgery in her mid-30s.
Before the surgery, she had given birth to twins, and her health had suffered due to polycystic ovary syndrome and thyroid issues.Â
âI had little kids, and Iâd already tried every fad diet,â Hartman said. âMy primary care physician, who has never experienced obesity herself, just kept telling me to âjust walk a little more and put down the fork and eat a little lessâ â that was pretty much the only advice I got from her about weight management.â
Studies have shown that weight loss advice from doctors rarely includes effective methods, and typically falls into the generic âeat less, move moreâ variety.Â
This doctor was also an internal medicine specialist whose practice was said to be geared toward patients with more complicated health profiles, Hartman said. Eventually, Hartmanâs endocrinologist recommended different treatment options, like medication and surgery.Â
âEven when researchers do very nice, controlled studies, only about 5% of people are able to lose 20% of their weight with lifestyle interventions alone. Forty-eight percent of people are able to lose 5% of their weight,â said Angela Fitch, MD, associate director of the Weight Center at Massachusetts General Hospital. âThe biggest thing I tell people is that itâs not about your character; itâs about your chemistry.âÂ
Getting regular exercise and eating a balanced diet are good lifestyle choices for everyone, not just those with obesity. But according to Fitch, patients usually need another intervention for successful weight management.
At the Massachusetts General Hospital Weight Center, Stanford says, itâs about trying different therapies and seeing how patients respond. Successful treatment involves every part of a person: genetics, hormone levels, sleep patterns, food access, and mental health. And in her experience, this multidisciplinary approach works.Â
âA large majority of my patients â people Iâve been seeing for 10 or 12 years who have continued with care â probably an excess of 90% are successful in their treatment strategies,â she said.Â
A personâs weight management strategies often have to change over time. Even after Hartman lost significant weight from bariatric surgery, her weight began to creep back up (a not uncommon experience). She started taking a prescribed GLP-1 receptor agonist â a group of drugs that includes semaglutide (Ozempic, Wegovy) â to help her maintain her weight.Â
How Doctors and Patients Can Get Better Results Together
For heavier people who donât have access to a multidisciplinary, patient-focused weight center â and doctors who donât provide those specialized services â there are still ways everyone can achieve better treatment results.Â
For doctors: Youâre seeing patients with obesity, but do those patients feel âseenâ? Is your practice set up to accept and accommodate heavier patients? McClellan suggests looking at areas you may not have thought about previously, such as gowns that fit larger bodies, larger chairs in the waiting room, and scales with higher weight limits.
Education is key, said Maria Daniela Hurtado Andrade, MD, PhD, an obesity medicine doctor at the Mayo Clinic in Jacksonville, FL. Hurtado Andrade pointed out that new therapies are being developed to manage weight loss, and some (like semaglutide) have already been used for years to treat diabetes. âWhile some providers are willing to start using these medications, it is not enough,â she said. Remember: âWe should be treating obesity as any other chronic disease, just like high blood pressure or diabetes.âÂ
For patients: Check online for lists of âweight-neutralâ or âsize-friendlyâ providers endorsed by other larger-bodied patients. Lists like these are places where patients can add the names and information of providers theyâve had positive experiences with.Â
Ask questions and advocate for yourself, McLellan urges, even if youâre not comfortable doing so. âAm I going to be given a sheet or a gown that fits my body? Are they using a blood pressure cuff with the correct size? Are they taking your blood pressure the minute youâre hurried back to a room?â (According to the CDC, a patient must be seated with their back supported for at least 5 minutes with their feet flat on the ground in order to get an accurate blood pressure reading.)Â
But whatâs made the biggest difference for her is being clear with doctors and nurses about how sheâs feeling in the moment, and how her previous experiences in health care have contributed to that.Â
Since incorporating these strategies, McLellan said she has finally been able to receive the care she deserves from a compassionate provider.Â
âI told [my doctor], âI want to be healthy,ââ she recalled. âAnd we went through my lab results together. I had done a full blood panel, and he scooted his chair toward me and looked me straight in the eye and said, âYou are healthy.ââ
 | Nutrition Research |
Funding for drug treatment centers in Oregon, financed by the state's pioneering drug decriminalization policy, stood at over a quarter-billion dollars Friday as officials called for closer monitoring of where the money goes.
That need for oversight was demonstrated Wednesday when state officials terminated a $1.5 million grant agreement with a drug recovery nonprofit in Klamath Falls accused of failing to submit completed expenditure and data reports and buying a building for more than double the authorized amount.
That $1.5 million is just a drop in a huge bucket — $264.6 million has been allocated to date for recovery centers — and state officials have a massive responsibility to ensure the money does what it is supposed to: combatting drug use in a state with one of the nation's highest addiction rates.
Oregon's drug decriminalization had a rocky start after voters approved it in a 2020 ballot measure. Only a tiny number of people have accessed treatment services after being ticketed for possessing drugs, and funding to treatment providers was delayed.
But as of Friday, $184 million has been handed out to these behavioral health resource networks, or BHRNs, in a state of 4.2 million people.
To ensure things run smoothly, the Measure 110 Oversight and Accountability Council, responsible for overseeing addiction and recovery centers and the funds to support them, needs more staff, officials say. And the Oregon Health Authority needs more leverage to address bureaucratic and administrative barriers to oversight.
But a bill to provide all that remains stuck in the Senate, along with more than 100 other bills, because of a walkout by Republican senators that began on May 3 seeking to block Democratic initiatives on abortion rights, transgender care and gun safety.
“This proposed legislation is grounded in the fundamental principles vital to the success of Measure 110,” Monta Knudson, CEO of Bridges to Change, an addiction recovery organization based in Portland, told lawmakers.
The GOP stayaway casts doubt on the bill being passed, even though it had strong bipartisan support as it cleared the House.
Oregon's 2020 ballot measure marked the first time a U.S. state decriminalized hard drugs. It reframed the “war on drugs” to treatment instead of incarceration. Anyone caught with user amounts can call a hotline for help or face a maximum $100 fine. Tax revenues from Oregon's legal marijuana industry finance the treatment as well as harm reduction through needle exchanges and overdose medications.
But with so much money involved, opportunities for abuse are ripe.
The Measure 110 Oversight and Accountability Council voted Wednesday to terminate its $1.55 million grant agreement with a provider in Klamath Falls after it allegedly failed to submit completed expenditure and data reports.
“I don’t really have any confidence in this grantee to move forward with funds because we are already catching a lot of flak about Measure 110," council member Hubert Mathews, Jr. said at the meeting "And I think we need to have grantees that can follow the procedures to be able to do this work.”
Mathews and another council member, though, expressed surprised that no state officials visited Red is the Road to Wellness in person, or other BHRNs (pronounced “burns”).
“That’s kind of incredible," Mathews said. "I think we should be able to visit some of these BHRNs to see what they’re doing physically. That would probably help. I don’t know how that would happen. I think we need to have a process.”
Red is the Road to Wellness has already been provided with more than $1 million of its allocation, the health authority said. The health authority can recover those funds if it determines any was spent outside the scope of the grant, said health authority spokesman Tim Heider.
The grant included $290,500 to purchase a building, but instead Red is the Road to Wellness bought a property for $750,000 and failed to secure a state interest in the property as required by the health authority, Heider said.
William Barnes, the Klamath Falls outfit's executive director, said in a phone interview Thursday that meeting the health authority's reporting requirements is a challenge.
“The Measure 110 process has been a learning experience for everybody involved, including our organization," Barnes said. He said he had invited health authority staffers to visit his facility, but they never took him up on it.
Barnes said he spent $561,000 in grant funding for the purchase of the building, and improvements, with the remainder coming from outside sources. In a statement Friday, Barnes said the building will have eight apartments of recovery housing, a recovery drop-in center, employment office and a bakery offering on-the-job training.
Barnes said he'll appeal the termination while still continuing to serve marginalized communities of color.
___
This version fixes a typographical error to correct Oregon’s population to 4.2 million. | Drug Discoveries |
Often life introduces one to new experiences, and people find a different way to their sociability, a new reason to explore. For people who have undergone a life-changing incident losing their sense of hearing, hearing aid devices greatly help. Enabling these special souls to communicate and reciprocate to thoughts around them. However, it was quite unknown until this time that these tiny devices could do much more than enrich one’s social life. Hearing aids can improve brain processing, keep one mentally sharp and eliminate signs of fatigue or depression. Also, studies reveal these can reduce the chances of cognitive decline among adults at risk of dementia. That’s a lot, right? Moving on, let’s have a look into the details.
Hearing Aids Reduce Cognitive Decline In Older Adults
A study published in The Lancet reveals how treating hearing impairment can help diminish the risks of dementia in the elderly. The researchers organized randomized controlled trials of adults aged between 70 and 84 with untreated hearing loss. They chose four community centers across the USA for the study site.
The study’s results offer compelling evidence that treating hearing loss can be a powerful tool to amplify cognitive functioning among the elderly. Also, this particular way can bring down the chances of dementia. However, the team also focused on the fact that the success rate of treating hearing loss also depends on an individual’s risk of cognitive decline.
There were two types of respondents at each community center. Elderly adults part of a longstanding observational study of cardiovascular health and new additions from the same community., but healthier than the former. Few of them were randomized to hearing aids or audiological counseling. While the others went for generalized counseling sessions. The research lasted 3 years, with the respondents showing up for follow-up twice a year.
With the aim of finding a change in the cognition score, the team came up with multiple tests. The list goes as delayed word recall, logical memory, digit span backward, and incidental learning.
Hearing Aids Help Elderly With Mental Acuity
A study by Texas A&M University does reveal how researchers had measured the concentration levels, memory, and information processing speed of a group with impaired hearing. The respondents were in their 50s and 60s, conditioned with bilateral sensorineural hearing loss, and had never used hearing aids before the test.
After two weeks of them using a hearing aid, there was a sharp improvement in their cognitive functions. The later tests revealed higher percent scores in recalling words and selective attention. Also, the participants could now process information quickly responding faster.
Elderly People Get To Maintain A Better Body Balance With Hearing Aids
Another study by the Washington University School Of Medicine did reveal how wearing hearing aids help with the maintenance of body posture. That means the elderly with a device on are less likely to fall and get hospitalized for treatment.
The researchers chose respondents who were already bilateral hearing-aid users aged over 65 years. To evaluate their balance level, these respondents were made to participate in the tandem stance test and the Romberg foam test. The performance was better in people using hearing aids than those not.
Hearing Aids Does Help With Improvement In Thinking Skills
According to a study by JAMA Neurology, hearing aids do help with a crucial role in protecting the thinking abilities of humankind. The researchers studied more than 137,000 people, keeping a tab on them from 2 to 25 years.
As per the results, people using a hearing aid had 19% lower chances of cognitive decline than those not. Also, there was an improvement of 3% in the cognitive test scores of the people using the tiny devices, with great impact. The researchers believed that hearing aid did help the affected come out of social isolation and mingle with everyone. This can be the prime cause for them to be able to fight off dementia and show improvement in thinking skills.
So that is all about hearing aid making life simple for the elderly and the young. Proven that these devices are available within an affordable price range, one feeling a change in the hearing must always seek to use it. | Medical Innovations |
Obese and overweight people brains have different appetite control centres in their brains to those of normal weight, a new study suggests.
Researchers say their findings add further evidence to the relevance of brain structure to weight and food consumption.
According to the Office for Health Improvement and Disparities, almost two-thirds of adults in the UK are overweight or living with obesity.
This increases the risk of developing health issues like type 2 diabetes, heart disease and stroke, cancer and poor mental health.
Several factors influence how much people eat and what they eat, including genetics, hormone regulation, and the environment they live in, researchers say.
However, it is not entirely clear what happens to the brain to tell us whether we are hungry or full.
Past studies have shown that the hypothalamus - a small region of the brain about the size of an almond - plays an important role.
Dr Stephanie Brown, from the Department of Psychiatry at the University of Cambridge, said: "Although we know the hypothalamus is important for determining how much we eat, we actually have very little direct information about this brain region in living humans.
"That's because it is very small and hard to make out on traditional MRI brain scans."
Professor Paul Fletcher, the study's senior author, also from the Department of Psychiatry at Cambridge, said: "The last two decades have given us important insights about appetite control and how it may be altered in obesity.
"Metabolic researchers at Cambridge have played a leading role in this.
"Our hope is that, by taking this new approach to analysing brain scans in large datasets, we can further extend this work into humans, ultimately relating these subtle structural brain findings to changes in appetite and eating and generating a more comprehensive understanding of obesity."
Most evidence for the role of the hypothalamus in appetite regulation comes from animal studies, which indicate complex interacting pathways within the hypothalamus, with different cell populations acting together to tell us when we are hungry or full.
Read more:
Obesity patients made to feel like 'second-class citizens'
From Ozempic to Wegovy, the weight loss injections taking TikTok by storm
Bringing cake to office 'as harmful as passive smoking'
To get around this, researchers used an algorithm developed using machine learning to analyse brain scans taken from 1,351 young adults across a range of BMI scores.
They looked for differences in the hypothalamus when comparing individuals who are underweight, healthy weight, overweight, or living with obesity.
According to the findings, the overall volume of the hypothalamus was significantly larger in the overweight and obese groups of young adults.
The researchers describe a significant relationship between volume of the hypothalamus and body mass index (BMI).
The differences were most apparent in those sub-regions of the hypothalamus that control appetite through the release of hormones to balance hunger and fullness.
While the exact significance of the finding is unclear, one explanation is that the change relates to inflammation, the researchers suggest.
Previous animal studies have shown that a high-fat diet can cause inflammation of the hypothalamus, which in turn prompts insulin resistance and obesity. | Nutrition Research |
Pricing In The End of Obesity
The world is about to radically change and Wall Street is frantically trying to figure out who the winners and losers will be.
The world is about to radically change and Wall Street is frantically trying to figure out who the winners and losers will be.
Everyone from Walmart to Nestle and countless other major companies are weighing in on how GLP-1 drugs are going to impact their businesses.
If you haven’t heard, GLP-1 drugs are a new class of medicines that some people are calling “miracle drugs.” They were originally designed to treat diabetes, but they are being found to have a ton of additional health benefits.
These drugs mimic GLP-1 (glucagon-like peptide-1), which is a hormone that regulates blood sugar.
“When blood sugar levels start to rise after someone eats, these drugs stimulate the body to produce more insulin. The extra insulin helps lower blood sugar levels,” according to the Mayo Clinic.
In 2010, the Danish pharmaceutical company Novo Nordisk began selling a GLP-1 drug called liraglutide, which was marketed under the name Victoza. Users of Victoza injected it daily to treat diabetes, and one of the side effects that came with the drug is slight weight loss.
Curious about the weight loss, researchers at Novo Nordisk dug a bit deeper. They found that injecting GLP-1 into rats caused them to eat significantly less.
They also found that in humans, GLP-1 sends signals to many different parts of the body— including the gut, the brain, and other organs. In combination, these signals make it so someone feels much fuller and less hungry.
Novo Nordisk saw this as an opportunity. In 2014, it released another higher-dose version of liraglutide specifically for weight loss. It was called Saxenda and it resulted in weight loss of around 6%.
Now, liraglutide was a pretty effective drug, both for diabetes and weight loss. But one issue with it is it had to be injected every day. That’s obviously a hassle. So, over the next few years, Novo continued to do research in an effort to find a longer lasting version of the drug— which it eventually did.
That drug, called semaglutide, was approved for diabetes in 2017. Sold under the brand name of Ozempic, it only had to be injected once a week since it lasted longer in the body.
But it turns out that convenience isn’t the only benefit of the longer lasting GLP-1 drug. It also leads to much more weight loss—15% of the user’s body weight, or two-and-a-half times as much as liraglutide.
No one knows why semaglutide has so much more of a potent effect on weight loss than liraglutide, but it does. And by taking the weight loss potential up to 15%, the drug set off a frenzy.
Once it became known that Ozempic leads to such significant weight loss, demand for the drug exploded as doctors began prescribing the medication to treat obesity, even though it wasn’t approved for that use.
Finally, in 2021, Novo got FDA approval to sell a higher dose version semaglutide specifically for weight loss called Wegovy. That drug is now a bigger seller than Ozempic is.
Dominating A Massive Market
Novo Nordisk is sitting pretty. It dominates the fast-growing category of GLP-1 drugs for obesity.
Right now, its only real competitor is Eli Lilly, whose drug tirzepatide has been shown to lead to even bigger weight loss than Novo’s semaglutide—20% of body weight or more.
That drug, which combines GLP-1 with the hormone GIP (gastric inhibitory polypeptide), has been sold for diabetes under the brand name of Mounjaro since 2022, and could be approved for obesity as soon as this year.
Once approved, Mounjaro for obesity will almost certainly be a smashing success. Demand for these weight loss drugs is insatiable, even though they can cost over $1,000 per month.
Wall Street analysts expect that sales for anti-obesity drugs could increase from $2.5 billion in 2022 to more than $40 billion by 2030 (some even believe that sales could top $100 billion by the end of the decade).
Initially, almost all of those sales will be for the anti-obesity drugs created by the two companies I’ve been talking about, Novo Nordisk and Eli Lilly.
Each of those companies is expected to control roughly half of the market for anti-obesity drugs for the next few years at least.
That dominance is reflected in the market values of the two companies. Today, Novo is worth just under $400 billion. It’s so big that the government of Denmark—a tiny nation with a population of only 6 million— has started to publish economic statistics that exclude the impact of the pharmaceutical company.
Meanwhile, Eli Lilly has become a giant as well. It’s currently valued at around $550 billion, making it the 10th-most-valuable company in the world by market cap.
That said, even though Novo Nordisk and Eli Lilly will dominate the market for anti-obesity drugs for much of this decade, competitors are working on drugs of their own.
Pharma companies like Pfizer, Amgen, Altimmune and others are testing GLP-1 drugs that show a lot of promise. Some of these might be oral medications, some of them you might have to take only once per month, and some of them might result in extremely significant weight loss approaching 30%.
But none of these drugs is likely to hit the market before 2026 at the earliest.
Thanks for reading Sumit's Investment Takes! Subscribe for free to receive new posts and support my work.
Massive Repercussions
You can probably tell by now that anti-obesity drugs are going to be huge and that the pharmaceutical companies that sell them are going to make a lot of money.
But that isn’t the most interesting consequence of the emergence of this new, revolutionary class of medicines.
If these drugs see widespread use and rates of obesity start to decline, the repercussions could be massive.
Obesity today is an enormous, global health care issue. The World Health Organization estimates that more than 1 billion people globally are obese— or one in eight people.
The risk of heart disease, strokes, type 2 diabetes, osteoarthritis, sleep apnea, fatty liver disease, and certain cancers are much higher when you’re obese. Not to mention, nearly one out of five adult deaths is caused by obesity.
The cost in terms of human health is extremely high. And so too is the economic cost. Treating the complications that arise from obesity costs hundreds of billions—if not trillions of dollars.
Any drugs that can alleviate obesity would be revolutionary, both in terms of the benefits to human health and the benefits to the economy.
A recent study showed that Novo Nordisk’s Wegovy (semaglutide) reduced the risk of major adverse cardiovascular events by 20% in adults who are overweight or obese. That is a big, big deal.
There’s also evidence that GLP-1 drugs might be able to help with conditions like alcoholism, fatty liver disease, Parkinson’s and even Alzheimer’s.
The Losers
The data seems to suggest that there are potentially some massive health benefits from GLP-1 drugs, which is great for individuals and for society.
That said, it’s not great for everybody. There are many companies that benefit from the status quo—a world in which rates of obesity are high and rising.
These companies profit either directly or indirectly from obesity, and anything that makes obesity less prevalent is going to hurt them.
Case in point is Medifast, which sells traditional weight loss products— meal plans, coaching sessions, and things like that. Medifast recently said that GLP-1 drugs are hurting its business.
Meanwhile, the stock of Resmed— which sells devices to treat sleep apnea— has plunged in recent weeks as investors speculate that fewer obese people will translate into fewer people with sleep apnea.
The stocks of Dexcom— which sells continuous glucose monitoring systems— and Insulet— which sells insulin pumps— have similarly been punished as investors reason that the incidence of type-2 diabetes could go down in the future if obesity rates decline.
Even stocks of some pharma companies have been hit, like those working on treatments for fatty liver disease, a condition that is common for those with obesity.
Because obesity is such a widespread issue that causes so many health problems, a reduction in obesity rates has the potential to reverberate far and wide across the health care industry.
We could see fewer knee placements, fewer heart surgeries, fewer statins being prescribed—the list goes on and on.
Not to mention, there could be an impact outside of health care, as well. We’re starting to see people speculate about the effect that GLP-1 drugs could have on the food industry.
Executives at Walmart and Nestle were asked about this recently and they suggested that yes, people are probably going to eat less due to these drugs.
That said, neither Walmart nor Nestle were too concerned about these drugs having an impact on their businesses.
Nestle said that it might see fewer sales of sweets, but that it might also see an increase in sales for its healthier food brands like Lean Cuisine. At the same time, its coffee, water and pet care brands shouldn’t be affected.
Walmart said that it might see fewer sales of grocery items, but that it might also see an offsetting increase in apparel sales as people buy more clothes as they lose weight.
In other words, diversified businesses like Nestle and Walmart are probably going to be okay. But it’ll be interesting to see the impact on companies like McDonalds, Wendy’s, and Coca Cola, who are in the business of selling cheap calories.
It’ll also be interesting to see the more indirect consequences of GLP-1 drugs. One analyst thinks that they will benefit dating app companies like Match.com and Bumble because if people lose a lot of weight and feel better about themselves, they might be more inclined to use these apps.
So, this is all fascinating stuff to think about. Could these drugs really bring about an end to obesity? And if so, what impact will that have on businesses, the economy, health care, etc.?
Of course, as with any new promising innovation, it’s probably a good idea to temper our expectations. I’m certainly not claiming that these are miracle drugs or that people should rush out and use them.
That’s for each individual and their doctor to decide.
Over time, we’ll also get a better sense of whether there are downsides to these drugs. Historically, weight loss drugs have come with major side effects.
GLP-1 drugs don’t seem to have those same crippling side effects, but it’s still early (there is evidence that they can cause gastrointestinal issues for some people in the short-term and they might increase the risk of thyroid cancer in the long-term).
We’ll see what happens.
Thanks for reading Sumit's Investment Takes! Subscribe for free to receive new posts and support my work. | Drug Discoveries |
FOR IMMEDIATE RELEASE
“Mechanochemical Activation of Silicone for Large-Scale Fabrication of Anti-Biofouling Liquid-like Surfaces”
ACS Applied Materials & Interfaces
When entering public restrooms, it’s hard not to dwell on what germs previous users have left behind in the toilet bowl. Imagine, instead, a self-cleaning system that doesn’t require a brightly colored gel. Researchers reporting in ACS Applied Materials & Interfaces have developed a simple, transparent coating that makes surfaces, like porcelain, more water-repellent. They show how this surface treatment effectively prevents bacteria from sticking to the inside of a toilet bowl.
Coatings can be applied to glass and porcelain to ensure water droplets easily slide off, preventing fog or bacterial films from developing, for example. To add this water-repellant property to surfaces, scientists typically engineer microscopic structures, like the tiny barbs and hooks on bird feathers, to trap air or oils between the surface and water droplets. But this approach is typically labor intensive and can change the appearance of the surface. Another approach is to graft slippery polymer chains onto a surface, and those polymers act like a permanent oil slick. However, this technique can involve harsh chemicals and isn’t feasible for use on everyday items. So, Mustafa Serdar Onses and coworkers wanted to find a more practical way to make polymer-grafted surfaces repel water and impede growth of bacterial films.
Their selected approach involved grinding poly(dimethylsiloxane) (PDMS), a silicone oil, in a ball mill for an hour. In the mill, small tungsten carbide balls bombarded the oil at high speeds, breaking apart some of the polymer’s chemical bonds and forming new molecules. The team hypothesized that the milled PDMS would graft quickly onto surfaces, such as glass or porcelain, forming a durable, oily layer.
The researchers brushed the milled oil onto one side of a sterilized toilet’s bowl interior, leaving the other half untreated. Then they poured sterile human urine combined with E. coli and S. aureus bacteria into the toilet and subsequently swabbed what was left behind on both halves of the bowl. Bacteria culture tests showed that the PDMS-treated area inhibited 99.99% of the bacterial growth as compared to the untreated area. Additional experiments showed that both porcelain and glass surfaces coated with the milled PDMS strongly repelled water, suggesting that, in the first test, urine and bacteria slipped right down the treated toilet bowl’s wall. The researchers say that their transparent and colorless toilet bowl treatment method could be a practical way to self-sanitize shared surfaces for public health applications.
The authors acknowledge funding from the Erciyes University and the Scientific and Technological Research Council of Turkey.
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Note: ACS does not conduct research, but publishes and publicizes peer-reviewed scientific studies. | Medical Innovations |
A grassroots organization continues to sell illegal drugs in Vancouver and the police seem to be looking the other way -- and that isn't because they have been keeping their dealings a secret.
Drug User Liberation Front (DULF) co-founder Jeremy Kalicum says that the Vancouver Police Department (VPD) doesn't view the members of his nonprofit organization as criminals, despite the fact that they are breaking the law.
"I can feel it when I'm talking to people," the advocate tells V.I.A., pointing to a change in the general attitude of elected officials, government employees, and law enforcement. "Everybody is on board and sees the value," he adds, noting the main issue is navigating public perception.
While many people consider substance abuse a health issue, removing the barriers for people to access a "safe supply" of drugs is far more complicated, he explains.
And while the B.C. government announced in May 2022 that it will remove criminal penalties for people who possess 2.5 grams or less of certain illegal drugs for personal use, Kalicum and DULF's other co-founder, Eris Nyx, point out that the new rules aren't preventing deaths.
Vancouver deaths increase following B.C. exemption
The three-year exemption under the Controlled Drugs and Substances Act (CDSA) came into effect in January. However, in the first seven months of the year, a staggering 1,455 deaths in the province were attributed to toxic drugs, which is the largest number on record, according to preliminary data released by the BC Coroners Service.
As of July, over 190 British Columbians have died due to an "unregulated drug supply" for the 13th consecutive month.
In response, DULF continues to hand out illicit drugs, including cocaine, heroin, and methamphetamine, to coincide with the release of the coroner's monthly death toll, calling on the government to allow them an exemption to provide drug users with a "safe" alternative via compassion clubs. The substances handed out are tested via Mass-Spectrometry, Nuclear Magnetic Resonance spectrometry, and High-Performance Liquid Chromatography, ensuring that they are free from harmful cuts, buffs, and adulterants.
In August 2022, the non-profit began operating a compassion club and launched a study of its members, conducting interviews every three months. People who use street drugs purchase them at about 50 to 80 per cent less than what they would pay for them on the street. Plus, they also "know" what they are getting.
DULF says the substances are "clearly labelled" to ensure program participants know the "contents, potency and quality of their drugs."
At the one-year mark, the group found "substantial decreases in overdose, prevalence of police interactions, hospitalizations, and reductions violence related to drugs" as well as what they claim "prevents over $100,000 of profit from supporting organized crime," according to DULF's just-released report.
When asked how they arrived at that sky-high figure, Kalicum explains that they purchased the drugs "in bulk" off of the dark web "at cost." The average drug user purchases substances off the street at a "marked up" price, not unlike how a boutique would sell a product versus a wholesale company like Costco. They also based the pricing of psychoactive street drugs on a study conducted by the University of Victoria.
No deaths from the DULF drugs
Ideally, compassion clubs would be supplied by pharmaceutical companies, cutting off all gang involvement, he noted, stressing that the group doesn't have many options at this point.
Most importantly, however, Kalcium says there were no deaths related to drugs provided by the compassion club.
“With this pilot program, we wanted to demonstrate what people who use drugs have known since this crisis began. That access to a regulated, non-exploitative, and consistent supply of drugs saves lives, reduces crime, and improves the health of people who use drugs," Kalicum underscores.
"It is with profound frustration and unimaginable grief, that we ask for the government to act now and regulate the illicit market before more lives are lost."
The VPD supports a variety of harm reduction strategies and believes they can save lives lost to drug toxicity "if used in conjunction with treatment, education, and appropriate enforcement," Sgt. Steve Addison tells V.I.A.
But police must also enforce the law and anyone who "violates the Criminal Code or the Controlled Drugs and Substances Act could face charges," he adds.
Unregulated drug toxicity is the leading cause of death in B.C. for persons aged 10 to 59, accounting for more deaths than homicides, suicides, accidents, and natural diseases combined.
The lives of at least 12,739 British Columbians have been lost to unregulated drugs since a public health emergency was first declared in April 2016. | Drug Discoveries |
More than 14 percent of the world’s population may have had Lyme disease, an analysis released on Monday revealed.The research, published in BMJ Global Health, is the result of an examination of nearly 90 studies. It offers an unprecedentedly robust picture of how common the tick-borne illness may be."As far as I’m aware, this is the first global seroprevalence work that’s been done," said Dr. Peter Krause, a senior research scientist at the Yale School of Public Health who was not involved in the new study. Seroprevalence refers to the measurement of antibodies in blood.For the analysis, the researchers compiled studies that looked at how common antibodies to the bacteria Borrelia burgdorferi, which causes Lyme disease, are in humans. Of the more than 158,000 people involved in those studies, around 23,000 had the antibodies, suggesting they were either currently infected or had been in the past. Lyme disease is the most common tick-borne illness in Europe and North America, but it's not evenly distributed around the wold.The new study showed that Central Europe had the highest share of residents with Lyme disease — 21 percent — compared to around 9 percent in North America. That's similar to Krause’s own research, which found that 11 percent of people sampled in New England in 2018 were positive for antibodies to Borrelia burgdorferi. Most U.S. cases of Lyme disease are in the Northeast and upper Midwest.The new analysis included participants from Asia, Australia, the Caribbean, Europe and North and South America. The Caribbean had the lowest share of people with Lyme disease at just 2 percent — an expected finding, given that the region consists mostly of island nations."There are areas where the disease does not exist," Krause said.But Lyme disease has grown more prevalent with time: Around 8 percent of people studied from 2001 to 2010 had Lyme disease antibodies, according to the new study. From 2011 to 2021, the share was 12 percent. In the U.S., confirmed cases of Lyme disease rose 44 percent from 1999 to 2019, according to the Centers for Disease Control and Prevention.The new analysis offers a few explanations for the trend. Deer ticks, which spread Lyme disease to humans, prefer warm, humid climates. Rising global temperatures have resulted in longer summers and shorter winters, which consequently are enabling ticks to become more abundant and widespread. Humans are also encroaching upon forested areas, where ticks generally live. A third reason, Krause said, is that deer populations have expanded, giving ticks more opportunities to feed and reproduce."Wherever deer are, the number of ticks explodes," he said.Symptoms of Lyme disease Around 70 to 80 percent of people who contract Lyme disease develop a bull's-eye rash at the site of the tick bite, according to the CDC. The rash usually appears three to 30 days after the bite, and it can expand up to 12 inches wide. It may feel warm to the touch but typically doesn't itch or hurt.Other symptoms include fever, chills, headache, fatigue and muscle or joint aches shortly after a tick bite; these can affect people who don’t develop a rash, too. A small minority of people may not have symptoms, Krause said. But in more serious cases, people can develop severe headaches, neck stiffness, nerve pain, dizziness, heart palpitations, shortness of breath, arthritis, or sudden weakness or paralysis on one side of the face in the days or months after a bite."There are people who've had even longer episodes of fatigue and not feeling well or brain fog, and we don't have a complete understanding of it," Krause said. Antibodies to Borrelia burgdorferi bacteria may persist for at least 16 months, according to one study, and up to 10 or 20 years, according to another.Although 14 percent might sound like a high infection rate to those unfamiliar with Lyme disease, Krause said the estimate didn't shock him."This is not like, 'Oh my gosh, there’s so much more disease than we thought there was,'" he said. "These numbers are a bit higher than I would have thought, but this isn’t a revolutionary finding.”The rise and fall of a Lyme disease vaccineThe best way to avoid a tick bite is simply to stay out of places where they are prevalent: wooded, bushy areas with tall grass. If you do visit this type of environment, Krause said, apply insect repellant and wear long sleeves with long pants tucked into socks."If you go into a wooded area, you have to do tick checks later," he said.People who get a tick bite can seek antibiotics, but Krause said they don't always eliminate the symptoms."What appears to be the case — at least there's some reasonable evidence for this — is that although the Lyme organism is killed with antibiotics, the organism itself doesn't break down very well. It sort of hangs around in a dead form," he said. He added: "We really do need a vaccine. That’s probably the best hope for us to really get control of it." The Food and Drug Administration approved a vaccine called LYMErix in 1998 that was shown to prevent Lyme disease in clinical trials. But GlaxoSmithKline, the developer of that vaccine, pulled it off the market in 2002."It worked, but the company stopped using it because it took three injections and there was a group of people who claimed, falsely, that it was causing arthritis," Krause said.Krause said another Lyme vaccine could become available in a couple of years. A candidate from Pfizer has shown early promise in trials. | Disease Research |
Oregon lawmakers spent the 2023 legislative session nibbling at the edges of the state’s addiction crisis — then many returned home to find streets lined with open drug use, soaring overdoses and polling that makes clear voters are fed up.
Now top Democrats have concluded far more urgent action is needed.
As lawmakers prepare for the month-long session that begins in February, the question of how to limit easy access to fentanyl while better assisting Oregonians caught up in addiction is the most pressing riddle in Salem.
The answers will come in part from a special committee announced last week, and given a mandate to “seek comprehensive solutions to the drug and addiction crisis.”
At least one solution the committee might consider is clear: Making it far easier to convict people for dealing drugs.
“I’m trying to understand what is the thing that we need to give officers to shut down these open-air drug markets,” said Senate Majority Leader Kate Lieber, D-Portland, co-chair of the new Committee on Addiction and Community Safety Response. “What’s happening right now in Portland — in Oregon — is unacceptable, and we have to send the message that it’s no longer acceptable to be a drug dealer here in the state of Oregon.”
Recently, Lieber has been talking up a concept long advocated by Republican lawmakers and Oregon district attorneys.
In 2021, the Oregon Court of Appeals issued a ruling that upended more than three decades of precedent on how the crime of “delivering a controlled substance” was defined under state law. With the move, police and prosecutors suddenly faced a higher bar to convict people of dealing illicit drugs, and say they now have to settle for possession charges that carry more lenient punishments.
The appeals court opinion became the law of the land on Thursday when it was upheld by the Oregon Supreme Court.
Lawmakers can’t alter that legal reasoning, but they can change state law. And after unsuccessfully pushing a bill to counter the decision two years in a row, Oregon prosecutors now feel the wind at their backs — even as defense attorneys and criminal justice reformers protest.
“What we need to do in order to stop trafficking behavior is the system needs to be a hammer,” said Kevin Barton, the Washington County district attorney. “We don’t have a hammer anymore.”
The beginning of ‘Boyd’
In 1986, a Portland woman named Joycelyn Boyd was arrested with 23 small bags of heroin and admitted to police that she intended to sell them. Police hadn’t witnessed her selling the drugs, but the evidence led prosecutors to charge Boyd with delivery of a controlled substance — drug dealing — anyway.
Boyd was convicted, and she appealed. The Oregon Court of Appeals agreed with prosecutors that the mere fact police hadn’t seen Boyd in the act of selling was immaterial since her intent to do so was clear from the individual baggies.
The 1988 ruling was the birth of what’s since become known in Oregon as a “Boyd delivery.” For 34 years it meant that police and DAs around the state could convict suspected drug dealers of dealing — not just possession or attempted dealing — merely for catching them with an incriminating stash.
Prosecutions based on the Boyd decision were popular. The Oregon Justice Resource Center, which opposes the practice, recently commissioned an analysis that looked at a sampling of drug delivery cases. It suggested Boyd deliveries were involved in roughly half of those cases from 1990 to 2021.
“Certainly it’s easier to prosecute people for delivery when you’re not actually having to prove they have committed the crime of delivery,” said Malori Maloney, an attorney with the OJRC. “But there’s a fundamental unfairness.”
And as the state Supreme Court has now confirmed, it wasn’t legal.
In 2021, appeals court judges revisited the Boyd decision while considering another case, this one involving a man named Brian G. Hubbell who was caught with fentanyl separated into discrete packages. And this time, judges reached a far different conclusion. They tore into the 1988 decision as “not just wrong but plainly wrong,” determining that Boyd deliveries should never have been allowed under the law.
In the wake of the so-called Hubbell decision, police and prosecutors say it has become unreasonably tough to convict people for dealing.
Rather than filing a delivery charge after, for instance, finding someone with drugs in a traffic stop, police now need to put in the effort to catch a dealer making a sale. That level of police work is particularly challenging for law enforcement agencies as they grapple with staffing challenges, they say.
“They have to go the extra step of either allowing the drugs to be delivered… or put a confidential informant or an undercover detective on the receiving end,” said Marcia Harnden, police chief in the city of Albany. “We get slowed down.”
In Multnomah County, District Attorney Mike Schmidt’s office says it has seen a 75% reduction in referrals of drug delivery cases in recent years, though it is careful not to blame Hubbell alone.
“Anyone who attributes it to only one thing is coming in with an agenda,” said Aaron Knott, Schmidt’s policy director. “But when you ask prosecutors what has complicated the prosecution of particularly high quantity levels of drugs …the number one thing they point to is the Hubbell decision.”
Under the new legal landscape, prosecutors are still able to charge people arrested with significant amounts of drugs with possession or attempted delivery. But they argue the penalties — even for felony charges — are often easy to reduce down to probation or a limited prison stay.
“We can come into contact with defendants who are in possession of really troubling amounts of drugs, and the best we can do is possession of a controlled substance,” Knott said. “We all know that those drugs are being dealt.”
A new urgency
Prosecutors have worked to roll back the Hubbell decision for years.
In each of the last two legislative sessions, the Oregon District Attorneys Association has found Republican lawmakers to sponsor a bill that would tweak the criminal code and allow prosecutors to file cases based on Boyd deliveries again. But with the matter still making its way through the courts, they found Democrats unreceptive.
“That was not allowed to get through two sessions in a row,” said state Rep. Lily Morgan, R-Grants Pass, who sponsored one such bill. “The legislative fix should move forward.”
Suddenly influential Democrats appear to agree. Lieber and her co-chair on the new addiction committee, Rep. Jason Kropf, D-Bend, plan to seriously look into the matter.
“I want to see us have that treatment infrastructure so that everybody who’s in crisis can get help,” Kropf said. “We also have to make sure we are addressing the impacts on public safety when it comes to addiction.”
The debate has caught the attention of Gov. Tina Kotek, too. While announcing she would redirect Oregon State Police to combat drug dealing in Portland last week, the governor nodded to reversing the Hubbell decision as a possible next step.
The discussion that emerges next year will be far broader than the Hubbell case.
Lawmakers are taking on addiction as a coalition of well-heeled Portlanders float a ballot measure that would reverse the drug decriminalization experiment launched by 2020′s Measure 110, mandate treatment for users, and even codify Boyd deliveries into law. That measure could hang heavily over the upcoming session, as could polling that suggests voters regret decriminalization.
Related: VIDEO | Oregon Measure 110 explained
Lieber and Kotek have both mentioned proposals to prohibit drug use in public — a change that the City of Portland has clamored for recently. Prosecutors, feeling political momentum for the first time in years, could use the current crisis to press for even steeper penalties for dealers and stronger consequences for people repeatedly caught with small amounts of drugs.
Republicans like Morgan see those discussions as overdue. While GOP lawmakers called for recriminalizing drugs during this year’s session, Democrats dismissed that possibility and were generally leery of making changes to drug policy. The party did support closing a loophole in state law that made it impossible to file a misdemeanor charge for fentanyl possession.
“We were told that nothing changing Ballot Measure 110 would have been considered” during the session, said Morgan, the lone Republican lawmaker traveling to Portugal later this month as part of a group of Oregon officials looking into that country’s experience with drug decriminalization. “They wanted to allow more time for the programs to be implemented.”
But if Democratic lawmakers are newly receptive to cracking down on drug sales, they can expect plenty of pushback.
Defense attorneys warn that reverting to the old ways of prosecuting dealers risks falling back on drug war policies that had disastrous outcomes for communities of color.
“If we’re not careful in how we amend Oregon law, we risk inadvertently scooping up people who suffer from addiction and sell small amounts of drugs and treat them the same as cartels,” said Mae Lee Browning, a lobbyist for the Oregon Criminal Defense Lawyers Association, who called Oregon’s use of “Boyd deliveries” a national anomaly.
Lieber, Kropf and other lawmakers say they’re sensitive to such critiques and want to prioritize getting addicts into treatment.
“I’m super interested in getting accountability in the public health side of the system,” said Lieber.
“People have a right to be able to walk down the street and not have an open-air drug market in their backyard.” | Drug Discoveries |
A Nova Scotia woman says her mother-in-law died after she left an emergency room where she waited for seven hours before giving up.
Now she’s gathering stories from Nova Scotians with similar experiences to spark change in the province’s health-care system.“I did not think I would be sitting in this chair yesterday morning, advocating potentially for better health care,” said Katherine Snow from Port Caledonia in Cape Breton.“But I’ll do it for my mother-in-law, and I’ll do it for my daughter who is missing her nan.” Katherine Snow said in a video chat with Global News her family is feeling anger after the death of her mother-in-law. Global News Snow’s mother-in-law, Charlene, arrived at the Cape Breton Regional Hospital in the early afternoon of Dec. 30, 2022 with “intense jaw pain” and flu-like symptoms. Story continues below advertisement Snow said Charlene had been ill in bed for days, and having heard of overcrowded hospitals in the past weeks, she didn’t want to endure the wait times.Nonetheless, she “mustered up the energy to go” that Friday.“We stayed in frequent touch with her because she was in there by herself. My husband offered to come in and sit with her… But she said it was so full that there weren’t any seats for anyone to sit down and keep her company,” Snow said.The 67-year-old woman waited seven hours before giving up and calling her husband, Freddie, for a drive home, Snow said.“It just became too uncomfortable for her,” she said. “She decided that she would leave and try her luck at the local outpatient clinic the next morning.“Charlene didn’t make it to the next morning; Her heart stopped just an hour after leaving the hospital. Charlene Snow was 67 years old when she died just an hour after leaving a Cape Breton emergency room, without being seen by a doctor. Submitted by Katherine Snow In the obituary, Charlene Snow’s family described her as the matriarch of the family, the “glue.” She’s remembered for her “extremely kind heart, hilarious wit and contagious laugh.” Story continues below advertisement Her family has gone through several stages of grief in the past 12 days.“We definitely experienced shock and then sadness. And now I think… we’re definitely in the in the part where we’re angry.“In an email statement from the Nova Scotia Department of Health and Wellness, Minister Michelle Thompson said she was “deeply saddened” to hear about Charlene’s passing.“I wish to extend my sincere thoughts and condolences to the family during this difficult time.”Katherine Snow said her family spoke to a patient advocate department to request a review of what happened that night. Just before speaking with Global News, she received a note from an ER physician at the Sydney hospital saying that they are looking into it.“We just want to know what happened,” she said. “It would be reassuring for us if we knew that everything was done that could have been done. And if not, we want to know why things weren’t done that could have been done.“It’s a big part of the grieving process for us because it was so sudden.” Story continues below advertisement Thompson confirmed in the email to Global News that Nova Scotia Health conducted an initial review as soon as they became aware of the incident.“There is now a formal investigation to determine what happened. The results of the investigation will be shared with the family when complete and the recommendations from the investigation will be acted on,” the statement read.“I know firsthand that we have very skilled healthcare professionals that work in our emergency departments and across the healthcare system that work tirelessly to provide Nova Scotians the care they need and deserve,” the minister said, in part. Trending Now “I know the healthcare system has been under immense pressure for some time, including the wait times in emergency departments. I want Nova Scotians to know we are committed to getting answers. Despite the pressure, I am urging Nova Scotians: please continue to seek care when you need it.”Later in the day, an emailed statement from Premier Tim Houston read:“My heartfelt condolences go out to the family. This is a terrible loss for them, their friends and the Cape Breton community.I understand that Nova Scotia Health has started an investigation to determine what happened, and the results will be shared with the family. Story continues below advertisement I know that wait times in our emergency departments are concerning. I can assure you that the Minister of Health and Wellness and Nova Scotia Health are exploring all ways to improve patient access to care throughout our system when they need it the most. We will continue to update the public with our progress.” Submitted by Katherine Snow Charlene Snow is seen with her granddaughter, Katherine’s daughter, Nora. Submitted by Katherine Snow Though the grieving family is angry about their sudden loss, Snow says the anger isn’t directed towards health-care workers. Story continues below advertisement “We understand that the staff that work within the health care system are suffering as much as the patients that need to take advantage of it,” she said. “We in no way want any anger or bad thoughts directed at staff members who are already working under such challenging conditions.”What they do want are answers — and change. Channeling grief into inspiring change Thursday morning, Snow launched a website titled Nova Scotia Healthcare Crisis, which she hopes will encourage Nova Scotians with similar experiences to share their stories.“We weren’t really sure what we were going to do when (Charlene) first passed away,” Snow said. “We knew that we didn’t want to let it go. Story continues below advertisement Charlene died just a day before 37-year-old Allison Holthoff died at the Cumberland Regional Health Care Centre emergency department.Earlier this week, Gunter Holthoff told reporters his wife waited for seven hours in excruciating pain at the Amherst hospital before she died. Her story shook the province and prompted one health advocate to warn the health-care system is in a “dire situation.”It also prompted the Nova Scotia NDP to call on the province to conduct an inquiry into deaths in Nova Scotia’s emergency rooms, after receiving data showing there were 558 emergency room deaths recorded in 2022.Snow said she had reached out to the Holthoff family, “to let them know that we get it and we understand and we experienced the same thing as they did.”Her website will serve as a place where stories like theirs can have a home and be heard.“I’m going to use the skills that I have to try to facilitate some kind of change in the health-care system,” she said.It’s not just for families who have experienced tragedies, but also health-care workers who want to be heard. Story continues below advertisement “I hear you and I will give your story a home. I will give it a place to live,” Snow said. “They don’t have to give me their name… I just want this site to paint a clear picture of what’s happening in health care — on both sides of the fence.”On Wednesday, she took to Facebook to call out for people’s stories, saying “We were robbed and it’s time that we are offered significantly better options for emergency care.”The post got more than 320 comments and 1,600 shares, but it didn’t stop there.“I was quite overwhelmed yesterday. My Facebook inbox was full, my email inbox was full, I received texts.” Snow said.While it may take some time to organize people’s stories for the website, Snow said she hopes it’s seen by the province’s health officials.“I hope that by reading actual stories that they will start to understand, and forge a path for change.”If you have a similar experience from emergency rooms in Canada, we want to hear your story. Please reach out using the form below, and you may hear back from us. Story continues below advertisement © 2023 Global News, a division of Corus Entertainment Inc. | Health Policy |
Your little one is congested. What should you do?
In a child age 3 or under, this can be a challenge. For starters, itâs not always obvious whatâs causing that stuffy nose. Infants and toddlers often catch colds because they are just starting to build up their immunity to common viruses. But there are many other potential causes of congestion.
Youâre also limited by the treatments that are OK to use in children younger than 4. You shouldnât turn to cold medicines for relief. They can be dangerous for infants and toddlers.
Fortunately, there are plenty of safe and effective treatments that you can try.
The First Step
Before you or your pediatrician can decide on a treatment plan, you need to know whatâs causing that stuffy nose. And there are many possible causes.
Nasal congestion happens when blood vessels and tissue in the nasal cavity fill up with too much fluid. It can make it hard to sleep and lead to problems like a sinus infection (sinusitis). Your baby may also have trouble feeding if they are congested.
The color of mucus doesn't reveal whether it's a viral or bacterial infection.Â
The cause of congestion could instead be an allergy, which would require a doctor visit and possibly an allergy test. Congestion can even happen if a piece of food or another object gets lodged in your childâs nose. This, too, needs a visit to the emergency room or your pediatrician. Donât try to remove anything but mucus from your babyâs nose on your own.
Sometimes, congestion may be a sign of a more serious problem. A stuffy nose due to a cold can often be treated with saline drops, time, and some TLC. If there are other symptoms, especially a fever and thick, yellow mucus, call your pediatrician as soon as possible.
Safe Treatments
One of the safest and most effective ways to help clear a babyâs congestion is with a saline (salt water) spray or nose drops. These products are available without a prescription.
If you use drops, place two drops in each nostril to loosen the mucus inside. Then use a suction bulb immediately afterward to withdraw the saline and mucus. You can place a rolled up towel under your babyâs shoulders so you can gently tilt the head back a little to make sure the drops get up into the nose.
Squeeze the bulb before you place it in the nose. That way, when you release the bulb, it will pull out mucus from inside. If you squeeze when the bulb is already inside a nostril, it will give off a puff of air that could push the mucus farther into the nasal cavity.
Squeeze out any mucus inside the bulb onto a tissue.
Do this about 15 minutes or so before you feed your child and before bedtime. This will help your baby breathe more easily when they nurse, take a bottle, or go down to sleep.
Some saline solutions also contain medicine. Avoid these. Plain saline drops or sprays will work fine. Just make sure to wash and dry the suction bulb after each use.
Steamy Solutions
There are other ways to moisten the nasal passages.
A vaporizer or humidifier that releases a cool mist into the room is usually safe, as long as you keep it out of your babyâs reach. Place it close enough so that the mist reaches your baby while they sleep, or while youâre in the room together snuggling or playing.
To avoid mold and bacteria growth, change the water every day, and clean and dry the vaporizer, according to the machineâs instructions.
You may also try this tried-and-true solution: Take your baby into the shower. Let your shower and bathroom get nice and steamy while you hold your baby close for a few minutes. This can help to clear your babyâs head before bedtime.
Donât use hot water in a humidifier, since it can cause burns.
3 More Tips
Follow some of these other steps to help clear up your babyâs stuffy nose:
- Place a pillow under the mattress so thereâs a slight angle with your childâs head higher than the feet. That may help drain mucus out of the sinuses. If your child is still a baby in a crib, donât do this. You should keep pillows and other things out of their sleeping area to lower the risk of SIDS (sudden infant death syndrome). Most pediatricians recommend doing so until your child is 2 years old.
- Encourage your child to drink more water. Fluids help thin mucus, but donât force it. Even if your child just sips some more water throughout the day, that will help.
- If your little one is old enough, teach them to blow their nose. To show them how, exhale through your own nose. Place a tissue by your nostrils so your baby can see the air move the tissue as you exhale. Ask them to blow into a tissue the same way. | Disease Research |
COLUMBUS, Ohio — Ohio school districts could begin arming employees as soon as this fall under a bill signed into law Monday by GOP Gov. Mike DeWine.The law, as enacted, requires up to 24 hours of training before an employee can go armed, and up to eight hours of annual training. The training programs must be approved by the Ohio School Safety Center, and DeWine announced he’s ordering the center to require the maximum 24 hours and the maximum eight hours.Schools can provide additional training if they wish, DeWine said.Before announcing the bill signing, the governor outlined several other school safety measures he and lawmakers have promoted, including $100 million for school security upgrades in schools and $5 million for upgrades at colleges.The state is also adding 28 employees to the school safety center to work with districts on safety issues and to provide training under the new law. Ohio has also provided $1.2 billion in wellness funding for schools to address mental health and other issues, the governor said.The new law “is giving schools an option, based on their particular circumstances, to make the best decision they can make with the best information they have,” DeWine said.The governor said his preference remains that school districts hire armed school resource officers, but said the law is another tool for districts that want to protect children. He emphasized that it’s optional, not a requirement.Ohio Gov. Mike DeWine discusses a law that gives school districts the option of arming trained school employees on June 13, 2022, in Columbus, Ohio. (Andrew Welsh-Huggins/AP)Mayors of Ohio’s biggest cities, including Cincinnati, Columbus, and Cleveland, planned an afternoon news conference to highlight gun violence in their communities and outline their differences with the governor over gun issues. Nan Whaley, DeWine’s Democratic opponent for governor, also planned a news conference, after denouncing his decision to sign the bill.The signing came the same day a new law went into effect making a concealed weapons permit optional for those legally allowed to carry a weapon.Democrats have said the law sends the wrong message coming so soon after the massacre of 19 children and two teachers at an elementary school in Uvalde, Texas. Republicans say the measure could prevent such shootings. Lawmakers fast-tracked the legislation to counter the impact of a court ruling that said, under current law, armed school workers would need hundreds of hours of training.The measure is opposed by major law enforcement groups, gun control advocates, and the state’s teachers unions. It’s supported by a handful of police departments and school districts. | Health Policy |
Kane Muskett, 27, from North Lincolnshire, has just months left to live, leaving behind his three young children.
The father had spent years being treated for gastritis but a devastating scan revealed that he, in fact, was battling liver cancer.
But in September 2022, Kane was told the heartbreaking news that he only had a year to live.
Now he is hoping to raise awareness about his cancer and help those who are also suffering, GrimsbyLive reported.
He plans to use his time left to go on holiday and create as many memorable memories as he can with his children.
He said: "It all started a couple of years ago with me having a lot of time off work and going back and forth to the doctors being treated for gastritis. No matter what they did, nothing got any better though."
"After a blood test and the scan, I found out I had liver cancer in September 2022."
Kane is sadly not new to the news of cancer after his mother passed away from cancer when he was only 10 years old and also his grandmother years later.
He added: "Sadly, cancer is quite prevalent in my family and I knew something was wrong so it wasn't a massive surprise when they told me.
"I knew for sure when I was pulled into a side room in the hospital and about five or six doctors came in after me.
"When they first told me, it was really hard to hear, but after about half an hour I'd calmed down a bit. I just had to get on with it and then I went to Leeds in November and they told me I had about a year to live and that they couldn't operate because my liver was over a main artery."
Kane says he has prepared himself for the inevitable and the thought of his children, Poppy, 8, Kyro, 3, and Ivy, nine months, are what keep him going.
He said: "They're the only reason I get upset about the situation, but they're also the thing that keeps me going.
"With the chemo though it's been hard to do much with them. I read a book about parents with cancer to Poppy so she understands it a little bit and Kyro knows dad's poorly, but we don't want to upset them too much."
Despite the heartbreaking news, Kane is determined to use his final months for good and create lasting memories with his family.
"As soon as I found out, I went to Amsterdam with my brother and booked to go to Tenerife with my family. I just want to get as many holidays in before I can't do it anymore.
"I want to make memories with my children too and raise awareness of the illness to make sure others can get their diagnosis before it's too late."
Kane believes if he had a scan earlier, his cancer would have been treatable.
He added: "My liver is now twice the size of a normal liver. I don't really like showing my emotions though so I'm just trying to keep a brave face at the minute, but I know that my family are finding it quite difficult, especially my brother."
To donate to Kane's fundraiser, click here. | Disease Research |
PYMCA/Avalon/Avalon via Getty Images
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People who practice cognitively enhanced tai chi, significantly improved their scores on memory tests.
PYMCA/Avalon/Avalon via Getty Images
People who practice cognitively enhanced tai chi, significantly improved their scores on memory tests.
PYMCA/Avalon/Avalon via Getty Images
Your keys aren't in the spot you thought you left them? Can't recall the title of a book? I've had those moments.
Amid our busy lives, distraction or fatigue may explain our forgetfulness. But instances of 'brain freeze' make me realize I want to do everything in my power to help keep my brain sharp.
There's plenty of evidence that exercise can help protect our bodies and brains. And as we age, daily movement doesn't need to be super intense. In fact, a new study finds tai chi, a form of slow-moving martial arts, can help slow down cognitive decline and protect against dementia.
The study included about 300 older adults, in their mid-70's on average, who had all reported that their memory was not as good as it used to be.
As part of the study, all the participants took a 10-minute test, called the Montreal Cognitive Assessment, to gauge cognitive function. A normal score is 26-30. A person who scores between 18 and 25 is considered to have mild impairment which means they don't have dementia but they're not as sharp as they used to be, and may need to work harder to maintain everyday activities. The average score of participants at the start of the study was 25.
Allison Aubrey/NPR
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A tai chi class held at the North Potomac Community Rec Center, in Potomac, Md. Tai chi has been shown to improve balance, prevent falls and help slow down cognitive decline.
Allison Aubrey/NPR
A tai chi class held at the North Potomac Community Rec Center, in Potomac, Md. Tai chi has been shown to improve balance, prevent falls and help slow down cognitive decline.
Allison Aubrey/NPR
The study found that people who practiced a simplified form of tai chi, called Tai Ji Quan twice a week for about six months improved their score by 1.5 points. This increase may not sound like a lot, but study author Dr. Elizabeth Eckstrom says "you've basically given yourself three extra years," of staving off decline. The study is published in Annals of Internal Medicine.
A person with mild cognitive decline can expect to lose, on average, about a half point each year on the test, and once their score drops under 18, people experience quite a bit of impairment from memory loss and cognitive decline, Eckstrom explains.
So, based on these results, "if you're able to keep doing [tai chi] two or three days a week on a routine basis, you're going to get extra years before you hit that decline into dementia," she says.
Eckstrom and her collaborators also tested a more rigorous type of tai chi, called Cognitively Enhanced Tai Ji Quan, where they layered on extra challenges. For example, participants were asked to spell a word, backwards and forward, as they moved through a series of tai chi moves.
"You're really forcing your brain to think hard while you're also doing the fluid mind-body movements," Eckstrom explains.
The people who practice this type of cognitively enhanced tai chi improved their scores by about 3 points. "We've just given you six extra years of cognitive function," she says. "That's a lot."
Her theory on why tai chi is effective is that it combines the memorization of the movements, known as forms, almost like a dance choreography. "So, you're getting the physical activity, plus the memory piece," she says.
Dr. Joseph Quinn, a neurologist at Oregon Health & Science University, who was not involved in the study, says the results fit with a body of evidence, including a meta-analysis, showing the benefits of tai chi. "This has fascinated me," Quinn says, because the results are impressive, but "honestly, I don't understand why it works so well," he says.
The benefits of cardiovascular workouts, which help protect the heart and the brain, are better understood, he says. But tai chi isn't much of an aerobic workout, so he says perhaps the meditative component has a stress reduction effect that helps explain the other benefits.
"It becomes a meditative practice," says Mary Beth Van Cleave, 86, who lives in a retirement community with her wife and their cat in the Portland, Oregon area. She started tai chi at age 75 and says her practice helps her feel grounded and enables her to let go of stress. "It's become an important part of my life," Van Cleave says.
In terms of a cognitive boost, she thinks tai chi helps with concentration. "I'm more conscious of trying to do one thing at a time," she says.
One limitation of the study is that most of the participants were non-Hispanic white and about two-thirds had college degrees. It's hard to know whether the benefits would hold up for the broader population. A study published last year found there's a disproportionate burden of cognitive impairment and dementia among Black and Hispanic populations in the U.S., and among people with less education. Researchers say they'd like to see efforts to make tai chi more accessible given the benefits, and given that by age 65, about 1 in 5 people has mild cognitive impairment.
If you've never done tai chi, which is a martial-art that incorporates a series of movements, known as forms, with a focus on controlled breathing, too, it may look like nothing much is happening. But that's a misconception, Van Cleave says, "We are working very hard, " she explains. And, she says the physical benefits are pronounced.
"There are so many times I've avoided a fall," she says. "That's because of the balance that tai chi gives me," Van Cleave says.
Many studies have shown that practicing Tai Chi can help prevent falls and improve balance in older adults, and the benefit is greatest for people who keep up a regular practice over time.
This story was edited by Jane Greenhalgh | Mental Health Treatments |
Media caption, Imogen says people notice her feeding tube more than her wheelchairHow would you feel if the first question many strangers asked was "what's wrong with you?" or "what's that on your face?"That is the reality for 11-year-old Imogen from Caldicot, Monmouthshire, who said she has had enough after people started touching her face.Imogen has cerebral palsy and has been fed through a tube since last March because she was unwell and losing weight."The most annoying thing possible with people, and adults do this too, is they stare at you and because it's on my face they keep eye contact with me the whole time," she said."Normally I just stare at the floor and then they stop."BBC Wales is following Imogen and her mum Catherine over the next year, as they navigate challenges that are faced by many families with a disabled child - accessing education and other services and seemingly endless medical appointments. Image caption, Imogen says she stares at the floor so people don't stare at herImogen has been home-schooled since she was six because her mum has been in dispute with the council about her needs, including over the provision of disabled toilets.Monmouthshire Council said all schools in the county had disabled toilets. Bespoke toilet facilities had been installed for Imogen, it added, in schools identified by the family, as well providing training and resources to staff. She hopes to re-enter mainstream education this year and start secondary school in September.Image caption, Imogen relies on her wheelchair to get around due to her treatmentImogen has been undergoing treatment to try to help her walk and since September she has been in casts to stretch her muscles and could walk short distances in them.Last week, she tried new splints to give her better support, but the transition has not been straightforward, so for the moment it means that Imogen has to rely on her wheelchair again and crawl up the stairs in her house.There will be more doctors appointments, so it is a big year ahead, but one of the main things Imogen wants is to talk about is how people behave around her. "People grab your face. Touch you," she said. "Once a random child picked this up [her tube] and said 'what is this?'Image source, Family photoImage caption, The 11-year-old's hobbies include basketball"The thing I struggle with is when I am with my friends who are all in wheelchairs, they get it," she said. "But when I am trying to make friends with new people, the first question is always 'what's that thing on your face?'"It's sometimes hard to explain because, especially a lot of children don't understand the medical terms of it," she said. "Sometimes I just say to the younger ones, it helps me stay strong like a superhero. It's annoying."Catherine says they became used to people staring when Imogen was younger and in her wheelchair but that was happening less as she has got older. Image source, Family photoImage caption, Horse riding is another pastime Imogen enjoysBut since having the tube fitted last year, Catherine said it became much more noticeable, recalling a difficult shopping trip before Christmas when they were stared at the whole time."Staring at her makes her feel really uncomfortable and self-conscious," said Catherine, who is Imogen's full-time carer. "And I think people probably just don't realise how uncomfortable it makes her feel. "Actually if they were to decide to spark up a conversation, not just touch her and stare. But it's also how they ask. Sometimes we get 'what's wrong with you? Or 'we hope it's not permanent'."Image source, Family photoImage caption, These are the casts being fitted to Imogen's legs to help stretch out her muscles"I would happily talk about it, if they asked me," Imogen said. "They could have said, 'if you don't mind me asking, not meaning to be rude, why are you a wheelchair user?' "It just depends how they ask really. It's ok to ask questions. We are not going to take offence."Imogen is sport mad and plays tennis for Wales, as well as loving horse riding and basketball, swimming and surfing.So if you see her and her mum out on the court or on the beach, they are hoping you might stop and think about what you say and do around her and other people with disabilities. | Medical Innovations |
Abstract
To construct tissue-like prosthetic materials, soft electroactive hydrogels are the best candidate owing to their physiological mechanical modulus, low electrical resistance and bidirectional stimulating and recording capability of electrophysiological signals from biological tissues1,2. Nevertheless, until now, bioelectronic devices for such prostheses have been patch type, which cannot be applied onto rough, narrow or deep tissue surfaces3,4,5. Here we present an injectable tissue prosthesis with instantaneous bidirectional electrical conduction in the neuromuscular system. The soft and injectable prosthesis is composed of a biocompatible hydrogel with unique phenylborate-mediated multiple crosslinking, such as irreversible yet freely rearrangeable biphenyl bonds and reversible coordinate bonds with conductive gold nanoparticles formed in situ by cross-coupling. Closed-loop robot-assisted rehabilitation by injecting this prosthetic material is successfully demonstrated in the early stage of severe muscle injury in rats, and accelerated tissue repair is achieved in the later stage.
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Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author upon reasonable request. Source data are provided with this paper.
Code availability
All customized MATLAB code used for in vivo demonstration in this work is available in a repository at https://github.com/chwchw2/C-RAR-demo.git.
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Acknowledgements
This study was financially supported by the National Research Foundation of Korea grant funded by the Korean government (MSIT) (nos. RS-2023-00208262 (M.S.) and 2020R1C1C1005567 (D.S.)). This research was also supported by the Institute for Basic Science (no. IBS-R015-D1). This research was also supported by the Korean Fund for Regenerative Medicine grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Health & Welfare) (23B0102L1).
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Extended data figures and tables
Extended Data Fig. 1 The RAR system based on muscle IT-IC interfacing without the sciatic nerve stimulation.
a, Schematics of the RAR system based on the TA muscle-tissue conduction by the IT-IC hydrogel without using the peripheral nerve interface. The TA muscle EMG signal evoked by voluntary walking is recorded by the EMG electrode. When specific TA muscle EMG signals are detected, the robotic assistance is activated. The rat’s leg movement is then fully supported by the robotic assistance. b, Recorded EMG signals and waveforms (inset) of untreated rats using the RAR system. c, Photographs of unsynchronized robot activation and the corresponding abnormal steps. d, Recorded EMG signals and waveforms (inset) of IT-IC hydrogel-treated rats using RAR. e, Photographs of robotic assistance and the corresponding normal steps.
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Source data for supplementary figures.
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Cite this article
Jin, S., Choi, H., Seong, D. et al. Injectable tissue prosthesis for instantaneous closed-loop rehabilitation. Nature 623, 58–65 (2023). https://doi.org/10.1038/s41586-023-06628-x
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DOI: https://doi.org/10.1038/s41586-023-06628-x | Medical Innovations |
Drones enabled the use of defibrillators before ambulance arrival
Researchers at Karolinska Institutet have evaluated the possibility of alerting drones equipped with automated external defibrillators (AED) to patients with suspected cardiac arrest. In more than half of the cases, the drones were ahead of the ambulance by an average of three minutes. In cases where the patient was in cardiac arrest, the drone-delivered defibrillator was used in a majority of cases. The results have been published in the journal The Lancet Digital Health.
"The use of an AED is the single most important factor in saving lives. We have been deploying drones equipped with AED since the summer of 2020 and show in this follow-up study that drones can arrive at the scene before an ambulance by several minutes. This lead time has meant that the AED could be used by people at the scene in several cases," says Andreas Claesson, associate professor at the Center for Cardiac Arrest Research at the Department of Clinical Research and Education, Södersjukhuset, Karolinska Institutet, and principal investigator of the study.
Every year, around 6,000 people in Sweden suffer a sudden cardiac arrest, but only a tenth of those affected survive. Although an early shock with a AED can dramatically increase the chance of survival and there are tens of thousands of AED in the community, they are not available in people's homes where most cardiac arrests occur.
To shorten the time to defibrillation with an AED, Karolinska Institutet, together with Region Västra Götaland, SOS Alarm and the drone operator Everdrone, has since 2020 tested the possibility of sending out a drone with a AED at the same time as an ambulance is alerted.
The project covered an area of approximately 200,000 people in western Sweden. An initial study conducted in the summer of 2020 in Gothenburg and Kungälv showed that the idea was feasible and safe.
"This more comprehensive and follow-up study now shows in a larger material that the methodology works throughout the year, summer and winter, in daylight and darkness. Drones can be alerted, arrive, deliver AED, and people on site have time to use the AED before the ambulance arrives," says Sofia Schierbeck, PhD student at the same department and first author of the study.
The emergency center gave instructions
In the study, drones delivered an AED in 55 cases of suspected cardiac arrest. In 37 of these cases, the delivery took place before an ambulance, corresponding to 67 percent, with a median lead of 3 minutes and 14 seconds.
In the 18 cases of actual cardiac arrest, the caller managed to use the AED in six cases, representing 33 percent. A shock was recommended by the device in two cases and in one case the patient survived.
"Our study now shows once and for all that it is possible to deliver AED with drones and that this can be done several minutes before the arrival of the ambulance in connection with acute cardiac arrest," says Andreas Claesson. “This time saving meant that the healthcare emergency center could instruct the person who called the ambulance to retrieve and use the AED in several cases before the ambulance arrived."
The research was mainly funded by the Swedish Heart-Lung Foundation.
Publication
"Drone delivery of automated external defibrillators compared with ambulance arrival in real-life suspected out-of-hospital cardiac arrests: a prospective observational study in Sweden", Sofia Schierbeck, A Nord, L Svensson, M Ringh, P Nordberg, J Hollenberg, P Lundgren, F Folke, M Jonsson, S Forsberg, A Claesson, The Lancet digital health, online November 23, 2023, doi: 10.1016/S2589-7500(23)00161-9 | Medical Innovations |
Laura Winham, 38, had severe mental illnesses and was ‘abandoned’ by NHS and social services, family allegeA severely mentally ill woman whose dead body lay in her home unnoticed for more than three years was effectively “abandoned and left to die” by NHS and social services who missed repeated chances to save her, her family has alleged.
Laura Winham, 38, had schizophrenia, struggled to look after herself, and had become estranged from her family. She was found in a “mummified, almost skeletal state” at her social housing flat in Woking, Surrey, by police and relatives in May 2021.
Her family said welfare and care services had not only failed to act on clear signs of Winham’s deteriorating health in the months and years before her death, but had subsequently neglected to carry out routine checks that would have led to the discovery of her body. During the three-and-a-half years in which her body lay undisturbed, no determined attempts to establish her wellbeing were made, despite her disability benefits being stopped and her gas cut off, and her repeated failure to reply to letters, phone calls and texts, or answer the door.
Winham’s sister Nicky accused social care, mental health services and Laura’s social landlords of “turning a blind eye” to multiple warning signs of her plight. “Everybody who was in contact with Laura and had a duty to her at some stage simply wiped their hands of her and forgot her. She was abandoned and left to die,” she said.
She added: “No one should have to suffer the way Laura did due to the lack of support given to her mental health. We now must live with the devastating sadness of what has happened, and we are sharing our story because we do not want any other families to suffer in this way.”The family spoke before a pre-inquest hearing into Winham’s death due to be held on Monday 30 January to establish the scope of the inquest, which the family argues should examine whether various care and welfare services acted appropriately, and how she became “lost in the system”.
Her family described how Winham had overcome physical disability, deafness, heart problems and teenage mental health issues to do well at school and graduate from university. She had been sociable and had friends, her family said, until her mental health took a drastic turn for the worse.
In 2006 she was sectioned for a period under the Mental Health Act, but subsequently became progressively more erratic, hearing voices and experiencing hallucinations which the family said led her to aggressively reject them. Over the following years they became almost entirely estranged from her.
Winham is believed to have died in November 2017, just weeks after police officers who visited the flat over a minor issue reported concerns to social services about her clear self-neglect, the lack of food in the flat and her seeming unawareness of access to local care services
Despite being informed by the police that Winham’s phone was not working, adult social care teams tried to call her. They subsequently wrote to her with details of local food banks and contact details for support organisations. The case was closed after two weeks, with no welfare check made.
Winham’s family believe agencies missed at least two earlier potential chances to intervene.
In 2016 the Department for Work and Pensions wrote to her several times to warn that her disability living allowance was ending and she would have to re-apply for its replacement, personal independence payment. When she did not respond or re-apply, they cut off benefits without carrying out welfare checks.
In 2014, a housing association staff member referred Winham to local community mental health services, reporting that she appeared to have “untreated mental health issues” was physically very thin, said she had no friends and believed she was being watched by people. The referral seemingly did not lead to meaningful action.
Winham’s body was found in May 2021, when the family visited her to inform her her father had died. They called police after her brother Roy, taking “one last look” through the letter box of her flat, saw what he thought was a foot poking out from under a blanket.
The police forced entry, finding a pile of unopened letters, as well as opened letters containing bills from creditors. Markings made on her calendar had stopped in November 2017, not long after she had written on it “I need help”. She was identified by her dental records.
A Surrey county council spokesperson said: “This is a truly tragic case and our sympathies and deepest condolences are with Laura’s family and friends. It’s important that every aspect of this complex case is reviewed and we’re committed to participating fully in the inquest process. This will include providing any information that is needed to support the coroner’s enquiries.”
The DWP has been contacted for comment.
The year is 2033. Elon Musk is no longer one of the richest people in the world, having haemorrhaged away his fortune trying to make Twitter profitable. Which, alas, hasn’t worked out too well: only 420 people are left on the platform. Everyone else was banned for not laughing at Musk’s increasingly desperate jokes.
In other news, Pete Davidson is now dating Martha Stewart. Donald Trump is still threatening to run for president. And British tabloids are still churning out 100 articles a day about whether Meghan Markle eating lunch is an outrageous snub to the royal family.
Obviously I have no idea what the world is going to look like in a decade. But here’s one prediction I feel very confident making: without a free and fearless press the future will be bleak. Without independent journalism, democracy is doomed. Without journalists who hold power to account, the future will be entirely shaped by the whims and wants of the 1%.
A lot of the 1% are not big fans of the Guardian, by the way. Donald Trump once praised a Montana congressman who body-slammed a Guardian reporter. Musk, meanwhile, has described the Guardian, as “the most insufferable newspaper on planet Earth.” I’m not sure there is any greater compliment.
I am proud to write for the Guardian. But ethics can be expensive. Not having a paywall means that the Guardian has to regularly ask our readers to chip in. If you are able, please do consider supporting us. Only with your help can we continue to get on Elon Musk’s nerves. | Mental Health Treatments |
An elderly dementia patient was failed by the system put in place to protect Northern Ireland's most vulnerable adults.
Stanley O'Neill was not showered for three months and was found wrapping a cord around his neck.
Despite healthcare guidelines, those and other failings were not referred for adult safeguarding investigations.
A review also criticised his nursing home for not being open and transparent with the 79-year-old's family.
Mr O'Neill died in hospital on 20 December 2021.
His family said they had been left "devastated" by a series of failings around his care identified by a Belfast Health Trust investigation.
In a statement Bradley Manor Care Home offered its condolences and apologised to Mr O'Neill's family.
Its spokesperson said: "The safety of our residents is, and always has been, of paramount importance to us but on this occasion we failed to meet some high standards that are rightly expected of us.
"The Covid-19 pandemic was an unprecedented period for the adult social care sector and although we offer no excuses we were faced with unique stresses and an enormously challenging climate."
The adult safeguarding system is meant to protect vulnerable adults in the healthcare system when staff, relatives or patients raise concerns about their well-being.
But in an interview with BBC News NI, Northern Ireland's public healthcare watchdog said vulnerable adults in Northern Ireland were being failed.
'He was our rock'
Sophie O'Neill and her grandfather were incredibly close and she described him as "the rock" of her family.
But when Stanley O'Neill received a dementia diagnosis everything changed.
Things became unmanageable at home and a number of nursing home and hospital stays followed.
In January 2021, during the pandemic, Mr O'Neill became a resident at Bradley Manor in north Belfast. He was placed there by the Belfast Health Trust following a hospital stay.
His granddaughter Sophie said her family began flagging a number of concerning incidents.
She said: "Initially there were two unwitnessed falls at night that we were worried about but then I noticed that his call bell had been removed from his room.
"It was only passed on to us weeks later because I asked staff and they said that he was seen wrapping the cord around his neck and they had removed it."
Sophie added: "I was completely shocked and couldn't understand why it had taken so long to inform his family.
"So for me safeguarding issues were happening and there was no action taken."
The first time Sophie said she heard the term "safeguarding referral" being used was when her grandfather was taken to hospital in December 2021.
Sophie found Mr O'Neill unresponsive in his room in Bradley Manor and he was admitted to the Mater Hospital in Belfast.
Sophie said: "When I arrived one of the hospital staff said they were concerned about grandad.
"They said his oral care was the worst they had ever seen, and that's when, finally, the hospital started talking about an adult safeguarding referral."
'Failed in care'
Mr O'Neill was admitted to hospital on 6 December and died 14 days later.
His family did not receive a phone call about the adult safeguarding referral until two days after his death and investigators were unaware that he had died.
The case has been referred to the coroner, who will eventually determine the official cause of death.
Sophie said: "The whole point of a safeguarding referral is to protect someone so this was too late for my granddad."
Mr O'Neill's case was eventually investigated by the Belfast Health Trust as a serious adverse incident.
A serious adverse incident is defined as any event or circumstance that led or could have led to serious unintended or unexpected harm to patients.
Investigation reports should be submitted within 12 weeks from the date the incident is reported.
His family received a draft report in April 2023. It found:
- in the last three months of his life there were aspects of Mr O'Neill's care in Bradley Manor that fell short of the expected standard
- there was a failure to engage with the family to better communicate with them in an open and transparent way
- there was a lack of showering during the last three months of Mr O'Neill's life
- a failure by the nursing home to provide adequate oral care
- incidents of aggression from Mr O'Neill during personal care were recorded by the nursing home
- after a number of falls in the nursing home, it did not recommend any changes to prevent or reduce future falls
- when Mr O'Neill was found with a call bell cord around his neck there was a failure to respond to it appropriately as an adult safeguarding incident and the family was not informed in a timely manner
- staff were not always clear what compounded an incident or how it should be reported
- another incident in which Mr O'Neill was recorded as hitting another resident was referred to adult safeguarding. It was considered a symptom of his progressing condition but his family was not informed
The report concluded that there were failures by all parties involved in Mr O'Neill's care.
Following the report into his case, learning letters have been issued to health and social care staff on how to manage adult safeguarding issues.
'Not fit for purpose'
The number of adult safeguarding referrals in Northern Ireland has increased in recent years from 4,778 in 2019 to 6,897 in 2021.
The Department of Health said the increase could relate to "greater public awareness of adult abuse".
The failings identified in Mr O'Neill's case come as the Northern Ireland Public Services Ombudsman (Nipso) has been raising concerns about Northern Ireland's adult safeguarding system.
"From a number of cases that have come into my office, I think it is clear that our adult safeguarding system is not fit for purpose," said ombudsman Margaret Kelly.
"A lot of the time it is families who have had to draw the attention to healthcare staff about potential failings in care and that just isn't right."
In recent years the ombudsman's office has dealt with eight nursing and care home cases - in seven of those, adult safeguarding was an issue.
The ombudsman cases included:
- someone who was wrongly positioned in a bed and, as a result choked, and vomited
- a patient who was not appropriately fed and suffered a degree of malnutrition
- an adult with a learning disability not given pain relief
- a resident who suffered a fractured leg after not being treated appropriately and also choked on her dentures for 24 hours before the care home realised
"Unfortunately while these cases show serious failings, I think they are the tip of the iceberg," Ms Kelly said.
She added: "Northern Ireland is in danger of falling behind when it comes to protecting our most vulnerable."
Northern Ireland is still the only part of the UK and Ireland without specific adult safeguarding legislation, despite commitments by a number of health ministers to implement it.
The Department of Health said it recognised there were "shortfalls" in the current legislation and a new adult safeguarding bill would be brought forward once the Northern Ireland Executive and Assembly returns.
Bradley Manor said the wellbeing of its residents was its main focus and it had already implemented a number of changes to address the shortfalls identified by the report.
The Belfast Trust said it has undertaken enhanced monitoring at the care home and worked to implement quality and safety improvements.
Reflecting on her grandfather's case, Sophie said: "If any other families go through this I would just advise them to not be afraid to speak up for your loved one."
A broken safeguarding system. A family seeking answers. This is Stanley's story. | Epidemics & Outbreaks |
The Covid pandemic may have impacted brain health in people in the UK aged 50 and over, according to a new study.
More than 3,000 volunteers completed yearly questionnaires and online cognitive tests to measure changes in memory, and other faculties, as the pandemic unfolded.
The results revealed a decline, irrespective of Covid infection.
Stress, loneliness and alcohol consumption may explain some of the findings, experts say.
Coping with Covid fears, worries and uncertainties and disruption to routines may have had a "real, lasting impact" on brain health, they say.
The rate of the drop in cognitive function was accelerated during the first year of the pandemic, when lockdowns occurred, the study found.
For memory issues, the decline continued into the second year.
People who already had some mild memory problems before the pandemic began had the worst overall decline.
The study, called PROTECT - published in The Lancet Healthy Longevity - was set up to help understand how healthy brains age and why some people develop dementia.
It uses brain-training games to check memory skills and reasoning, while the questionnaire looks for possible risk factors that could harm brain health.
The plan is to keep the study running in the future to see how participants fare, and what lessons can be learned to help others.
Based on the current findings, lead investigator Prof Anne Corbett, from the University of Exeter and previously King's College London, says pandemic conditions may have hastened brain decline.
"Our findings suggest that lockdowns and other restrictions we experienced during the pandemic have had a real, lasting impact on brain health in people aged 50 or over, even after the lockdowns ended.
"This raises the important question of whether people are at a potentially higher risk of cognitive decline which can lead to dementia.
"It is now more important than ever to make sure we are supporting people with early cognitive decline, especially because there are things they can do to reduce their risk of dementia later on.
"So if you are concerned about your memory, the best thing to do is to make an appointment with your GP and get an assessment."
Dr Dorina Cadar, a dementia expert from Brighton and Sussex Medical School, said the effect of the pandemic on the general population had been "catastrophic".
"Many of the long-term consequences of Covid-19, or the restriction measures implemented around the world, remain unknown,"
She recommended more research, and said although the findings could not prove cause and effect, there is mounting evidence that some of the factors described, such as social isolation, can negatively impact brain health.
Dr Susan Mitchell from Alzheimer's Research UK said: "While our genetics play an important role in the health of our brains as we age, we know that a range of health and lifestyle factors can impact our brain health.
"Sadly, there's no sure-fire way to prevent dementia yet, but meanwhile, taking care of our brains can at least help stack the odds in our favour. It's never too early or too late to think about adopting healthy habits, which includes looking after your heart health, keeping connected and staying sharp." | Mental Health Treatments |
Tobacco giant Philip Morris wielded a vast pro-tobacco “propaganda” campaign that violated public health law, a new French lawsuit alleges.
Despite a ban on tobacco advertising in France, Philip Morris’s French subsidiary used its ‘smoke-free world’ slogan to mask its online promotion of its cigarette and heated tobacco business, according to the lawsuit, which was filed in Paris last month by the Comité National contre le Tabagisme, a French anti-smoking advocacy organization.
Philip Morris distorted government health warnings, established misleading websites and touted products such as heated tobacco as potentially “less harmful” alternatives to smoking, despite a lack of scientific evidence on the long term health impact, the lawsuit claims.
Hugo Lévy, the lawyer representing CNCT, said Philip Morris’ marketing strategy for its IQOS heated tobacco products harkens to an earlier era when tobacco companies engaged in large-scale propaganda campaigns to sell cigarettes.
“The lie behind ‘smoke free alternatives’ is as coarse as the lie behind R.J. Reynolds’s ‘More Doctors Smoke Camels’ campaign,” Levy said. “We are beyond illegal advertising: it is propaganda.”
As part of the lawsuit, CNCT also named the president of Philip Morris France, Jeanne Polles, as an “accomplice” by contributing to and appearing in news articles and videos as part of the company’s strategy.
Philip Morris did not respond to a request for comment.
The stakes in the case are more reputational than financial. The lawsuit seeks to have a judge essentially repudiate Philip Morris’ entire approach to marketing its products via its ‘smoke free world’ campaign. The company, CNCT alleges, is using that campaign to disguise its true intention: to market heated tobacco and other smokeless products, while still dominating the French cigarette market.
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In a previous case, CNCT accused Philip Morris of illicit advertising, and won damages — a judgment the tobacco company is appealing.
Philip Morris’ IQOS uses an electronic device to heat a tobacco stick to a lower temperature than a traditional cigarette. It is one of a number of so-called smokeless products marketed by Philip Morris and other tobacco companies as a replacement for cigarettes. On its website, Philip Morris describes IQOS as a “better choice” than cigarettes.
The science behind smokeless products is still emerging. Some scientists believe the emissions IQOS creates is, in fact, smoke — and that it and other products, such as e-cigarettes, pose potential long-term health risks.
“The rhetoric aims to make people believe that there is a lesser danger of use even though there is no conclusive scientific certainty on this point. This rhetoric’s only aim is the illicit promotion of the products sold by Philip Morris France,” CNCT wrote.
Anti-tobacco groups have long claimed that the tobacco companies are simply trying to get people hooked on another nicotine product, and that if they were serious about creating a smoke-free world they’d stop selling cigarettes altogether.
Philip Morris France, which is estimated to sell almost half of the country’s cigarettes under brands that included Marlboro and Chesterfield, is a subsidiary of the global tobacco giant Philip Morris International. Smoking is responsible for an estimated 75,000 early deaths in France each year, according to an estimate cited in the lawsuit.
Online campaign tactics
In a 34-page complaint seen by The Examination, CNCT alleges that Philip Morris France deployed “commercial propaganda,” distorting information about heated tobacco provided by the French government and the U.S. Food & Drug Administration.
Philip Morris France is also accused of breaching transparency rules when it encouraged consumers to respond to a European Commission consultation on smoking regulations. “Defend your IQOS,” Philip Morris France wrote to French users of the company’s heated tobacco device.
CNCT also alleges that Philip Morris France created a website called “Popular Misconceptions about Cigarettes.” While fine print said that the website did not intend to promote the sale of Philip Morris products, the website directed visitors to the company’s advertising and related websites, according to the lawsuit.
The company also joined a campaign, which included advertisements in the Paris metro, to warn consumers of counterfeit cigarettes, citing health risks. CNCT argues that, in reality, the purpose was to encourage consumers to buy original products, including those made by Philip Morris France. The company’s Twitter account was also a source of indirect tobacco advertising, which is prohibited under French law, CNCT alleged.
In French law, there is no system of punitive damages but CNCT has asked the court to force Philip Morris France to pay the advocacy organization, which is recognised as a public utility, more than $450,000 if found guilty given its role and costs incurred fighting smoking.
“This is a large-scale strategy involving significant investment,” CNCT wrote of the activities of Philip Morris France. “In reality, the only goal is self-serving communications to hide the ongoing trade in conventional cigarettes and heated tobacco products whose purported safety is a fiction.”
Will Fitzgibbon contributed reporting. | Health Policy |
English bulldogs must be bred with less extreme features to improve their health and to prevent breeding from being banned in the UK on welfare grounds, veterinarians have said.A study by the Royal Veterinary College found that distinctive features of English bulldogs such as their flat faces, protruding lower jaws and folds of skin contribute to them being twice as likely as other breeds to have health problems and substantially shorter lives.The problems with breathing, skin and eye conditions, among others, are so serious that experts on the study called for an “immediate redefinition of the breed” in the hope of encouraging breeders – and buyers – to prioritise healthy animals rather than supposedly cute features.“The issues with English bulldogs are really issues with humans and what we deem cute and what we deem acceptable,” said Dr Dan O’Neill, a senior author on the study at the Royal Veterinary College. “We need people to view dogs not from a human perspective, where short noses and wrinkled skin are considered cute, but from the dog’s perspective, where good innate health is cute.”To investigate the health of English bulldogs, the researchers examined the medical records of 2,662 English bulldogs and 22,039 other breeds selected at random in 2016 from veterinary practices across the UK. The bulldogs were substantially younger, with less than 10% aged eight and above, compared with more than a quarter of other breeds, indicating a substantially shorter lifespan.Stark differences were seen in the health of the animals, too, according to the study in Canine Medicine and Genetics. English bulldogs were twice as likely as other breeds to be diagnosed with at least one health problem, with predispositions found for 24 out of 43 conditions the vets looked at.Many of the problems the bulldogs developed were directly linked to features that some breeders encourage due to their popularity with buyers. Compared with other breeds, English bulldogs were 38 times more likely to have skin fold dermatitis, 27 times more likely to have “cherry eye” – a prolapsed eyelid gland – and 19 times more at risk of particular airway abnormalities caused by their shortened skulls. “Consequently, immediate redefinition of the breed towards a moderate conformation is strongly advocated to avoid the UK joining the growing list of countries were breeding of English bulldogs is banned,” the experts write.Some countries, such as Norway and the Netherlands, are already taking action to in effect ban the breeding of English bulldogs and some other breeds on animal welfare grounds, though many dogs bought in the UK are imported or sold by dealers who operate outside official breeding guidance. “The vast majority are not bred by breeders, but farmed, often in appalling conditions, to meet a market and sold on the internet to anyone who will pay the money,” said O’Neill.Sonia Saxon, a PR representative for the Bulldog Breed Council, said: “The bulldog breed standard, which is our ‘blueprint’ to help us breed the bulldog, does not call for any exaggerations or unsoundness; in fact it guides us away from them.“If all bulldogs were bred to this standard, and the health tools available utilised, we would not see some of the so-called bulldogs being advertised on social media of various types, coats, colours and size that are purposely bred for exaggeration with little regard for the health and welfare of the UK’s national breed.”She added: “The Bulldog Breed Council would like to work with the Kennel Club to find a better means of communication to educate the public when buying a puppy.” | Disease Research |
As a single woman with a chronic illness, Emma Postance always knew becoming a mother would be extra difficult for her. The 42-year-old has multiple sclerosis, a lifelong, incurable condition that can lead to sufferers needing a wheelchair. She also had ovarian cancer in her 30s. Despite her health issues, she was determined to hold her own child in her arms – and used sperm donation to conceive her baby as a solo mum. But now Emma has learned she has an aggressive brain tumour and might not even live to see her tot turn four – and little Alice will be left without a dad or a mum. Emma, who works in operations for a stockbroking firm, says: “Of course, I thought, ‘Am I being selfish doing this, being desperate for a baby?’ “But other people with MS have children all the time. The tot was conceived with donated sperm (
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©Stan Kujawa) The mum may have just months left (
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©Stan Kujawa) “I was always aware that my MS meant I could suddenly go downhill, but I had gone 10 years without any relapse and had always been stable. “I was prepared for the fact I might be in a wheelchair, but never anything more than that.” Then came the diagnosis, in September, that she had a stage-four glioblastoma brain tumour. Doctors estimated she had just two years before 20-month-old Alice would likely become an orphan. Emma says: “It is horrific thinking that my miracle daughter won’t grow up with a parent.” Although she doesn’t for a moment regret her decision to have Alice, adding: “Never ever regret. She is my little miracle and I adore her.” The solo mum’s health issues began in her late 20s, when she discovered she has relapsing-remitting MS after getting double vision on a girls’ holiday to Portugal in 2008. As MS affects the brain and nerves, relapses can worsen symptoms to blindness or needing a wheelchair. Suffering no relapses, Emma decided that her MS was stable enough to try for a baby with her partner at the time. Three miscarriages followed, all before the 12-week scan stage. Emma and Alice at her parents' home (
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©Stan Kujawa) After the couple split, Emma was still set on being a mum. Approaching her 40s, she started exploring becoming a solo parent using a sperm bank. So in January 2019 she went for a fertility check-up – and was shocked when doctors found an ovarian tumour. Emma says: “Being diagnosed with MS in your late 20s is horrible, but to be told there is a tumour is really awful. I hadn’t gone for the check up, who knows what could have happened?” Luckily the cancer hadn’t spread, and her ovary was removed. With only one ovary left, Emma, who lives with her parents in Tadley, Hampshire, felt time to become a parent was running out. She says: “I said to my parents, ‘I can meet a man at any age, but I can’t have children at any age’.” Bringing a child into the world as a solo parent with MS carried the possibility of that child being left on their own. But Emma had a positive outlook. “You can’t live life worrying about what might happen,” she says. “I could get knocked over by a bus tomorrow or be in a car crash.” Assuming she would meet a partner in the future, she went ahead with IUI, a procedure which involves sperm being injected into the womb, during the Covid pandemic. Emma knew becoming a mother would be difficult (
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©Stan Kujawa) She says: “Everyone was so supportive. They knew how much I wanted a baby and they never questioned it. A family doesn’t have to mean mum and dad, it can mean grandparents, uncles, aunts and cousins, too.” Emma chose a donor online through a European sperm bank after her parents paid for it as a Christmas present. A 30-year-old British man with brown hair and eyes stood out – he liked playing guitar and said he loved his nieces and nephews and wanted to help others. Emma – herself an aunt to three girls – thought he sounded like a nice guy, the sort of bloke you could chat to in the pub. The rules meant she could never contact him. She decided to go ahead. One insemination in July 2020 failed, so she tried again a few weeks later. It worked, and Alice Matilda – who was lying breech – was born by C-section in April 2021, weighing 6lb 11oz. Emma’s mum stepped up to act as birthing partner, and both her parents moved in to help their single daughter raise her baby. “Holding her for the first time was the best moment,” the new mum says. “She was so beautiful.” Eighteen months later, Emma was on a Spanish holiday with friends when she started having headaches, which she put down to sleep deprivation as a new parent. But then a routine MS scan revealed something on her brain. Emma was in absolute denial over what it meant. The mum might not even live to see her tot turn four (
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©Stan Kujawa) She says: “I never in a million years imagined it would be what it was.” A CT scan confirmed a tumour, and Emma was booked in for a craniotomy to remove it. Tests showed it was a stage-four glioblastoma, a type of tumour diagnosed in 2,200 people each year. And although the tumour had been cut out, it would grow back in 12-24 months. The average glioblastoma survival time is 12-18 months. Emma was given two years to live. The implication was horrendous – not only for her, but also for what it would mean for Alice – life without her mother. Emma recalls: “They said not to Google it, but I did and it was devastating. I went to my parents and I cried. Then I went to my brother and his wife and broke down.” Back when Alice was four months old, Emma had asked her brother if he would care for the tot if anything happened to her – and Andrew had replied, “Of course”. Now, with the clock ticking towards Alice being orphaned, she had to ask him that question again for real. She recalls: “I said, ‘I don’t think I am going to be here in a couple of years and I think you will have to bring Alice up for me’. “I was petrified and devastated. It was without a doubt, the worst day of my life. All I could think was Alice is going to lose her mummy, my parents will lose their daughter and my brother is losing his sister.” While Emma is now having intensive chemotherapy and radiotherapy to extend her life, there is no cure. When the tumour returns, if it is accessible and she is well enough, doctors could operate again – but there is no guarantee they will. So she is putting things in place for Alice to be adopted by Andrew and also writing her will. She says: “I need to start looking at all the scary stuff. “I have been lucky enough to have a good job for the last 15 years, so I have some savings for her.” She is also fundraising for private immunotherapy treatment in Germany or the US. Not available on the NHS, the £250,000 treatment prolongs life, on average, by four months. Emma says she is under no illusion it will cure her. She adds: “But if it can give me just a few more months or years, it would mean everything. “If I last two years, Alice will be three-and-a-half. I just want her to be able to remember me, and the older she is, the more chance I have of that.” Emma and Alice playing at home (
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©Stan Kujawa) Because Alice is so young, it is likely she won’t remember her mum. So Emma is asking people make videos of the two of them together so her girl can at least hear her recorded voice. She is also making photo albums and writing a journal to leave behind, so that even if Alice doesn’t have her mum for real, she’ll be able to turn to the written mementos. Emma’s heartbroken family are also having to come to terms with the massive changes and loss the future holds. For her brother Andrew and his wife Jessica that will mean taking Alice into their home and caring for her alongside their own three daughters. Andrew, 43, a chartered mechanical engineer who lives in Cardiff, says: “When Emma asked us to take Alice there was no question about it, but it’s not how it should be. “Emma is in the prime of life and Alice is so young, which makes everything so much more difficult.” Emma always wanted to be a mum, he says, calling her “a natural”. Kim's family was supported by Maggie's, which provides free practical, emotional and social support to people with cancer and their family and friends. Maggie's has 24 centres across the UK. Visit maggies.org or call 0300 123 1801 Jim's family and friends are raising money for Pancreatic Cancer UK, the only charity dedicated to the disease and staffed entirely by specialist nurses. Visit pancreaticcancer.org.uk. To donate to Jim's family's fundraiser, visit justgiving.com/fundraising/jimharveydigital Ceri was helped by a CLIC Sargent social worker throughout her treatment. The charity helps children and young people with cancer face their treatment and the concerns that come with it. Visit clicsargent.org.uk Macmillan Cancer Support offers information and support for people living with cancer in the UK. Its phone line on 0808 808 00 00 is open seven days a week from 8am-8pm. Visit macmillan.org.uk Marie Curie is the UK’s leading end of life charity. The charity provides frontline nursing and hospice care, a free support line and a wealth of information and support on all aspects of dying, death and bereavement. For a full range of cancer support services, visit mariecurie.org.uk/help/support/support-directory/health-organisations He adds: “A lot of people wouldn’t do what she has done, because it can be tough, but she is amazing. While she has had MS and ovarian cancer, she has always been relatively lucky – and then this comes along and there is no answer.” And for little Alice it means life without her mum – or any parent. There is at least a chance that one day Alice might find the donor. When she turns 18, she can request his contact information – but there’s a long time to go until then. Emma says: “It’s entirely up to her. For now, the most important thing is for her to have as much time as possible with her mum.” To donate to Emma’s therapy, go to gofundme.com/f/please-help-in-emmas-battle-against-brain-cancer Read More Read More Read More Read More Read More | Disease Research |
Cocaine demand and supply are booming worldwide, and methamphetamine trafficking is expanding beyond established markets, including in Afghanistan where the drug is now being produced, a United Nations report said Sunday.
Coca bush cultivation and total cocaine production were at record highs in 2021, the most recent year for which data is available, and the global number of cocaine users, estimated at 22 million that same year, is growing steadily, the U.N. Office on Drugs and Crime said in its annual World Drug Report.
Cocaine seizures have, however, grown faster than production, containing the total supply to some extent, the report said. The upper band of the estimated total supply was higher in the mid-2000s than now.
"The world is currently experiencing a prolonged surge in both supply and demand of cocaine, which is now being felt across the globe and is likely to spur the development of new markets beyond the traditional confines," the UNODC report said.
"Although the global cocaine market continues to be concentrated in the Americas and in Western and Central Europe (with very high prevalence also in Australia), in relative terms it appears that the fastest growth, albeit building on very low initial levels, is occurring in developing markets found in Africa, Asia and South-Eastern Europe," it said.
While almost 90% of methamphetamine seized worldwide was in two regions - East and Southeast Asia and North America - seizure data suggests those markets have stabilized at a high level, yet trafficking has increased elsewhere, such as the Middle East and West Africa, the report said.
It added that reports and seizures involving methamphetamine produced in Afghanistan suggested the drug economy was changing in that country, where 80% of the world's illicit opium poppy, which is used to make heroin, is produced.
"Questions remain regarding the linkages between illegal manufacture of heroin and of methamphetamine (in Afghanistan) and whether the two markets will develop in parallel or whether one will substitute the other," it added. | Drug Discoveries |
- The Biden administration unveiled the first 10 prescription drugs that will be subject to price negotiations between manufacturers and Medicare.
- The announcement kicks off a controversial process under the Inflation Reduction Act that aims to make costly medications more affordable for older Americans.
The Biden administration on Tuesday unveiled the first 10 prescription drugs that will be subject to price negotiations between manufacturers and Medicare, kicking off a controversial process that aims to make costly medications more affordable for older Americans.
President Joe Biden's Inflation Reduction Act, which passed in a party-line vote last year, gave Medicare the power to directly hash out drug prices with manufacturers for the first time in the federal program's nearly 60-year history. The agreed-upon prices for the first round of drugs are scheduled to go into effect in 2026.
Here are the 10 drugs subject to the initial talks this year:
- Eliquis, made by Bristol-Myers Squibb, is used to prevent blood clotting to reduce the risk of stroke.
- Jardiance, made by Boehringer Ingelheim, is used to lower blood sugar for people type 2 diabetes.
- Xarelto, made by Johnson & Johnson, is used to prevent blood clotting to reduce the risk of stroke.
- Januvia, made by Merck, is used to lower blood sugar for people with type 2 diabetes.
- Farxiga, made by AstraZeneca, is used to treat type 2 diabetes.
- Entresto, made by Novartis, is used to treat certain types of heart failure.
- Enbrel, made by Amgen, is used to treat rheumatoid arthritis.
- Imbruvica, made by AbbVie, is used to treat different types of blood cancers.
- Stelara, made by Janssen, is used to treat Crohn's disease.
- Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill, insulins made by Novo Nordisk.
The Medicare negotiations are the centerpiece of the Biden administration's efforts to rein in the rising cost of medications in the U.S. Some Democrats in Congress and consumer advocates have long pushed for the change, as many seniors around the country struggle to afford care.
But the pharmaceutical industry views the process as a threat to its revenue growth, profits and drug innovation. Drugmakers like Merck and Johnson & Johnson and their supporters aim to derail the negotiations, filing at least eight lawsuits in recent months seeking to declare it unconstitutional.
The drugs listed Tuesday are among the top 50 with the highest spending for Medicare Part D, which covers prescription medications that seniors fill at retail pharmacies. That's based on data from June 1, 2022, to May 31, 2023, according to the Centers for Medicare and Medicaid Services, or CMS.
The drugs have been on the market for at least seven years without generic competitors, or 11 years in the case of biological products such as vaccines.
Drugmakers have to sign agreements to join the negotiations by Oct. 1. CMS will then make an initial price offer to manufacturers in February 2024, and those companies have a month to accept or make a counteroffer.
The negotiations will end in August 2024, with agreed-upon prices published on Sept. 1, 2024. The reduced prices won't go into effect until January 2026.
If a drugmaker declines to negotiate, it must either pay an excise tax of up to 95% of its medication's U.S. sales or pull all of its products from the Medicare and Medicaid markets.
The pharmaceutical industry contends that the penalty can be as high as 1,900% of a drug's daily revenues.
After the initial round of talks, CMS can negotiate prices for another 15 drugs for 2027 and an additional 15 in 2028. The number rises to 20 negotiated medications a year starting in 2029 and beyond.
"I think it's incredibly important to keep in mind that the negotiation process is cumulative," said Leigh Purvis, a prescription drug policy principal with AARP Public Policy Institute. "We could have as many as 60 drugs negotiated by 2029."
CMS will only select Medicare Part D drugs for the medicines covered by the first two years of negotiations. It will add more specialized drugs covered by Medicare Part B, which are typically administered by doctors, in 2028.
The drug price talks are expected to save Medicare an estimated $98.5 billion over a decade, according to the Congressional Budget Office.
Merck, Johnson & Johnson, Bristol-Myers Squibb and Astellas Pharma are among the companies suing to halt the negotiation process. The industry's biggest lobbying group, PhRMA, and the U.S. Chamber of Commerce have filed their own lawsuits.
The suits make similar and overlapping claims that Medicare negotiations are unconstitutional.
The companies argue that the talks would force drugmakers to sell their medicines at huge discounts, below market rates. They assert this violates the Fifth Amendment, which requires the government to pay reasonable compensation for private property taken for public use.
The suits also argue that the process violates drugmakers' free speech rights under the First Amendment, essentially forcing companies to agree that Medicare is negotiating a fair price.
They also contend that the talks violate the Eighth Amendment by levying an excessive fine if drugmakers refuse to engage in the process.
The suits are scattered in federal courts around the U.S. Legal experts say the pharmaceutical industry hopes to obtain conflicting rulings from federal appellate courts, which could fast-track the issue to the Supreme Court.
Some drugmakers have confirmed their intention to bring their legal battle to the nation's highest court.
"As we look forward, we're going to take this to the fullest, which means we'll take it through District Court and, if need be, into Circuit Court and ultimately to the Supreme Court," Merck CEO Robert Davis said during an earnings call earlier this month. "So, really that's the strategy."
Meanwhile, the Biden administration has vowed to fight the legal challenges.
Biden and his top health officials have embraced the lawsuits as evidence that they're making progress in the fight to cut drug prices.
"Big Pharma doesn't want this to happen, so they're suing us to block us from negotiating lower prices so they can pad their profits," the president said in a speech at the White House last month. "But we're going to see this through. We're going to keep standing up to Big Pharma." | Health Policy |
Sydney — Australia will ban imports of disposablefrom January 1, the government said Tuesday, slamming the devices as recreational products addicting children. The block on single-use vapes is aimed at reversing a "disturbing" increase in vaping among young people, Health Minister Mark Butler said.
Australia first revealed the import ban in May but had not given a start date until now.
Vaping had been sold to governments as a tool to help long-term smokers quit, Butler said.
"It was not sold as a recreational product, especially not one targeted to our kids, but that is what it has become," the minister said. "The great majority of vapes contain nicotine, and children are becoming addicted."
About one in seven children aged 14-17 uses vapes, the government said in a statement. It cited "consistent evidence" that young Australians who vape are about three times more likely to take up tobacco smoking.
Legislation will also be introduced in 2024 to outlaw the manufacture, advertising or supply of disposable vapes in Australia, the government said.
The import ban was hailed by the Australian Medical Association.
"Australia has been a world leader in reducing smoking rates and the subsequent health harms, so the government's decisive action to stop vaping in its tracks and prevent further harm is very welcome," said association president Steve Robson.
The government said it was also introducing a scheme to enable doctors and nurses to prescribe vapes "where clinically appropriate" from January 1.
Australia's anti-smoking battle
Australia has a long record of fighting smoking.
In 2012, it became the first country to introduce— a policy since copied by France, Britain and others.
High taxes have pushed up the price of a packet to about Aus$50 (US$33).
For some people who would otherwise never have smoked, vaping is a "dangerous gateway" to tobacco, said Kim Caudwell, senior lecturer in psychology at Australia's Charles Darwin University.
"So you can understand how at the population level, increased vaping and a resurgence of tobacco use will impact population health in the future."
Neighboring New Zealand until recently stood alongside Australia at the forefront of the battle against smoking.
But its new conservative coalition government, which took power this week, has now promised to scrap a so-called "generational smoking ban" that would have stopped sales of tobacco to anyone born after 2008.
"I was absolutely shocked and appalled. It is one of the worst days I can remember for public health," University of Otago tobacco control expert Richard Edwards told AFP. "It is public health vandalism."
for more features. | Health Policy |
"As an amputee, you avoid hills, you avoid rocks," says Milly Pickles. "Because you can't feel your foot and you don't know what's going to happen."
Milly's just returned from Slovenia, where she competed in the Red Bull 400.
Known as the "world's steepest race", it's an all-out 400m (1,310ft) sprint up a ski slope with inclines of up to 75 degrees.
"It was unbelievably tough, it was so awful," Milly tells BBC Newsbeat. "Every time I looked up, it felt like there was forever to go."
Despite that, the 26-year-old did reach the finish line, becoming the first amputee to do so.
And Milly says she's never felt prouder - not least because she'd been unable to train until a week before the race.
A complication with her prosthetic had left her unable to walk for about three months, so Milly was "shocked" to even complete the challenge.
"It means the absolute world, because it's like I did the impossible," she says.
Milly was 20 when she had to have her right leg amputated below the knee after she was electrocuted in an accident.
"It completely changed my life," she says.
"I understood the value of life. Now I'm so grateful to know that I am alive."
Milly, who is from Hertfordshire and now lives in London, threw herself back into her degree, trained for the Paralympics and shared her recovery online with tens of thousands of followers.
She then decided to take on the Red Bull 400 - a test that brings particular challenges for an amputee, according to Milly.
Firstly, her choice of prosthetic.
"You would think blades would be really good for it," says Milly.
"But the hill is so steep, you can't even push yourself into the running blade to then propel forward."
She opted instead for her "walking leg" which she says "loves to twist a lot".
"Obviously I can't feel what I'm doing, so when I put my foot down I don't know if it's actually safe or not," says Milly.
"I was just having to really trust in my prosthetic leg."
Milly also had to consider the best way to remain balanced.
She says she slipped a few times but was focused on finding spots where fellow competitors had put their feet to help.
"Not having an ankle really limits me as well because if I was to fall, which I did, you can't really move your foot to save yourself," she says.
Milly completed the course in 17 minutes and 26 seconds and says: "Your mind gives up before your body does - my mind is what got me through."
"I was just so happy that I'd finished," she says. "I've been crying for days, because I'm just so proud of myself."
Despite the huge physical demands of the race, Milly tells Newsbeat she hadn't been able to train much beforehand - just six days, in fact.
Earlier this year she got a sore that took longer than expected to heal, meaning she couldn't wear her prosthetic, and therefore walk, for about three months.
So when the event drew closer, she didn't feel super-prepared.
"Physically, I was weak," she says. "I was not ready for it at all."
Milly says she couldn't stop crying as she approached the starting line and the realisation of what faced her sunk in.
She says: "I just thought, 'What on earth am I about to do?'
"That's when it really hit me that I'm an amputee, I've got three toes on my human foot, I have not walked for three months this year⦠and I am about to do it."
Milly is planning to compete again next year - hopefully with a bit more training under her belt - to improve on her time.
She also dreams of running a marathon in the future.
Milly says it's important to her that she shares her journey to inspire others.
"When I first lost my leg, I was desperate to find other amputees like me," she says.
"All I wanted was to see where I would be in the next five, six years, but I had no-one for that.
"So when I started sharing my journey online, that's when I thought: 'OK, I can be the person that I never had for other people'."
Her advice for anyone going through a life-changing event?
"To take a step back, sit back, but then get ready for your comeback. There's so much life to live and I'm just grateful to be alive to live it," she says.
"So leg or no leg, at least I'm here." | Aerobics & Cardio |
1 in 3 American adults are at risk for developing Chronic Kidney Disease during their lifetime, a devastating condition currently affecting an estimated 37 million Americans. 15% of adults are estimated to have CKD, but 90% do not know they have it. Racial and ethnic minority populations in the U.S. shoulder a disproportionate burden of both CKD risk and negative outcomes. What obstacles stand in the way of timely diagnosis? Conversations around treatment often focus on dialysis and transplant, but are there additional options? How do we ensure easy access to all available treatment options for those suffering and at risk for CKD? And how can we address devastating disparities? The Hill will convene physicians, patient advocates, and health equity experts for an important conversation on treating chronic kidney disease. Tuesday, June 14, 20221:00 PM ET/10:00 AM PT Speakers: Rep. Brett Guthrie (R-KY), Member, Energy & Commerce CommitteeRep. Donald Payne, Jr. (D-NJ), Co-chair, Peripheral Artery Disease CaucusTom Duvall, Division Director, Division of Special Populations and Projects, Seamless Care Models Group, Center for Medicare and Medicaid InnovationRichard Knight, President, American Association of Kidney Patients Kevin Longino, CEO, National Kidney FoundationSusan Quaggin, MD, FASN, President, American Society of NephrologyElena Rios, MD, MSPH, FACP, President and CEO, National Hispanic Medical Association Sponsor Perspective: Kevin Bernier, Executive Director, Advocacy Relations, US Pharmaceuticals Moderator: Bob Cusack, Editor-in-Chief, The Hill Join the conversation! Tweet us: @TheHillEvents using #TheHillCKD Sponsored By Tags | Disease Research |
As we head into another winter, Covid numbers have been ticking up. But how worried should we be about Covid these days – can we treat it like a cold, or have we become blase about an illness that could still pose a threat to elderly and clinically vulnerable people?
How does Covid compare to a cold or seasonal flu?
Seasonal flu has been a benchmark for Covid since early in the pandemic, and for some time Covid has had a lower mortality rate. Last winter Covid caused fewer deaths than flu – 10,000 versus just over 14,000, according to the UK Health Security Agency. However, Covid remains a more serious illness than a typical cold, with one study showing that for people who become ill enough to be hospitalised, Covid still has a higher risk of death. “The problem is a lot of people say they’ve got flu when they haven’t,” said Prof Paul Hunter, an expert in infectious diseases at the University of East Anglia. “Flu is not nothing – it is a nasty infection that typically kills 20,000 people in a winter.”
In terms of the overall impact on the health service, Covid is still likely to add to pressures this winter. “We’re not in 2020 or 2021 and that’s a good thing,” said Prof Christina Pagel, of University College London. “But we’re also not in 2019. We’ve still got a new disease that’s killing thousands of people each year and we’ve got long Covid.”
Do we still keep track of how many people are infected with Covid ?
Since the Office for National Statistics infection survey wrapped up in March, it has been hard to know how many people are infected in the UK. However, official UKHSA figures, which show infections in hospital, indicate whether infection rates are rising or falling. This week’s figures suggest that infections, which had been steadily increasing since August, are now going down again across all age groups.
Has Covid become a seasonal illness?
Last year, as new variants arrived in quick succession, there were multiple large waves of infection, including during the summer months. This hasn’t been the case in 2023, which some say indicates Covid is settling into a seasonal pattern, with indoor mixing and lower temperatures allowing the virus to spread more readily in winter. “In pandemics with relatively short durations of immunity you always get a series of gradually dampening waves as you move towards the endemic equilibrium,” Hunter said. “Seasonality will ultimately start playing a role. The other human coronaviruses generally follow a seasonal pattern where they peak between November and February.”
Is the possibility of new variants still a threat?
The so-called Pirola variant (official name BA.2.86) prompted unease after being detected in Denmark in July and steadily spreading to other countries. The strain has a large number of mutations, raising the risk that it could evade existing immunity or could have changed in a way that makes it more virulent or more infectious. This has not transpired to be the case with this particular strain. “There was a lot of hype but that’s been a bit of a damp squib,” said Hunter. “It’s still gradually increasing as a proportion of all infections but not dramatically so.”
The prospect of a new variant causing a dramatic resurgence may be receding but scientists remain alert to this possibility and continue to monitor the emergence of new strains – although England has dropped its wastewater surveillance programme. “It’s a confusing time,” said Prof Danny Altmann, an immunologist at Imperial College London. “If you live in my world, where you’re still looking at sequences of viruses, we’ve still got our guard up. But nobody has the stomach for that fight any more.”
If you have symptoms, should you stay off work, isolate, and do you need to test?
It is still advisable to stay at home and avoid social contact if you have Covid symptoms. However, views vary on testing. Shropshire community NHS trust apologised last week after issuing an email warning staff not to test for Covid because it could result in them “having to remain at home for longer than their symptoms persist”. Pagel said: “I think that’s just ridiculous. If there’s one place where you really don’t want to give people Covid, it’s in hospital. We have a staffing crisis in the NHS but this is such a bad way to deal with it. If you’re giving Covid to older people and those with other health conditions, they end up in hospital for longer, so you’re making bed issues worse and you end up with more people off work.”
Pagel says testing can still be valuable because returning to exercise too quickly after Covid can lead to a slower recovery – so if you know you’ve had Covid you can take it easy. And if you develop long Covid, knowing that you’ve had an infection can be useful for diagnosis.
Who is being offered a booster this time around?
This autumn, boosters are being offered to everyone over 65 years old and those who are clinically vulnerable. About 35% of over-65s have taken up this offer since 1 September. For those outside the eligible groups, it is not possible to pay privately for a Covid booster injection at a pharmacy, but this could change next year. There has been little demand for private vaccinations until recently because previously all over-50s were eligible for NHS vaccination. However, several companies, including Moderna, have recently submitted applications to the Medicines and Healthcare products Regulatory Agency to update their licences to allow them to supply vaccines in individual pre-filled syringes, which would make it easier for pharmacies to offer one-off doses.
Is long Covid still a problem?
As immunity builds up in the population, the chances of Covid turning into long Covid has reduced substantially, although the total number has become harder to track. In March, when the ONS recorded its last survey, an estimated 1.9 million people in the UK (2.9% of the population) said they believed they had long Covid (symptoms continuing for more than four weeks), with 381,000 of these (20%) reporting that their ability to undertake their day-to-day activities had been “limited a lot”. Last month, the ONS reported that record numbers in the UK – 2.5 million – were not working due to long-term ill health, with evidence that long Covid could be having an impact.
“We’re still seeing people every week coming to our clinic,” Altmann said. “It’s still a thing – still an enormous thing.” | Epidemics & Outbreaks |
Image source, Hudgell SolicitorsImage caption, Laura Winham, of Woking, had schizophreniaThe family of a woman who lay dead in her flat for more than three years have told how they were unable to have any contact because of privacy laws, and how they eventually found her body.Laura Winham, 38, had schizophrenia and had refused contact with family who she thought were trying to harm her.Her brother Roy said the family were unable to get information about her.After repeated attempts to contact her, they found her when they peered through the letter box of her Woking flat.She was found in May 2021 but is thought to have died in November 2017.Her siblings said she grew up in a loving family and attended school and university, but developed mental health problems and did not return home after the first time she was sectioned.The family said they took a decision to limit contact because it put her under "enormous stress", but believed she would have a care plan.However, they could not get any information."She refused contact from the mental health team with her family, which she was allowed to do, which prevented doctors from speaking to us, or hospitals," her sister Nicky said.They continued sending letters, text messages and cards.Roy told the PM programme on Radio 4 it had been "very difficult", adding: "Thirty six years of all of that and then it's taken away from you because of privacy."Image source, Hudgell SolicitorsImage caption, Laura's body was discovered by her brother on the first floor flat of this buildingAfter their father became ill, they stepped up attempts at contact. After his death, they continued knocking on her door.On their last visit, they were about to leave when Roy decided to take another look.He said: "When I peered through the letter box, it looked like blankets was there, but as I looked down I thought I saw a foot."There was a top, that hoodie she had on, that I thought was in with the blankets and things."That's when I managed to get a little bit more of an angle, really pushing the brushes aside, and you could see the face, the body, which, after calling the ambulance, they said 'do you think she's still alive?'."He said: "Something made me go back up the stairs that day, but unfortunately it's left me with something that haunted me for a long time."A pre-inquest review is due to be held on Monday.Related Internet LinksThe BBC is not responsible for the content of external sites. | Mental Health Treatments |
A team of European researchers has developed a new test that can accurately measure biological aging in a clinical setting. The discovery was made while studying patients for the aging effects of chronic kidney disease.
The new test is an epigenetic clock -- a type of biochemical assessment that looks at DNA to understand how well the body is aging in contrast to its chronological age -- and is the first of these cutting-edge tests to be proven to perform accurately in a clinical setting, in both healthy and unhealthy tissue.
The work was led by a partnership between the University of Glasgow and the Karolinska Institutet, Stockholm, and is published in the Journal of Internal Medicine as part of a study into the aging effects of chronic kidney disease and its associated treatments.
The research team studied more than 400 patients with chronic kidney disease in Sweden alongside around 100 matched population controls, to better understand the impact on ageing of the disease, including during dialysis treatment and after kidney transplant. To do this, researchers used a range of tests including blood biomarkers, skin autofluorescence and epigenetic clocks. The team used the clocks to measure the change in biological age of around 47 patients one year after kidney transplantation, or one year after the start of their dialysis treatment, as well as how the healthy tissue in 48 controls aged by comparison.
The results showed that for patients with chronic kidney disease, their biological clock is ticking faster than the average person's. This continues to be the case even after dialysis treatment. Indeed, patients' biological clocks were only shown to slow down following a kidney transplant.
However, while the epigenetic clocks all showed a similar picture, the research team found that none of the current clocks could be shown to be accurate in a clinical setting, and all were found to be inaccurate to differing degrees when tested in healthy tissue over time.
To address this, the team developed a new, more accurate epigenetic clock -- the Glasgow-Karolinska Clock -- that works on healthy and unhealthy tissue. The results from this new clock matched what doctors saw in patients with chronic kidney disease, and also appeared to accurately assess healthy tissue too. This study is the first real-world test of epigenetic clocks in a normal ageing setting, and against clinical parameters.
As the body ages, a series of factors lead to epigenetic changes and loss of a chemical tag (DNA methylation) from your DNA. This is often associated with a range of disease common to ageing, such as chronic kidney disease, cancer and heart disease. Epigenetic clocks have been proposed as a 'gold standard' for measuring age accurately, beyond a person's biological age, as they are able to measure methylation tags on DNA.
Professor Paul Shiels, lead author of the study for the University of Glasgow, said: "This study is the first time in a clinical setting that we can accurately report on the extent of biological as opposed to chronological ageing in chronic kidney disease patients. Our findings, using the new Glasgow-Karolinska Clock -- show that not only are these patients aging faster than people in the general population, their accelerated aging only slows down once they have had a transplant. Treatment with dialysis does not appear to impact this process.
"This is also the first clinical test of epigenetic clocks, and the discovery that most are inaccurate when compared with medical evidence has led us to develop a new more accurate test which can accurately measure methylation tags on DNA of both healthy and unhealthy tissue. We have proven it is accurate to the high standards of a clinical setting.
"Methylation tagging of DNA is impacted by what we eat and also out gut microbiome. As a result, this new clock has real potential to be able to evaluate lifestyle interventions, including diet, that could benefit the public and help to address issues such as health inequalities."
Peter Stenvinkel, Professor at Karolinska Institutet, said: "I found the new tool to estimate effects of interventions on biological age of much interest. The tool could be used to study treatment strategies in patients with end-stage kidney disease -- a group subjected to premature aging."
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Alison Snyder reports via Axios: For more than 15 years, scientists have worked to build a complex cell with an entire genome built from scratch. This week they announced a major milestone: They've created synthetic versions of the 16 chromosomes in a yeast cell and successfully combined some of them in one cell. The feat is revealing new information about fundamental processes in cells, and it is a key step toward some scientists' vision of creating programmable cellular factories to produce biofuels, materials, medicines and other products.
The changes researchers made to yeast chromosomes fall into three main categories: increasing stability of the genome, repurposing codons (genetic sequences that carry instructions for reading DNA or RNA) and introducing a system that allows scientists to make millions of cells, each with different genetic properties. "A big problem is a lot of the things you want to make are actually toxic to the cells," [says Benjamin Blount, a synthetic biologist at the University of Nottingham in the U.K. and co-author of some of the scientific papers in a series published this week in Cell and Cell Genomics detailing the work]. With the system that reshuffles the genome and effectively mimics evolution, scientists can make many variants of yeast and pick the ones "that are really good at growing in the presence of what you're trying to make." Then, they're able to look at what's happened to their genomes to enable that particular strain to grow and make the desired product, and use that genetic information to develop strains of yeast suited for an industrial process.
The chromosomes still have to be combined in one cell that can survive, which means they have to be "basically indiscernible" from natural chromosomes in terms of the cell's fitness, Blount says. That required a lot of debugging of the genome, similar to what's done for computer code. One team was able to combine multiple chromosomes in one cell and it survived and reproduced, demonstrating a mechanism for bringing them together. Building the genomes -- and seeing when the cell doesn't work as expected as the result of one change or another -- has revealed fundamental information about genome biology, Blount says. For example, the team identified sequences in genes that interrupted a key process in the cell and led to mitochondria dysfunction, which is involved in some human diseases.
The changes researchers made to yeast chromosomes fall into three main categories: increasing stability of the genome, repurposing codons (genetic sequences that carry instructions for reading DNA or RNA) and introducing a system that allows scientists to make millions of cells, each with different genetic properties. "A big problem is a lot of the things you want to make are actually toxic to the cells," [says Benjamin Blount, a synthetic biologist at the University of Nottingham in the U.K. and co-author of some of the scientific papers in a series published this week in Cell and Cell Genomics detailing the work]. With the system that reshuffles the genome and effectively mimics evolution, scientists can make many variants of yeast and pick the ones "that are really good at growing in the presence of what you're trying to make." Then, they're able to look at what's happened to their genomes to enable that particular strain to grow and make the desired product, and use that genetic information to develop strains of yeast suited for an industrial process.
The chromosomes still have to be combined in one cell that can survive, which means they have to be "basically indiscernible" from natural chromosomes in terms of the cell's fitness, Blount says. That required a lot of debugging of the genome, similar to what's done for computer code. One team was able to combine multiple chromosomes in one cell and it survived and reproduced, demonstrating a mechanism for bringing them together. Building the genomes -- and seeing when the cell doesn't work as expected as the result of one change or another -- has revealed fundamental information about genome biology, Blount says. For example, the team identified sequences in genes that interrupted a key process in the cell and led to mitochondria dysfunction, which is involved in some human diseases. | Medical Innovations |
Single mother Debra Hamilton blames vaccine mandate for daughter Natalie Boyce's 'brutal, unnecessary' death
The devastated mother of 21-year-old Natalie Boyce has spoken out for the first time since her daughter's "horrific" death which she claims was caused by the once-mandated COVID-19 vaccine and "misdiagnosis by many medical professionals".
Single mother Debra Hamilton has shared the tragic story of her daughter Natalie Boyce who died almost a year ago.
Natalie - who would have turned 22 on Monday - was a "fit and healthy" university student from Melbourne who died on March 27, 2022, news.com.au reported.
The young woman was experiencing what she thought were flu-like symptoms when she died of "heart failure" at The Alfred Hospital, six weeks after receiving a booster dose of the Moderna vaccine.
Almost a year later, Natalie's mum has lashed out at authorities for once mandating COVID-19 vaccines and Victoria's health system for "mistreating" her daughter's illness.
“No parent should bury their child - especially from medical negligence and a compulsory vaccine," the 52-year-old told news.com.au.
The heartbreaking story was shared on Instagram where Ms Hamilton described how Natalie had fainted in her bedroom the morning after receiving the jab.
She said Natalie "assured me she would be OK" but continued to feel sick the following week, with "stomach pain, vomiting and a fever".
Natalie's condition continued to deteriorate despite multiple trips to doctors and several different hospitals, including a lengthy stay Monash Hospital in Clayton where the mother claims doctors had failed to correctly diagnose her daughter.
After "going in and out of consciousness", Ms Hamilton drove her daughter to Mulgrave Private Hospital where she was seen by an emergency doctor who straight away diagnosed her with "heart failure".
Natalie was then transferred to Alfred Hospital where she faced numerous heart complications over several weeks.
“For the next three weeks, Natalie had numerous procedures and scans but never regained consciousness,” Ms Hamilton wrote.
“She died on my passed mum’s birthday on the 27th of March, 2022. Her death certificate states Natalie died of myocardial infarction and that she had subacute myocarditis."
In September last year, the Therapeutic Goods Administration confirmed “a young woman in her 20s” had died after receiving the Moderna vaccine, which likely resulted in her myocarditis.
"After close consideration, the panel agreed that this woman’s myocarditis was likely to have been related to vaccination but acknowledged there were several other complicating factors that may have contributed to her death," the TGA wrote in a statement.
The TGA also confirmed in its vaccine safety report that: "Current evidence tells us at a population level, the risk of myocarditis and other heart problems after COVID-19 infection is higher than after COVID-19 vaccination."
Natalie received the Moderna booster on February 18 in order to keep her job at LeasePlan and attend in-person classes at Deakin University under the state’s strict vaccine mandates at the time.
"She was a happy, young healthy active girl who had her whole life ahead of her...That was all taken from her, and her death could have been prevented if she was given the correct care that she deserved," the mother continued.
"Doctors at both the Alfred and Mulgrave Hospitals could not believe Monash Medical doctors didn't bother to check her heart while she was there for nearly 16 hours.
"Natalie's death has destroyed her brother Hayden's and my life. The pain is often unbearable, our lives have changed forever.
"I strongly believe Governments were wrong to mandate these drugs with no long-term testing." | Vaccine Development |
The father of a junior doctor who took her own life says action must be taken to change a "toxic environment" at the hospital where she worked.
Dr Ravi Kumar, who also works for the NHS, was speaking ahead of the publication of a report into allegations of bullying at the University Hospitals Birmingham (UHB) NHS Trust, one of the largest hospital trusts in England.
The report has also examined claims of threats of disciplinary action against whistleblowers.
Dr Vaishnavi Kumar killed herself in June last year. The 35-year-old had been working at the Queen Elizabeth (QE) Hospital Birmingham.
Her parents say she left a note before taking a lethal overdose.
"She wrote a letter," her father told Sky News. "She very clearly mentioned that she was doing this because of the QE hospital."
After taking the overdose she waited three hours to call an ambulance. Her father says that when paramedics arrived "she said under no circumstances was she going to the QE hospital".
Dr Kumar says his daughter was "bright, fun-loving and compassionate" but things changed soon after she began working at the Queen Elizabeth Hospital.
"She started facing this toxic environment and she started getting a bit more worried and tearful and sometimes when she was coming back from work will say that people are belittling her and demeaning her.
"She used to get very stressed with some consultants when she was doing the handover because of the way they used to treat her during the handover, laughing at her for treatments and things like that.
"And she being a very senior registrar and also quite experienced and well-liked by all the others, that was becoming… it was taking a toll on her."
Dr Kumar says he hopes the Trust acts on the findings of the report.
"The first thing is to realise, accept that this has happened. The second thing is to find out why it has happened and action be taken" he said.
"It makes me angry and at the same time worried about other junior doctors who are going to follow her.
"Our lives stopped on the 22 June and it's very hard. Each day is a struggle.
"Now my main worry is to stop it happening to others and that is why I want to bring this forward so people realise that there is a toxic atmosphere".
The review into UHB has been chaired by Professor Mike Bewick, a former deputy medical director at NHS England, who is now an independent consultant.
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The Trust employs more than 20,000 people. As well as the Queen Elizabeth Hospital Birmingham it also operates Birmingham Heartlands Hospital, Good Hope Hospital in Sutton Coldfield, and Solihull Hospital.
In 2021 the Care Quality Commission rated the Trust as "requires improvement" and highlighted concerns about patient safety.
A spokesperson for University Hospitals Birmingham said: "Dr Vaishnavi Kumar was a much loved and respected doctor, who was popular with colleagues and patients alike. Her unexpected death was a tragedy and our heartfelt condolences remain with Vaishnavi's family.
"We have reflected on our response to Vaishnavi's death, have learnt lessons from this, and are acting on them.
"Dr Kumar wants his daughter's death to result in improvements in the support offered to all doctors in training and to see a change in the culture of the Trust. We are pleased that he has agreed to work with the Trust on this."
The Trust said it will respond in full to the findings of the report by Professor Bewick after it has been published.
:: Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email [email protected] in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK. | Mental Health Treatments |
Larese Jones, 9, of East Garfield Park, plays in the Crown Fountain on Michigan Avenue as temperatures spike Tuesday afternoon in Chicago.Ashlee Rezin/Sun-Times Temperatures at Midway Airport reached 100 degrees for the first time in a decade Tuesday as a heat wave belted the Chicago area, according to the National Weather Service.City leaders who gathered Tuesday morning to offer suggestions on how residents could stay safe during the heat wave recommended staying cool and drinking plenty of water.The extreme heat prompted the National Weather Service to issue an “excessive heat warning” in northern Illinois that expires Wednesday evening.By 3 p.m. Tuesday, temperatures at Midway had reached 100 degrees. It was the first time since July 2012 that the airport reached that mark, the weather service said. At O’Hare Airport, temperatures climbed to 96 degrees around 2 p.m., falling a few degrees shy of the record high for June 14 of 99 degrees set in 1987. Official temperature records for the city are measured at O’Hare.Anyone seeking a cool place should go to a city library, park district field house or one of the city’s six cooling centers.Rich Guidice, head of the city’s Office of Emergency Management and Communications, offered this advice for those who do not have air conditioning: keep shades drawn with windows slightly open, keep electric lights off or turned down, minimize the use of ovens of and stoves, wear loose, light cotton clothing and take cool baths and showers.Residents should not leave anyone, including pets, in a parked car — even for a few minutes, Guidice said during a news conference at OEMC headquarters in the West Loop.“Do not underestimate the health risks of heat and humidity, they are dangerous and, in some cases, can be deadly,” said Dr. Jennifer Seo, chief medical officer for the Chicago Department of Public Health.Residents were also encouraged to check on relatives, neighbors and vulnerable populations. If someone can’t be reached, people are encouraged to call 311 to request a well-being check, and of course, to call 911 if someone is experiencing a medical emergency.Matthew Beaudet, head of the Department of Buildings, said that building owners and managers have been asked to make sure all their cooling equipment is operating properly.Beaudet said members of his department has visited senior buildings to make sure equipment is functioning properly and if there are mechanical issues, they are “addressed swiftly.” The city will be operating six cooling areas to allow residents to get out of the heat, according to the Office of Emergency Management and Communications.These cooling areas are open from 9 a.m. to 5 p.m Monday through Friday (except for the Garfield Center, which will be open 24 hours):Englewood Center, 1140 W. 79th St.Garfield Center, 10 S. Kedzie Ave.King Center, 4314 S. Cottage Grove Ave.North Area Center, 845 W. Wilson Ave.South Chicago Center, 8650 S. Commercial Ave.Trina Davila Center, 4312 W. North Ave.Residents can also find relief in one of the city’s more than 75 Chicago Public Library locations and more than 250 Chicago Park District field houses as well as 176 splash pads.Lakefront beaches are also open. Park District pools will open later this month.People should be aware of the symptoms of heat exhaustion, a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids. Heatstroke is more serious and occurs when the body starts to lose its ability to regulate itself.The telltale signs of heatstroke:An extremely high body temperature, such as 103 degrees or aboveDizziness and nauseaA throbbing headache and a pulse that is rapid and strongSkin that is red, hot and dryA cold front will bring relief later this week. By Thursday, high temperatures will be in the low 90s, and Friday will be in the mid-80s. It could feel more like the 70s near Lake Michigan.The weekend is forecast to be sunny with highs in the 80s. Children play in the Crown Fountain on Michigan Avenue as temperatures spike Tuesday afternoon in Chicago.Ashlee Rezin/Sun-Times Children play in the Crown Fountain on Michigan Avenue on Tuesday.Ashlee Rezin/Sun-Times Emese Kovacs Taylor, on vacation from Maine, plays with her 5-year-old daughter, Aliz, Tuesday morning in the Crown Fountain on Michigan Avenue.Ashlee Rezin/Sun-Times Children play in the Crown Fountain on Michigan Avenue as temperatures spike Tuesday afternoon in Chicago.Ashlee Rezin/Sun-Times | Stress and Wellness |
More than 90% of women who are trying for a baby may have marginal or low levels of vitamins that are essential for a healthy pregnancy, according to researchers who say the problem will likely worsen as vegetarian diets become more popular.
Tests on more than 1,700 women in the UK, New Zealand and Singapore who planned to conceive revealed most were lacking nutrients found in abundance in meat and dairy products, many of which are crucial for healthy foetal development.
“We were surprised at how common low or marginal status was for these micronutrients,” said Prof Keith Godfrey, an epidemiologist and lead author on the study at the University of Southampton. “For the individual, the simple answer is that unless you’re following a really high-quality diet, you may need to consider taking a supplement.”
The women, aged 18 to 38, were recruited to the Nipper study, an international trial that is exploring whether combinations of nutrients and probiotics before and during pregnancy can improve the health of mothers and their babies.
Doctors measured blood levels of vital nutrients when the women were recruited and then randomly assigned them to receive either a standard vitamin supplement for pregnant women, which contained folic acid, beta-carotene, iron, calcium and iodine, or an enhanced version that had additional riboflavin, vitamins B6, B12 and D, probiotics, zinc and a form of sugar called myo-inositol.
Before conceiving, nine out of 10 women had marginal or low levels of folate, riboflavin, vitamin B12 or vitamin D, while many showed signs of vitamin B6 deficiency in late pregnancy, according to their report in Plos Medicine. As expected, the supplements improved the women’s vitamin levels, though not always to sufficient levels.
“More work needs to be done to identify the ideal quantities, but certainly the amounts we gave, which you can purchase over the counter at the chemist, were sufficient to substantially reduce the prevalence of deficiency,” Godfrey said.
Folic acid and vitamin D supplements are already recommended for women who are planning a pregnancy, but Wayne Cutfield, a co-author on the study and professor of paediatric endocrinology at the University of Auckland, said expectant mothers should also be given over-the-counter multivitamins.
While the study was broadly welcomed by researchers, some noted that Godfrey, Cutfield and others received grants from Nestlé and were co-inventors on patent filings around the enhanced supplement. Godfrey said the authors had no financial interest in the patents and that the analysis and paper were produced independently of the company.
Duane Mellor, a registered dietitian and senior lecturer at Aston Medical School, still had concerns, however. “The conflict of interest goes beyond the research and the paper,” he said. “It can relate to how the science is communicated after publication.”
Prof Asma Khalil, vice-president of the Royal College of Obstetricians and Gynaecologists, said the study’s finding that 90% of women had marginal or low levels of some vitamins was “concerning”. “This underscores the critical need for preconception and pregnancy supplementation, in amounts that can be bought over the counter,” she said. The RCOG advises that all women and pregnant people maintain a healthy balanced diet, and ensure they take folic acid and vitamin D supplements, she added.
“A big plus is that this is a randomised clinical trial of supplements before pregnancy,” said Prof Judith Stephenson at UCL. “The Nipper trial doesn’t provide all the answers, but if I were preparing for a pregnancy today, I would try to eat a nutritious diet, take an over-the-counter supplement, and check if I needed a higher dose of folic acid, for example if I had diabetes or obesity.”
Godfrey said the problem might become worse as society moved towards more plant-based diets, which can be low in vitamins B12 and D. “We are going to have to get our heads around fortifying foods in a more substantial way,” he said. “And we’re also going to have to get our heads around growing plant-based foods with higher levels of these micronutrients.” | Women’s Health |
A growing number of kids and teens are turning to weight loss surgery amid rising rates of pediatric obesity, according to a new study published in JAMA Pediatrics.
Between 2020 and 2021, there was a nearly 19% increase in weight loss surgeries among U.S. youths aged 10 to 19 years, as discovered by researchers from the University of Texas, University of Miami Miller School of Medicine, and University at Buffalo School of Medicine and Biomedical Sciences.
The researchers were particularly interested in looking at these trends after the American Academy of Pediatrics (AAP) released a statement in late 2019 endorsing increased access to bariatric surgery for teens, said lead study author Sarah Messiah, PhD, professor and pediatric obesity researcher at UTHealth Houston School of Public Health.
The study drew on data from across six years from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which accredits bariatric surgery centers in the U.S. and Canada.
"Historically, research shows pediatricians have been hesitant to refer their patients with severe obesity to bariatric surgery," Messiah told Fox News Digital in an email.
"Our findings show a steady increase in usage in the two years after the release of this AAP statement."
The increase was particularly high for racial and ethnic minority groups. That includes Hispanic/Latino, non-Hispanic Black/African American and others, possibly because they are "disproportionately impacted by cardiometabolic disease risk factors versus non-Hispanic Whites," Messiah said.
These risk factors include elevated blood pressure, lipids, insulin, glucose and waist circumference — all of which are risk factors for type 2 diabetes and cardiovascular disease as well as some types of cancer, she added.
The new study did have some limitations, Messiah said.
"We are always limited to the data we are analyzing in that it does not include the entire universe of all adolescents who have ever completed bariatric surgery in the U.S. during the analytical time period," she said.
"However, this dataset does include all adolescent patients who completed their surgery at a U.S. accredited center, which is the gold standard," the doctor also said.
AAP’s weight loss surgery recommendations
In January 2023, the AAP released its new pediatric obesity treatment guidelines, officially endorsing bariatric surgery and weight loss prescriptions for the first time.
"Teens age 13 and older with severe obesity (BMI ≥120% of the 95th percentile for age and sex) should be evaluated for metabolic and bariatric surgery," the guidelines stated.
There are four main types of bariatric surgery, according to the Cleveland Clinic: gastric bypass, sleeve gastrectomy, gastric band and duodenal switch.
There was a lot of resistance to the AAP’s recommendation, Messiah pointed out.
"However, our analysis would suggest that families are following their own path in terms of deciding to move forward with surgery for their adolescent," she said.
"It will be important that we support these families moving forward to ensure the best health outcomes for their adolescents as they age into adulthood."
Guidelines vary across hospitals
Children’s Mercy Hospital in Kansas City, Missouri, offers a laparoscopic sleeve gastrectomy.
Billed as a minimally invasive procedure, it involves removing a large portion of the stomach to suppress hunger, according to its website.
"People see it as ‘the easy way out,’ but it's honestly the only way out for 95% of people who are morbidly obese."
The hospital recommends exploring weight loss surgery for children who are at least 5 years old, have a BMI of at least 40 (or above 35 with other medical conditions) and have had at least six months of "supervised medical weight loss therapy."
Cincinnati Children’s Hospital in Ohio also has a bariatric surgery program, but its website states that it’s for "severely obese adolescents who haven’t had success with behavioral and nutritional approaches to weight loss."
Nationwide Children’s Hospital in Columbus, Ohio, offers two types of bariatric surgery: gastric bypass and gastric sleeve.
The website doesn’t specify a minimum age requirement, but patients must be at least 100 pounds over their "ideal body weight."
Opinions, experiences vary
Patients and physicians have gone online to share experiences and opinions on pediatric weight loss surgery.
These run the gamut from success stories to cautionary tales.
One bariatric surgeon on Reddit voiced concern about misconceptions of the procedure.
"People see it as ‘the easy way out,’ but it's honestly the only way out for 95% of people who are morbidly obese," the doctor wrote.
"Your metabolic rate will slow down significantly if you try to diet and lose weight, and your progress will slow down — and weight regain is almost inevitable. Bariatric surgery doesn't do that, and something like the gastric bypass hardwires in a malabsorptive component that can't be overridden."
"All the medical options need to be exhausted before they consider surgery, because surgery is irreversible."
"Do I think we should do bariatric surgery in teenagers? I won't be doing it any time soon, but I think that in a controlled setting with IRB approval, it is appropriate," the surgeon continued, referring to Institutional Review Boards.
"We have an entire demographic of teenagers with type 2 diabetes, obstructive sleep apnea and serious joint pains because of their weight," the surgeon also wrote. "It would be ignorant to overlook an obvious treatment for those conditions."
Another poster, however, shared that her friend opted for the bypass procedure at 16 years old and did not have a good experience.
"She’s now 26 and has gained all the weight back and more," she wrote.
"Her brain wasn’t done developing and she wasn’t mature enough to understand the consequences of such major surgery and to stick to the guidelines and deal with her disordered eating."
"With bariatric surgery, you're altering the anatomy of the GI tract."
Meanwhile, a surgery intern in a private hospital posted that the facility had performed an "astonishingly high number of bariatric cases" and recalled seeing many complications — even when very skilled surgeons did the procedures.
Weight loss doctor urges caution
Dr. Sue Decotiis, a triple board-certified weight loss physician in New York City, warned of the potential dangers of these surgeries in children and teens, given their "irreversible nature."
She told Fox News Digital, "With bariatric surgery, you're altering the anatomy of the GI tract, and that anatomy — if it's a bypass — can never be returned [to its original state]."
She added, "That means the individual is never going to be able to eat regular meals because the anatomy of the stomach has changed."
Another potential problem is that after the anatomy of the stomach is altered, Decotiis said, the person won’t be able to eat as much high-nutrition and high-fiber food because they will feel full immediately.
"This can make them gravitate toward processed foods because those are a lot easier to get down," she said.
Before going the surgery route for a child or teen, Decotiis recommends first making dietary changes, such as cutting out sodas and sugary foods and slowly introducing more nutritious fare.
And in the case of teens with severe obesity, the doctor pointed out that if they start with some of the newer weight loss medications that are available, surgery might not be necessary.
"All the medical options need to be exhausted before they consider surgery, because surgery is irreversible," Decotiis said.
The only exception, she said, is if the child or teen is "morbidly obese" (now known as Class III obesity, which is when a person has a BMI of 40 or higher, or 35 or higher along with obesity-related health conditions, per the Cleveland Clinic).
"Otherwise, it's not worth it because they will likely gain the weight back — and since their anatomy has been disturbed, getting proper nutrients will be difficult in the future." | Weightlifting & Bodybuilding |
A new Covid variant that is causing concern among scientists due to its large number of mutations has been detected in London.
The variant, dubbed BA.2.86, has been detected through genetic sequencing, although only a handful of such sequences have so far been reported. The first was reported in Israel, with the variant since being detected in Denmark and the US.
Now UK Health Security Agency (UKHSA) has confirmed the variant has been detected in the UK, making it the fifth such sequence worldwide to be reported.
“We are aware that BA.2.86 has been detected in the UK. UKHSA is assessing the situation and will provide further information in due course,” said Dr Meera Chand, deputy director at UKHSA.
The World Health Organisation announced on Thursday that it was designating it a “variant under monitoring” – while the US Centers for Disease Control and Prevention (CDC) has similarly reported that it is keeping a close eye on the variant after it was discovered in Michigan.
It is currently unclear whether the variant causes more severe disease than those that came before, or whether it will take off and become the dominant form of the virus.
But its many genetic changes – it has more than 30 mutations in the spike protein relative to the current predominant variant – and its detection in several countries, has put scientists on alert.
Prof Francois Balloux, director of the UCL Genetics Institute, said BA.2.86 was the most striking Covid strain the world has witnessed since the emergence of Omicron.
“The most plausible scenario is that the lineage acquired its mutations during a long-term infection in a immunocompromised person over a year ago and then spread back into the community,” he said.
“BA.2.86 has since then probably been circulating in a region of the world with poor viral surveillance, and has now been repeatedly exported to other places in the world.”
Balloux added that how well the new variant fared relative to other Omicron subvariants would become clearer in the coming weeks.
“Nothing is known at this stage about its intrinsic transmissibility and virulence,” he said.
“A priori, it is not expected to behave differently from current Omicron strains in circulation. Even in the worst case scenario where BA.2.86 caused a major new wave of cases, we are not expecting to witness comparable levels of severe disease and death as we did earlier in the pandemic when the Alpha, Delta or Omicron variants spread,” he added noting most people have now been vaccinated, infected with Covid, or both.
But, he said: “It remains that a large wave of infection by BA.2.86, or any future comparable variant, would be an unwelcome event.”
Prof Tom Wenseleers, an evolutionary biologist at the Catholic University of Leuven in Belgium, agreed.
“I would be very surprised if the high levels of population immunity would not keep on protecting us well against severe disease,” he said. “But all in all I would say it is relatively likely that this variant might cause an infection wave, even though right now it is impossible to say exactly how large, and also what the impact on hospitalisations will be.”
Prof Rowland Kao, an epidemiologist at the University of Edinburgh, said the appearance of a potential new variant of concern was not a surprise. “But,” he added, “ it doesn’t mean we are well prepared for it now.”
Among other issues, Kao said Covid appears to be on the rise once more, with hospitalisations also increasing. That, he added, was without evidence the new variant was a factor.
“We should expect that the usual combination of autumn return to school and university and work play a part, as well as possibly the seasonal factors,” said Kao. “Plus the bulk of vaccinations have now been some time ago, and even the most vulnerable are likely approaching the point where immune protection is fading.”
BA.2.86, Kao said, could potentially add to the pressures, noting that one worry was whether the variant would evade past immune protection and was sufficiently different as to make vaccines less effective.
“There is a good chance we are in for a bumpy ride, which will only be bumpier if this variant presents any added twists,” he said. | Epidemics & Outbreaks |
Cheryl Wilson went from running 5K races to struggling to walk a few blocks.
When it happened, Wilson, a 63-year-old wellness coach from Chesapeake, VA, shrugged it off as a charley horse. But the pain persisted for weeks and made walking unbearable. So Wilson finally went to see her doctor.
âAnytime I walked a short distance, I would get leg pain,â Wilson says. âIt was in my calf, behind the knee.â
In 2009, Wilson was diagnosed with peripheral artery disease (PAD). She had never heard of the condition, which affects 6.5 million adults over the age of 40. PAD happens when the arteries that transport blood from your heart to the rest of your body narrow. It can lead to sticky plaque buildup that can block blood flow and cause pain.
Wilson started her treatment plan, which included stents to expand the narrowed arteries in her legs, would be âone and done.â
Instead, 1 month after her initial procedure, Wilson was back in the cardiac catheterization lab so that her doctors could implant additional stents to keep her arteries open. They also prescribed cholesterol medication and blood thinners to improve blood flow and reduce the risks of heart attack and stroke.
The ordeal marked Wilsonâs realization that PAD âwasnât curable.â
Wilson learned that lifestyle changes could help ease the leg pain and prevent more damage. She focused on eating a balanced diet and started working out regularly again. She also quit smoking, which is linked to higher risk of more severe PAD, including a higher risk of amputation.
Walk More, Hurt Less
Wilson had been very active before her leg pains started. In fact, Wilsonâs cardiologist often used to see her walking on the treadmill at their gym. After Wilsonâs diagnosis, her doctor encouraged her to resume her solo workouts.
âYes, I was slow and it hurt and I would stop, but I wouldnât give up,â Wilson says.
Studies show that walking programs for PAD should hurt, at least a little. Researchers found that a high-intensity walking routine that increased leg pain led to more improvements in walking distance than a low-intensity walking routine.
âThe simplest and most successful treatment (for leg and arm pain) is supervised exercise therapy,â says Michael H. Criqui, MD, MPH, distinguished professor emeritus at the University of California, San Diego, School of Medicine. âPeople who undergo supervised exercise therapy will be able to walk longer and do more with PAD.â
The structured exercise program may include walking on the treadmill, cycling, and strength training for 30-45 minutes at least three times per week for 12 weeks.
âOnce you learn that it works and you stick with it, you can see changes in 3 to 4 weeks,â Criqui adds. The results can be âbetter than youâll get with medicines.â
Joshua Beckman, MD, professor of medicine at Vanderbilt University in Nashville and chairperson of the American Heart Association Vascular Health Advisory Committee, suggests a âslow and steadyâ approach to establishing a walking workout.
âWalk until you feel discomfort, stop and rest, and then start walking again,â Beckman says.
Thatâs the advice Wilson followed. She kept walking even when her pain was so bad that she wanted to give up. In 2020, 4 months after undergoing bypass surgery for PAD, she crossed the finish line of another 5K race.
âIt was a good ego booster that I could do it,â she says.
Other Treatment Options
Sometimes exercise alone may not be enough to banish arm and leg pain. Your doctor may prescribe medications to lower cholesterol or to thin your blood. Beckman says other drugs can help increase blood flow, lower pain, and help you walk farther.
A medical procedure called revascularization, which uses tiny balloons or stents to open the arteries, might also be needed, Beckman says.
For Wilson, her commitment to no smoking, eating clean, exercising, and taking her medications helped her return to her favorite activities.
âI think the thing that made me push harder was wanting my quality of life back,â Wilson says. When she got diagnosed, the pain kept her from running races -- an important part of her profession as a wellness coach.
âThose are the things people look up to you for,â she says. âSo I got back out there, took responsibility for my health and it worked.â | Disease Research |
Ingestible electronic device detects breathing depression in patients
Diagnosing sleep disorders such as sleep apnea usually requires a patient to spend the night in a sleep lab, hooked up to a variety of sensors and monitors. Researchers from MIT, Celero Systems, and West Virginia University hope to make that process less intrusive, using an ingestible capsule they developed that can monitor vital signs from within the patient's GI tract.
The capsule, which is about the size of a multivitamin, uses an accelerometer to measure the patient's breathing rate and heart rate. In addition to diagnosing sleep apnea, the device could also be useful for detecting opioid overdoses in people at high risk, the researchers say.
"It's an exciting intervention to help people be diagnosed and then receive the appropriate treatment if they suffer from obstructive sleep apnea," says Giovanni Traverso, an associate professor of mechanical engineering at MIT and a gastroenterologist at Brigham and Women's Hospital.
"The device also has the potential for early detection of changes in respiratory status, whether it's a result of opiates or other conditions that could be monitored, like asthma or chronic obstructive pulmonary disease (COPD)."
In a study of 10 human volunteers, the researchers showed that the capsule can be used to monitor vital signs and to detect sleep apnea episodes, which occur when the patient repeatedly stops and starts breathing during sleep. The patients did not show any adverse effects from the capsule, which passed harmlessly through the digestive tract.
Traverso is one of the senior authors of the study, along with Robert Langer, an MIT Institute Professor and member of MIT's Koch Institute for Integrative Cancer Research; Victor Finomore, director of the Human Performance and Applied Neuroscience Research Center at the West Virginia University School of Medicine; and Ali Rezai, director of the Rockefeller Neuroscience Institute at the West Virginia University School of Medicine. The paper appears in the journal Device.
Vital sign measurements
Over the past decade, Traverso and Langer have developed a range of ingestible sensors that could be used to monitor vital signs and diagnose disorders of the GI tract, such as gastrointestinal slowdown and inflammatory bowel diseases.
This new study focused on measuring vital signs, using a capsule developed by Celero Systems that includes an accelerometer that detects slight movements generated by the beating of the heart and the expansion of the lungs. The capsule also contains two small batteries and a wireless antenna that transmits data to an external device such as a laptop.
In tests in an animal model, the researchers found that this capsule could accurately measure breathing rate and heart rate. In one experiment, they showed that the sensor could detect the depression of breathing rate that resulted from a large dose of fentanyl, an opioid drug.
Building on those results, the researchers decided to further test the capsule in a clinical trial at the West Virginia University Rockefeller Neuroscience Institute. Ten patients who enrolled in the study were monitored using the ingestible capsule, and these patients were also connected to the sensors typically used to monitor sleep, so the researchers could compare measurements from both types of sensors.
The researchers found that their ingestible sensor was able to accurately measure both breathing rate and heart rate, and it also detected a sleep apnea episode that one of the patients experienced.
"What we were able to show is that using the capsule, we could capture data that matched what the traditional transdermal sensors would capture," Traverso says. "We also observed that the capsule could detect apnea, and that was confirmed with standard monitoring systems that are available in the sleep lab."
In this study, the researchers monitored signals emitted by the capsule while it was in the stomach, but in a previous study, they showed that vital signs can also be measured from other parts of the GI tract.
"The stomach generally offers some of the best signals, mainly because it's close to the heart and the lungs, but we know that we can also sense them elsewhere," Traverso says.
None of the patients reported any discomfort or harm from the capsule. Radiographic imaging performed 14 days after the capsules were ingested revealed that all of them had passed through the patients' bodies. The research team's previous work has shown that objects of similar size usually move through the digestive tract in a little more than a day.
Close monitoring
The researchers envision that this kind of sensor could be used to diagnose sleep apnea in a less intrusive way than the skin-based sensors that are now used. It could also be used to monitor patients when they begin treatment for apnea, to make sure that the treatments are effective.
Celero Systems, a company founded by Traverso, Langer, Jeremy Ruskin, a professor of medicine at Harvard Medical School, and Benjamin Pless, now CEO of the company, is now working on sensors that could be used to detect sleep apnea or opioid overdose.
"We know that people who have had an overdose are at higher risk of recurrence, so those individuals could be monitored more closely so that in the event of another overdose, someone could help them," Traverso says.
In future work, the researchers hope to incorporate an overdose reversal agent such as nalmefene into the device, so that drug release would be triggered when the person's breathing rate slowed or stopped. They are also working on strategies to lengthen the amount of time that the capsules could remain in the stomach.
Authors of the paper also include Pless, James Mahoney, Justin Kupec, Robert Stansbury, Daniel Bacher, Shannon Schuetz, and Alison Hayward.
More information: First-in-human trial of an ingestible vitals monitoring pill, Device (2023). DOI: 10.1016/j.device.2023.100125. www.cell.com/device/fulltext/S2666-9986(23)00184-9
This story is republished courtesy of MIT News (web.mit.edu/newsoffice/), a popular site that covers news about MIT research, innovation and teaching. | Medical Innovations |
Revealing structural secrets of a key cancer protein
Scientists have breathed new life into the study of a protein with an outsized link to human cancers because of its dangerous mutations, using advanced research techniques to detect its hidden regions.
The Ras family of proteins are enzymes that set in motion the growth, division and differentiation of many types of cells, and their genes have been identified as the most frequently mutated cancer-related genes in humans. The subject of this study, the K-Ras protein, is linked to 75% of all Ras-associated cancers.
Researchers at The Ohio State University are the first to detect a section of this protein's structure that had previously been unobservable by standard lab tools, revealing features and interactions related to the protein's mutations that put cells into a state of perpetual division—a classic cancer characteristic.
"We know these mutations are a significant problem: They cause deaths," said senior study author Rafael Brüschweiler, Ohio Research Scholar and professor of chemistry and biochemistry at Ohio State. "We know that structural biology can provide unique insights into the mechanisms of those mutations and can stimulate the search for potential cures."
"We now have a more complete picture of what this protein does, which means we can start thinking about how to neutralize it once it's in its mutated form. Information in this sense is power, and this information is out there now so that we and other researchers can use it and start to hypothesize."
The study was published recently in the journal Nature Structural & Molecular Biology.
Despite existing knowledge about K-Ras and its key functional relationships with molecules related to cell health, the protein has been deemed "undruggable" because its configuration—both in normal and mutated forms—hides sites in its structure that would be most promising as therapeutic targets. Precision is required when designing such drugs—interfering with a protein in the wrong way could do more harm than the disease caused by a mutation.
"K-Ras is the holy grail of cancer research—probably one of the most studied biological molecules worldwide because it plays such a key role in many cancers," Brüschweiler said. "But it has also been a huge challenge."
Brüschweiler and colleagues reported in 2019 on a technique that enabled observation of proteins that move too slowly to be detected by standard nuclear magnetic resonance (NMR) spectroscopy. The team decided a year later to begin applying those findings to the hunt for K-Ras's secret hiding places.
Standard NMR can follow a fast-acting protein but has trouble with a longer time scale of movement and interactions, and X-ray crystallography used to define protein structures does better with less movement and more time. Brüschweiler and colleagues could take into account both the dynamic nature of K-Ras as well as its interaction with the reactive ligand (GTP), first detecting faint signals from the hidden regions and then optimizing NMR experiments to strengthen those signals.
The study revealed two "switch" regions—tellingly, both located near a protein loop where the most dangerous mutations occur—in the K-Ras structure that had not been visible before. The team also established the complex structural dynamics behavior of the protein "backbone" that amplified additional features close to the switches. The backbone is essential to understanding a protein's structural properties—from there, characterizing amino acid side chains "is relatively straightforward," Brüschweiler said.
The experiments also added clarity to how the normal protein and its mutated forms differ: Under normal circumstances, K-Ras is more active when it is bound to the first of two partner molecules and maintains proper control of multiple cellular functions, including the return to an inactive state. When mutated, K-Ras gets stuck in the active phase and never takes a rest.
"We need active cells, but at some point they have to stop. Otherwise it's like never taking the foot off the accelerator in a car—at some point, you need to take your foot off because it's going too fast," he said. "That's the basic problem, that these mutations induce nonstop activity of the cell."
With the mutation-related switch regions now characterized, researchers have new drug targets to consider that could stifle the mutations without hampering K-Ras's essential cell functions.
"The switches and related areas where the switches interact are new candidates, which we now can monitor at unprecedented detail," Brüschweiler said. "This may not change the world overnight, but this is fundamentally new knowledge that has the potential to impact the health of human beings."
Brüschweiler has his own thoughts on what might come next, such as describing how existing drugs interact with the protein. Future work by his team and others will be supported by a new NMR instrument with a magnetic field of 1.2 gigahertz—which will be the most powerful NMR instrument in the United States—that has just arrived at Ohio State, where Brüschweiler is the principal investigator of the National Gateway Ultrahigh Field NMR Center.
More information: Alexandar L. Hansen et al, Excited-state observation of active K-Ras reveals differential structural dynamics of wild-type versus oncogenic G12D and G12C mutants, Nature Structural & Molecular Biology (2023). DOI: 10.1038/s41594-023-01070-z
Journal information: Nature Structural & Molecular Biology
Provided by The Ohio State University | Disease Research |
The World Health Organization said it has confirmed sexual transmission of mpox in the Democratic Republic of Congo for the first time as the country experiences its biggest outbreak, a worrying development that African scientists warn could make it more difficult to stop the disease.
In a statement issued late Thursday, the U.N. health agency said a resident of Belgium traveled to Congo in March and tested positive for mpox, or monkeypox, shortly afterward. The WHO said the individual "identified himself as a man who has sexual relations with other men" and that he had gone to several underground clubs for gay and bisexual men.
Among his sexual contacts, five later tested positive for mpox, the WHO said.
"This is the first definitive proof of sexual transmission of monkeypox in Africa," said Oyewale Tomori, a Nigerian virologist who sits on several WHO advisory groups. "The idea that this kind of transmission could not be happening here has now been debunked."
Mpox has been endemic in parts of central and west Africa for decades, where it mostly jumped into humans from infected rodents and caused limited outbreaks. Last year, epidemics triggered mainly by sex among gay and bisexual men in Europe hit more than 100 countries. The WHO declared the outbreak as a global emergency, and it has caused about 91,000 cases to date.
The WHO noted there were dozens of discrete clubs in Congo where men have sex with other men, including members who travel to other parts of Africa and Europe. The agency described the recent mpox outbreak as unusual and said it highlighted the risk the disease could spread widely among sexual networks.
The WHO added that the mpox outbreak this year in Congo, which has infected more than 12,500 people and killed about 580, also marked the first time the disease has been identified in the capital, Kinshasa, and in the conflict-ridden province of South Kivu. Those figures are roughly double the mpox toll in 2020, making it Congo's biggest outbreak, the WHO said.
Virologist Tomori said that even those figures were likely an underestimate and had implications for the rest of Africa, given the continent's often patchy disease surveillance.
"What's happening in Congo is probably happening in other parts of Africa," he said. "Sexual transmission of monkeypox is likely established here, but [gay] communities are hiding it because of the draconian [anti-LGBTQ+] laws in several countries."
He warned that driving people at risk for the virus underground would make the disease harder to curb.
The mpox virus causes fever, chills, rash and lesions on the face or genitals. Most people recover within several weeks without requiring hospitalization.
The WHO said the risk of mpox spreading to other countries in Africa and globally "appears to be significant," adding that there could be "potentially more severe consequences" than the worldwide epidemic last year.
Tomori lamented that while the mpox outbreaks in Europe and North America prompted mass immunization campaigns among affected populations, no such plans were being proposed for Africa.
"Despite the thousands of cases in Congo, no vaccines have arrived," he said. Even after mpox epidemics subsided in the West, few shots or treatments were made available for Africa.
"We have been saying for years in Africa that monkeypox is a problem," he said. "Now that sexual transmission has been confirmed here, this should be a signal to everyone to take it much more seriously." | Epidemics & Outbreaks |
For more than 20 years, the National Eating Disorders Association has operated a phone line and online platform for people seeking help for anorexia, bulimia, and other eating disorders. Last year, nearly 70,000 individuals used the help line.
NEDA shuttered that service in May, saying that, in its place, a chatbot called Tessa, designed by eating disorder experts with funding from NEDA, would be deployed.
When NPR aired a report about this last month, Tessa was up and running online. Since then, both the chatbot’s page and a NEDA article about Tessa have been taken down. When asked why, NEDA said the bot is being “updated,” and the latest “version of the current program [will be] available soon.”
Then NEDA announced on May 30 that it was indefinitely disabling Tessa. Patients, families, doctors, and other experts on eating disorders were stunned. The episode has set off a fresh wave of debate as companies turn to artificial intelligence as a possible solution for a mental health crisis and treatment shortage.
Paid staffers and volunteers for the NEDA help line said that replacing the service with a chatbot could further isolate the thousands of people who use it when they feel they have nowhere else to turn.
“These young kids … don’t feel comfortable coming to their friends or their family or anybody about this,” said Katy Meta, a 20-year-old college student who has volunteered for the help line. “A lot of these individuals come on multiple times because they have no other outlet to talk with anybody. … That’s all they have, is the chat line.”
The decision is part of a larger trend: Many mental health organizations and companies are struggling to provide services and care in response to a sharp escalation in demand, and some are turning to chatbots and AI, even though clinicians are still trying to figure out how to effectively deploy them, and for what conditions.
The help line’s five staffers formally notified their employer they had formed a union in March. Just a few days later, on a March 31 call, NEDA informed them that they would be laid off in June. NPR and KFF Health News obtained audio of the call. “We will, subject to the terms of our legal responsibilities, [be] beginning to wind down the help line as currently operating,” NEDA board chair Geoff Craddock told them, “with a transition to Tessa, the AI-assisted technology, expected around June 1.”
NEDA’s leadership denies the decision had anything to do with the unionization but told NPR and KFF Health News it became necessary because of the covid-19 pandemic, when eating disorders surged and the number of calls, texts, and messages to the help line more than doubled.
The increase in crisis-level calls also raises NEDA’s legal liability, managers explained in an email sent March 31 to current and former volunteers, informing them that the help line was ending and that NEDA would “begin to pivot to the expanded use of AI-assisted technology.”
“What has really changed in the landscape are the federal and state requirements for mandated reporting for mental and physical health issues (self-harm, suicidality, child abuse),” according to the email, which NPR and KFF Health News obtained. “NEDA is now considered a mandated reporter and that hits our risk profile — changing our training and daily work processes and driving up our insurance premiums. We are not a crisis line; we are a referral center and information provider.”
Pandemic Created a ‘Perfect Storm’ for Eating Disorders
When it was time for a volunteer shift on the help line, Meta usually logged in from her dorm room at Dickinson College in Pennsylvania.
Meta recalled a recent conversation on the help line’s messaging platform with a girl who said she was 11. The girl said she had just confessed to her parents that she was struggling with an eating disorder, but the conversation had gone badly.
“The parents said that they ‘didn’t believe in eating disorders’ and [told their daughter], ‘You just need to eat more. You need to stop doing this,’” Meta recalled. “This individual was also suicidal and exhibited traits of self-harm as well. … It was just really heartbreaking to see.”
Eating disorders are common, serious, and sometimes fatal illnesses. An estimated 9% of Americans experience an eating disorder during their lifetimes. Eating disorders also have some of the highest mortality rates among mental illnesses, with an estimated death toll of more than 10,000 Americans each year.
But after covid hit, closing schools and forcing people into prolonged isolation, crisis calls and messages like the one Meta describes became far more frequent on the help line.
In the U.S., the rate of pediatric hospitalizations and ER visits surged. On the NEDA help line, client volume increased by more than 100% compared with pre-pandemic levels.
“Eating disorders thrive in isolation, so covid and shelter-in-place was a tough time for a lot of folks struggling,” explained Abbie Harper, who has worked as a help line associate.
Until a few weeks ago, the help line was run by just five to six paid staffers and two supervisors, and it depended on a rotating roster of 90-165 volunteers at any given time, according to NEDA.
Yet even after lockdowns ended, NEDA’s help line volume remained elevated above pre-pandemic levels, and the cases continued to be clinically severe. Staffers felt overwhelmed, undersupported, and increasingly burned out, and turnover increased, according to multiple interviews.
The help line staff formally notified NEDA that their unionization vote had been certified on March 27. Four days later, they learned their positions were being eliminated.
“Our volunteers are volunteers,” said Lauren Smolar, NEDA’s vice president of mission and education. “They’re not professionals. They don’t have crisis training. And we really can’t accept that kind of responsibility.” Instead, she said, people seeking crisis help should be reaching out to resources like 988, a 24/7 suicide and crisis hotline that connects people with trained counselors.
The surge in volume also meant the help line was unable to respond immediately to 46% of initial contacts, and it could take six to 11 days to respond to messages.
“And that’s frankly unacceptable in 2023, for people to have to wait a week or more to receive the information that they need, the specialized treatment options that they need,” Smolar said.
After learning in the March 31 email that the helpline would be phased out, volunteer Faith Fischetti, 22, tried out the chatbot on her own, asking it some of the more frequent questions she gets from users. But her interactions with Tessa were not reassuring: “[The bot] gave links and resources that were completely unrelated” to her questions, she said.
Fischetti’s biggest worry is that someone coming to the NEDA site for help will leave because they “feel that they’re not understood, and feel that no one is there for them. And that’s the most terrifying thing to me.”
A Chatbot Can Miss Red Flags
Tessa the chatbot was created to help a specific cohort: people with eating disorders who never receive treatment.
Only 20% of people with eating disorders get formal help, according to Ellen Fitzsimmons-Craft, a psychologist and associate professor at Washington University School of Medicine in St. Louis. Her team created Tessa after receiving funding from NEDA in 2018, with the goal of looking for ways technology could help fill the treatment gap.
NEDA said Tessa was supposed to be a “rule-based” chatbot, meaning one that is programmed with a limited set of possible responses. It is not ChatGPT and cannot generate unique answers in response to specific queries. “So she can’t go off the rails, so to speak,” Fitzsimmons-Craft said.
The plan was for Tessa to guide users through an interactive, weeks-long course about body positivity, based on cognitive behavioral therapy tools. Additional content about bingeing, weight concerns, and regular eating was under development but not yet available to users.
There’s evidence the AI approach can help. Fitzsimmons-Craft’s team did a small study that found college students who interacted with Tessa had significantly greater reductions in “weight/shape concerns” than a control group at three- and six-month follow-ups.
But even the best-intentioned technology can carry risks. Fitzsimmons-Craft’s team published a different study looking at ways the chatbot “unexpectedly reinforced harmful behaviors at times.” For example, the chatbot would give users a prompt: “Please take a moment to write about when you felt best about your body?”
Responses included: “When I was underweight and could see my bones.” “I feel best about my body when I ignore it and don’t think about it at all.”
The chatbot seemed to ignore the troubling aspects of such responses — and even to affirm negative thinking — when it would reply: “It is awesome that you can recognize a moment when you felt confident in your skin, let’s keep working on making you feel this good more often.”
Researchers were able to troubleshoot some of those issues. But the chatbot still missed red flags, the study found, such as when it asked: “What is a small healthy eating habit goal you would like to set up before you start your next conversation?”
One user replied, “Don’t eat.”
“Take a moment to pat yourself on the back for doing this hard work, <<USER>>!” the chatbot responded.
Massachusetts Institute of Technology assistant professor Marzyeh Ghassemi has seen issues like this crop up in her own research developing machine learning to improve health.
Large language models and chatbots will inevitably make mistakes, but “sometimes they tend to be wrong more often for certain groups, like women and minorities,” she said.
If people receive bad advice or instructions from a bot, “people sometimes have a difficulty not listening to it,” Ghassemi added. “I think it sets you up for this really negative outcome … especially for a mental health crisis situation, where people may be at a point where they’re not thinking with absolute clarity. It’s very important that the information that you give them is correct and is helpful to them.”
And if the value of the live help line was the ability to connect with a real person who deeply understands eating disorders, Ghassemi said, a chatbot can’t do that.
“If people are experiencing a majority of the positive impact of these interactions because the person on the other side understands fundamentally the experience they’re going through, and what a struggle it’s been, I struggle to understand how a chatbot could be part of that.”
Tessa Goes ‘Off the Rails’
When Sharon Maxwell heard NEDA was promoting Tessa as “a meaningful prevention resource” for those struggling with eating disorders, she wanted to try it out.
Maxwell, based in San Diego, had struggled for years with an eating disorder that began in childhood. She now works as a consultant in the eating disorder field. “Hi, Tessa,” she typed into the online text box. “How do you support folks with eating disorders?”
Tessa rattled off a list of ideas, including resources for “healthy eating habits.” Alarm bells immediately went off in Maxwell’s head. She asked Tessa for details. Before long, the chatbot was giving her tips on losing weight — ones that sounded an awful lot like what she’d been told when she was put on Weight Watchers at age 10.
“The recommendations that Tessa gave me were that I could lose 1 to 2 pounds per week, that I should eat no more than 2,000 calories in a day, that I should have a calorie deficit of 500-1,000 calories per day,” Maxwell said. “All of which might sound benign to the general listener. However, to an individual with an eating disorder, the focus of weight loss really fuels the eating disorder.”
It’s really important that you find what healthy snacks you like the most, so if it’s not a fruit, try something else!Tessa, the chatbot
NEDA blamed the chatbot’s issues on Cass, the mental health chatbot company that operated Tessa as a free service. Cass had changed Tessa without NEDA’s awareness or approval, said NEDA CEO Liz Thompson, enabling the chatbot to generate new answers beyond what Tessa’s creators had intended.
Cass’ founder and CEO, Michiel Rauws, said the changes to Tessa were made last year as part of a “systems upgrade,” including an “enhanced question-and-answer feature.” That feature uses generative artificial intelligence — meaning it gives the chatbot the ability to use new data and create new responses.
That change was part of NEDA’s contract, Rauws said.
But Thompson disagrees. She told NPR and KFF Health News that “NEDA was never advised of these changes and did not and would not have approved them.”
“The content some testers received relative to diet culture and weight management, [which] can be harmful to those with eating disorders, is against NEDA policy, and would never have been scripted into the chatbot by eating disorders experts,” she said.
Complaints About Tessa Started Last Year
NEDA was aware of issues with the chatbot months before Maxwell’s interactions with Tessa in late May.
In October 2022, NEDA passed along screenshots from Monika Ostroff, executive director of the Multi-Service Eating Disorders Association in Massachusetts. They showed Tessa telling Ostroff to avoid “unhealthy” foods and eat only “healthy” snacks, like fruit.
“It’s really important that you find what healthy snacks you like the most, so if it’s not a fruit, try something else!” Tessa told Ostroff. “So the next time you’re hungry between meals, try to go for that instead of an unhealthy snack like a bag of chips. Think you can do that?”
Ostroff said this was a clear example of the chatbot encouraging “diet culture” mentality. “That meant that they [NEDA] either wrote these scripts themselves, they got the chatbot and didn’t bother to make sure it was safe and didn’t test it, or released it and didn’t test it,” she said.
The healthy-snack language was quickly removed after Ostroff reported it. But Rauws said that language was part of Tessa’s “pre-scripted language, and not related to generative AI.”
Fitzsimmons-Craft said her team didn’t write it, that it “was not something our team designed Tessa to offer and that it was not part of the rule-based program we originally designed.”
Then, earlier this year, “a similar event happened as another example,” Rauws said.
“This time it was around our enhanced question-and-answer feature, which leverages a generative model. When we got notified by NEDA that an answer text it provided fell outside their guidelines,” it was addressed right away, he said.
Rauws said he can’t provide more details about what this event entailed.
“This is another earlier instance, and not the same instance as over the Memorial Day weekend,” he said via email, referring to Maxwell’s interactions with Tessa. “According to our privacy policy, this is related to user data tied to a question posed by a person, so we would have to get approval from that individual first.”
When asked about this event, Thompson said she doesn’t know what instance Rauws is referring to.
Both NEDA and Cass have issued apologies.
Ostroff said that regardless of what went wrong, the impact on someone with an eating disorder is the same. “It doesn’t matter if it’s rule-based or generative, it’s all fat-phobic,” she said. “We have huge populations of people who are harmed by this kind of language every day.”
She also worries about what this might mean for the tens of thousands of people turning to NEDA’s help line each year.
Thompson said NEDA still offers numerous resources for people seeking help, including a screening tool and resource map, and is developing new online and in-person programs.
“We recognize and regret that certain decisions taken by NEDA have disappointed members of the eating disorders community,” she wrote in an emailed statement. “Like all other organizations focused on eating disorders, NEDA’s resources are limited and this requires us to make difficult choices. … We always wish we could do more and we remain dedicated to doing better.” | Mental Health Treatments |
Increasing Threat of Spread of Antimicrobial-resistant Fungus in Healthcare Facilities
For Immediate Release: Monday, March 20, 2023
Contact: Media Relations
(404) 639-3286
Candida auris (C. auris), an emerging fungus considered an urgent antimicrobial resistance (AR) threat, spread at an alarming rate in U.S. healthcare facilities in 2020-2021, according to data from the Centers for Disease Control and Prevention (CDC) published in the Annals of Internal Medicine. Equally concerning was a tripling in 2021 of the number of cases that were resistant to echinocandins, the antifungal medicine most recommended for treatment of C. auris infections. In general, C. auris is not a threat to healthy people. People who are very sick, have invasive medical devices, or have long or frequent stays in healthcare facilities are at increased risk for acquiring C. auris. CDC has deemed C. auris as an urgent AR threat, because it is often resistant to multiple antifungal drugs, spreads easily in healthcare facilities, and can cause severe infections with high death rates.
“The rapid rise and geographic spread of cases is concerning and emphasizes the need for continued surveillance, expanded lab capacity, quicker diagnostic tests, and adherence to proven infection prevention and control,” said CDC epidemiologist Dr. Meghan Lyman, lead author of the paper.
As further explained in the article, C. auris has spread in the United States since it was first reported in 2016, with a total of 3,270 clinical cases (in which infection is present) and 7,413 screening cases (in which the fungus is detected but not causing infection) reported through December 31, 2021. Clinical cases have increased each year since 2016, with the most rapid rise occurring during 2020-2021. CDC has continued to see an increase in case counts for 2022. During 2019-2021, 17 states identified their first C. auris case ever. Nationwide, clinical cases rose from 476 in 2019 to 1,471 in 2021. Screening cases tripled from 2020 to 2021, for a total of 4,041. Screening is important to prevent spread by identifying patients carrying the fungus so that infection prevention controls can be used.
C. auris case counts have increased for many reasons, including poor general infection prevention and control (IPC) practices in healthcare facilities. Case counts may also have increased because of enhanced efforts to detect cases, including increased colonization screening, a test to see if someone has the fungus somewhere on their body but does not have an infection or symptoms of infection. The timing of this increase and findings from public health investigations suggest C. auris spread may have worsened due to strain on healthcare and public health systems during the COVID-19 pandemic.
The CDC’s Antimicrobial Resistance Laboratory Network, which provides nationwide lab capacity to rapidly detect antimicrobial resistance and inform local responses to prevent spread and protect people, provided some of the data for this report. CDC worked to significantly strengthen laboratory capacity, including in state, territorial, and local health departments, through supplemental funding supported by the American Rescue Plan Act. These efforts include increasing susceptibility testing capacity for C. auris from seven Regional Labs to more than 26 labs nationwide.
CDC continues to work with state, local, and territorial health departments and other partners to address this emerging threat to public health. Review more information on C. auris, the Antimicrobial Resistance Threats Report that identified C. auris as an urgent threat in the United States, or the WHO fungal priority pathogen list that identifies C. auris as a priority globally.
CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world. | Epidemics & Outbreaks |
CBS Mornings June 14, 2022 / 1:11 PM / CBS News Instagram head on new tools for parents Head of Instagram Adam Mosseri on new parental control options 06:16 Instagram's parent company Meta is giving parents new tools to watch over teens. The company announced that starting on Tuesday, parents will have more power to supervise and limit their teens' time on both Instagram and its Oculus Quest virtual reality headsets. They will be able to monitor what they're doing, and who they are interacting with. Head of Instagram Adam Mosseri told "CBS Mornings" that as a father himself, he wants Instagram to lead on teen safety online. "As a dad and as someone who's talked to a lot of experts around the world, we believe that parents know what's best for their children. What I'm most excited about is providing more tools for parents to shape their children's experience on Instagram and on Quest VR into what's best for their teen, for their child," he said. Mosseri said Instagram's new feature will give parents more control over how long their teen spends on the social media site. "One of the changes we're launching this week is the parent can actually initiate that relationship, and then they can see how much time their teen spends on Instagram. They can set limits to that time, one new feature this week that they can actually pick periods of the week where their child can't use Instagram, maybe it's homework or school time," said Mosseri. Quest VR has a similar feature for parents as well. Instagram also announced a new "nudge" feature that will encourage teen users to get away from content or particular themes that they are spending too long on. The new features come after a report by The Wall Street Journal in September that indicated top executives at Instagram were warned by researchers about the potential harmful impacts of the platform to young users. Mosseri, who testified in December before a Senate subcommittee investigating the harmful effects of Instagram, said that the safety of Instagram's teen users is always a top priority. Head of Instagram Adam Mosseri testifies during a Senate Commerce, Science, and Transportation Committee hearing titled Protecting Kids Online: Instagram and Reforms for Young Users on Capitol Hill, December 8, 2021 in Washington, DC. The committee questioned Mosseri about how the platform impacts the mental health and safety of teens and children. (Drew Angerer/Getty Images) "I believe that one of our most important responsibilities is keeping teens safe online. I believe this is an industry-wide issue. I think we're leading on the issue. I think we've invested more than any other company on safety more broadly. These tools have been in the works for a long time," he said. "I can say that I'm proud of the work that we've done, but I also believe and I'm committed to as a parent that the work never ends and that we have to continue to innovate in the space," Mosseri added. The new features are available for Instagram users in the U.S. starting today. They will be rolled out to other countries, including the UK, Japan, Australia, Ireland, Canada, France and Germany later this month, with plans to go global before the end of the year. In: Facebook Instagram Meta Thanks for reading CBS NEWS. Create your free account or log in for more features. Please enter email address to continue Please enter valid email address to continue | Mental Health Treatments |
More than a quarter of ambulance patients in England waited more than an hour to be admitted to A&E in the last week of 2022, amid “one of the most difficult” winters in NHS history.Of all those arriving by ambulance in the week to 1 January, 26.3% waited with crews for more than 60 minutes.This affected 18,720 patients, much higher than in the past six winters and probably the highest recorded figure.Matthew Taylor, the chief executive of the NHS Confederation, said the figures “underline the stark reality of the pressures that NHS leaders, their staff and patients are enduring”, which he said represented “crisis conditions with inherent risks to patient safety”.He added: “We must learn the harsh lessons of this winter and the government must commit to giving the health and care system the tools and support it needs to avoid next winter being as bad as this one.“Critical to that is rapid action to address the worsening workforce crisis in health and care, as a first and vital step, and reaching a compromise with the unions to stop this damaging industrial action.”The figures show more than 43% of ambulance arrivals waited more than 30 minutes to be admitted into A&E in the same week, either waiting with crew in the back of an ambulance or in hospital corridors.The continuing impact of a combination of flu, Covid and the respiratory infection RSV are also contributing to put pressure on the service.More than 5,400 beds were required for flu patients in the week to New Year’s Day, up 45% on the previous week. The equivalent figure in winter 2021-22 was 39.The same data release shows that the number of patients in critical care beds with flu increased by more than a quarter (26%) to 336, compared with 267 the previous week.The number of Covid patients in hospitals across England rose by almost 1,200 compared with the previous week, with an average of 9,390 patients in hospital with Covid every day with 88 beds required each day on average for children with RSV.A further 12,809 beds were being taken up by patients who were medically fit to be discharged in the same week – a 30%rise on the previous winter.A total of 3,562 critical care beds were occupied in the last week of the year, two short of the same week in 2020-21.Miriam Deakin, the director of policy at NHS Providers, said the confluence of flu and Covid-19 mean “more people are requiring medical care at a time when the number of beds and staff is falling far short of what’s needed”.The NHS national medical director, Prof Sir Stephen Powis, said: ““It remains vital that people make the most of services like 111 online and as ever, only use 999 in an emergency, and it’s also crucial that those who are eligible come forward for flu and covid vaccines as soon as possible.”About one in 20 people in the community, or 2.5 million, had Covid in England in the week ending 28 December, up from one in 45 for the week ending 9 December. The number was one in 18 in Wales, one in 25 in Scotland and one in 16 in Northern Ireland, the most recent figures show.According to the latest data for England from the UK Health Security agency, the overall weekly hospital admission rate for Covid in the last week of the 2022 was 10.71 per 100,000. While this is a slight decrease from the week before, officials have warned the data may be affected by reporting delays and bank holidays.Asked by broadcasters after the figures were published, the health secretary, Steve Barclay, said the government recognised the “massive strain” on the health service.He said the government was putting in extra funding to tackle the issue, particularly focused on “getting people out of hospital who are fit to leave, but often are delayed on the wards”. | Epidemics & Outbreaks |
Congress can lower health care costs by holding hospital systems accountable
These are real stories of patients charged exorbitant prices for services. There are numerous examples like this across the country. Far from being fluke occurrences, the hospital industry has institutionalized anti-competitive practices that play a leading role in the health care affordability crisis. Over the last ten years, the cost of providing employee coverage has increased 47 percent, with hospital care serving as the top driver of health care costs.
The patients and families bearing the brunt of these costs agree that it’s time to take action. According to a recent national survey, nearly 80 percent of voters say the prices that hospitals charge for care are rising to unreasonable levels.
While it was once unthinkable that Washington would challenge the powerful hospital lobby, this issue has become a focus of the 118th Congress. A series of major hearings has shed light on how corporate hospital systems dramatically mark up prices for services and get around transparency requirements. Patients are rarely aware of the costs they will incur until they actually receive a bill. And with top hospitals charging a more than 5x markup, it’s no surprise that the industry is desperate to keep pricing abuses hidden.
These unreasonable price increases hurt patients seeking care — and they are downright alarming for employers who cover the cost of health coverage for millions of workers nationwide. It’s getting harder to provide high quality health benefits and even harder to compete for workers and increase wages.
A major focus of this congressional scrutiny is the growing practice of corporate hospitals establishing local monopolies and leveraging their market dominance to charge patients more. With hospital consolidation driving down competition, there’s no pressure for hospitals to bring costs back within reach for employees, retirees and their families. Patients are right to demand a more competitive landscape: prices at monopoly hospitals are 12 percent higher than in markets with four or more competitors.
One way that corporate hospitals use acquisitions to take advantage of patients is by charging exorbitant ‘facility fees’ for care received at their doctor’s office — not because a doctor’s office now resides inside a hospital, but simply because the hospital system acquired the practice. When a physician’s office is acquired by a hospital system, the prices increase on average by 14.1 percent. With site-neutral reforms that require the same rate for services regardless of where they are delivered, we could reduce cost-sharing and premiums by more than $470 billion over 10 years.
The days of these anti-competitive practices going unchecked may soon be numbered. In the House, both the Energy and Commerce and Education and Workforce committees have advanced bipartisan measures to crack down on dishonest billing. Lawmakers in both chambers have come together across the aisle to introduce measures to increase transparency and promote competition. This is encouraging progress, but much more urgency in Washington is needed to stem these unreasonable cost increases. Hospitals will stop at nothing to protect their fiefdoms and the profit margins they generate.
Through common-sense reforms, we can lower costs for consumers and hold corporate hospital systems accountable for making it harder for us to provide affordable coverage. That means reining in unreasonable markups, ensuring honest billing, promoting competition, and delivering real transparency in pricing — so patients are treated fairly and reasonably, whether they receive a test, a treatment, or even just a Band-Aid.
Michael Thompson is president and CEO of National Alliance of Healthcare Purchaser Coalitions and Tom Lussier is administrator of the Public Sector Health Care Roundtable.
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. | Health Policy |
More than 500 years ago, Leonardo da Vinci became fascinated by his anatomical dissection of the womb of a pregnant woman who had died and intended to uncover the secrets behind conception and pregnancy complications. But da Vinci was stumped. Shockingly, in 2023, there’s still so much left to unravel, as women’s health remains one of the most underfunded, under-researched, and underserved areas of investment and study.
It’s an opportunity with a massive audience — potentially every family — that because of the historic underinvestment, has very low competition. The market is on the brink of breaking through with genomics and AI rising to meet the extreme unmet need. Now is the time to invest and innovate.
As women increasingly share their experiences, their stories bring to life how America is failing moms and amplify the urgency for us to act and innovate breakthroughs in women’s and pregnancy health. Recent CDC data shows U.S. maternal mortality rates have increased by 40% — meaning pregnancy is more dangerous now than it was for our mothers.
The maternal health crisis is even more devastating for Black women, who are 2.5x more likely to die from pregnancy-related complications compared to white women. And 80% of pregnancy-related deaths are preventable, highlighting how we as a society must do more to make pregnancy and childbirth a dignified and safe experience for all. I believe as entrepreneurs, founders, technologists and more, we must lead the charge on this.
We’ve entered the golden age of medicine: From the lightning-fast development of COVID-19 mRNA vaccines that saved millions of lives to incredible progress on immunotherapy interventions targeting metastatic forms of cancer, to the advent of AI and machine learning to accelerate drug development across the healthcare spectrum, it’s an exciting time to be in medicine, given the pace of breakthroughs we’re seeing every day. Compared to crowded fields like oncology and other biotech areas, there are only a handful of players working to champion the big opportunities in maternal health and to truly be the leader in the space.
Women’s health remains one of the most underfunded, under-researched, and underserved areas of investment and study.
It’s clear that maternal health has been left behind among the breakthroughs in medicine. This is troubling because women’s health is family health. Women who experience pregnancy complications face an increased risk of heart disease, stroke, mental health conditions and premature death, and children born preterm are at increased risk for numerous challenges across their life span. This disproportionate impact on families means that women’s health should concern every one of us, not just mothers. This can, and must, change. Maternal health is family health.
Women’s health needs to be the new frontier in technology investing
Understanding and believing the truth that women’s health is family health is an important first step in ushering in a new wave of investment and attention to companies focused on advancing women’s health outcomes. This again highlights the huge need and opportunity — the market is large, with nearly 4 million babies born every year in the U.S. With a healthy pregnancy free of complications, children are more equipped to achieve good health outcomes over the course of their lives, creating positive ripple effects for the health of their families and their future families for generations to come.
Another important step to usher in investment and attention on women’s health is to increase the number of women in high-ranking positions within technology, venture capital, government institutions, and more. Simply put, we need more women in high-impact roles. Among venture investors, women represent only 9% of all venture capitalists in the U.S. Women hold only 25% of the seats in the U.S. Senate and 28% of the seats in the U.S. House. And only 37 women currently serving in Congress are mothers to children under the age of 18.
I’m happy to report that women make up roughly two-thirds of our leadership team at Mirvie.
In addition to adding more female investors, elected officials, founders, and CEOs, we need men in these positions to champion maternal health. It is mind-boggling that we’ve gone backward in the 21st century. Reversing the trends of maternal mortality and morbidity is one of the biggest societal challenges we face. We need to broaden the support and ensure both men and women are helping drive changes to create healthier futures for our families.
While there is a lot of “doom and gloom” surrounding the current state of maternal health, it’s important to recognize the promise and hope for breakthroughs on the horizon. From the prediction of pregnancy complications, targeted treatments if complications do arise, and a concerted effort to increase access to doulas and other care providers to improve outcomes, we’re on the cusp of propelling women’s health forward with increased investment, attention, and opportunity.
In the world of technology and venture capital, we have the immense privilege of being able to provide the necessary resources to fund life-changing — and even life-improving — companies that are pushing women’s health forward. Now is the time we give them the attention and investment they deserve to ensure we’re creating a world where every pregnancy is as safe and healthy as possible. | Women’s Health |
Researchers from several U.S. institutions are collaborating "to develop and test an implantable device able to sense signs of the kind of inflammation associated with cancer," reports CBS News, "and delivery therapy when needed." Northwestern said the implant could significantly improve outcomes for patients with ovarian, pancreatic and other difficult-to-treat cancers — potentially cutting cancer-related deaths in the U.S. in half. "Instead of tethering patients to hospital beds, IV bags and external monitors, we'll use a minimally invasive procedure to implant a small device that continuously monitors their cancer and adjusts their immunotherapy dose in real time," said Rice University bioengineer Omid Veiseh. "This kind of 'closed-loop therapy' has been used for managing diabetes, where you have a glucose monitor that continuously talks to an insulin pump. But for cancer immunotherapy, it's revolutionary."
The project and team are named THOR, an acronym for "targeted hybrid oncotherapeutic regulation..." explains an announcement from Johns Hopkins. "THOR's proposed implant, or 'hybrid advanced molecular manufacturing regulator,' goes by the acronym HAMMR..."
The project will take five and a half years, and includes funding for a first-phase clinical trial treating recurrent ovarian cancer slated to begin in the fourth year. The research is funded by America's newly-established Advanced Research Projects Agency for Health (ARPA-H), according to a statement from the agency, representing its "commitment to supporting Cancer Moonshot goals of decreasing cancer deaths and improving the quality of life for patients..."
And they're also funding two more projects: The Synthetic Programmable bacteria for Immune-directed Killing in tumor Environments (SPIKEs) project, led by a team at the University of Missouri in Columbia, Missouri, aims to develop an inexpensive and safe therapy using bacteria specifically selected for tumor-targeting. Through SPIKEs, researchers intend to engineer bacteria that can recruit and regulate tumor-targeting immune cells, boosting the body's ability to fight off cancer without side-effects from traditional medications. Up to $19 million is allocated towards SPIKEs.
An additional project, with up to $50 million in potential funding inclusive of options, seeks to map cancer cell biomarkers to drastically improve multi-cancer early detection (MCED) and streamline clinical intervention when tumors are still small. Led by the Georgia Institute of Technology in Atlanta, Georgia, the Cancer and Organ Degradome Atlas (CODA) project aims to understand the cellular profiles unique to diseased cancer cells. The CODA platform intends to develop a suite of biosensor tools that can reliably recognize a range of cancer-specific markers and, ultimately, produce a highly precise, accurate, and cost-effective MCED test that can identify common cancers when they are most treatable.
In a statement, ARPA-H's director said that "With these awards, we hope to see crucial advancements in patient-tailored therapies, better and earlier tumor detection methods, and cell therapies that can help the immune system target cancer cells for destruction."
The project and team are named THOR, an acronym for "targeted hybrid oncotherapeutic regulation..." explains an announcement from Johns Hopkins. "THOR's proposed implant, or 'hybrid advanced molecular manufacturing regulator,' goes by the acronym HAMMR..."
The project will take five and a half years, and includes funding for a first-phase clinical trial treating recurrent ovarian cancer slated to begin in the fourth year. The research is funded by America's newly-established Advanced Research Projects Agency for Health (ARPA-H), according to a statement from the agency, representing its "commitment to supporting Cancer Moonshot goals of decreasing cancer deaths and improving the quality of life for patients..."
And they're also funding two more projects: The Synthetic Programmable bacteria for Immune-directed Killing in tumor Environments (SPIKEs) project, led by a team at the University of Missouri in Columbia, Missouri, aims to develop an inexpensive and safe therapy using bacteria specifically selected for tumor-targeting. Through SPIKEs, researchers intend to engineer bacteria that can recruit and regulate tumor-targeting immune cells, boosting the body's ability to fight off cancer without side-effects from traditional medications. Up to $19 million is allocated towards SPIKEs.
An additional project, with up to $50 million in potential funding inclusive of options, seeks to map cancer cell biomarkers to drastically improve multi-cancer early detection (MCED) and streamline clinical intervention when tumors are still small. Led by the Georgia Institute of Technology in Atlanta, Georgia, the Cancer and Organ Degradome Atlas (CODA) project aims to understand the cellular profiles unique to diseased cancer cells. The CODA platform intends to develop a suite of biosensor tools that can reliably recognize a range of cancer-specific markers and, ultimately, produce a highly precise, accurate, and cost-effective MCED test that can identify common cancers when they are most treatable.
In a statement, ARPA-H's director said that "With these awards, we hope to see crucial advancements in patient-tailored therapies, better and earlier tumor detection methods, and cell therapies that can help the immune system target cancer cells for destruction." | Medical Innovations |
Sleep and Rising Temperatures: The Hidden Impact of Climate Change on Older Adults
Amir Baniassadi, PhD, researches environmental health, and in particular, the health and well-being of older adults within the built environment.
As we strive to better understand the multi-layered intricacies of aging, one issue coming to the forefront is the connection between sleep, the environment, and the overall health and well-being of older adults. In this blog post, I’ll break down a complex matter that recently became the central focus of my research.
Sleep: A key pillar of health
Sleep has profound implications for our health and daily function. As we age, our sleep patterns change—we may find ourselves waking up multiple times in the night or waking earlier in the morning. Sometimes, we might feel that we’re not sleeping as deeply as we used to.
These changes aren’t merely inconvenient; they can significantly impact our cognitive function, our physical health, and our overall quality of life. Disrupted sleep can lead to memory issues, increased risk of falls, and reduced ability to perform everyday activities. It can also affect our mood and general sense of well-being. As such, understanding the factors that influence sleep quality in older adults is crucial in our pursuit of healthier, happier aging.
The role of ambient temperature in sleep quality
Here’s an interesting fact: Sleep tends to come easier and is often deeper and more restful in a cooler environment. This isn’t arbitrary; it’s rooted in our biology. Our body temperature naturally dips at night, which helps to initiate and maintain sleep. When our sleep environment is too warm, it can interfere with this temperature drop, disrupting our sleep.
My recent research explored how these biological tendencies interact with our physical environment, specifically focusing on the role of nighttime ambient temperature in affecting sleep quality in older adults. For nearly 18 months, I monitored sleep quality and ambient temperature in 50 older adults, many of whom where residents of a Hebrew SeniorLife community. My research revealed that sleep quality was highest when the temperature of their room was between 68 and 74 degrees, and usually dropped as the temperature increased beyond 75. However, I found a great deal of difference between people, meaning that each person has their own optimal temperature range for sleep, which may even change over time.
Climate change and urban warming: A threat looming in the night
Climate change, a term now familiar to us all, is causing shifts in our planet’s weather patterns and temperature norms. One subtle but critical aspect of climate change is the rise in nighttime temperatures—a trend that has been gradually accelerating and is predicted to continue. As our planet warms, our nights, too, are getting hotter. In addition to this, urban areas are often warmer than their surroundings at night, a phenomenon known as the urban heat island effect. This effect is also getting more intense as urban expansion and development replace more of our green space with buildings, roads, and cars.
Intersecting paths: Sleep, health, and climate change
So, where does climate change intersect with sleep and the health of older adults? Here’s the link: As we’ve already discussed, warmer nights can disrupt sleep, and climate change is causing hotter nights. This can be particularly problematic for older adults, whose sleep patterns may already be more fragile due to the natural processes of aging. In light of climate change, sleep disruptions and their subsequent health implications could become a more widespread and persistent problem for older adults.
Navigating warmer nights: Strategies for better sleep
The situation, while challenging, is not without hope. At the individual level, there are various adaptive strategies you can employ to manage warmer nights and promote better sleep. My research shows that the home indoor environment has the most influence on sleep. So, even if the temperature outside is above 90 degrees, maintaining a cool home environment
- Find your personal sleep temperature: Each person is different and it is important to tune your environment to your specific needs. Using fans or air conditioning if available, you may wish to start with a room temperature between 68 and 74 degrees and then experiment with cooler temperatures to see how it affects your sleep.
- Stay hydrated: Don’t go to bed dehydrated. On hot days, be sure to remain hydrated throughout the day. For most people, drinking about two liters or 72 ounces of water a day is enough to stay hydrated. If you have a health condition or take medications that may affect your ability to stay hydrated, it is best to ask your health care provider for advice.
- Use light, breathable sleep wear: Wearing lighter sleep clothes and using a lighter cover on the bed can help regulate your body temperature and prevent overheating during the night.
- Prepare for bedtime: Engage in relaxing activities before bedtime, like reading or listening to calming music, to prepare your body for sleep.
- Watch your diet: Avoid eating heavy meals, high-sugar foods, and stimulants like caffeine close to bedtime.
Community support and care providers: A joint effort
In managing the impacts of rising temperatures on sleep, communities and health care providers play a critical role. It’s crucial that we work together to ensure the comfort and well-being of older adults, including when it comes to sleep. Care providers should incorporate temperature management strategies in their care plans. For older adults living independently, families and communities can help implement adaptive strategies, from ensuring the availability of air conditioning to providing guidance on sleep hygiene. With the advent of smart home sensors, it is now possible to monitor the ambient temperature of our home or that of our loved ones and take action when it starts to overheat.
As a society, we also need to think about the role that the built environment plays in the face of a changing climate. We need to reconsider our priorities when designing new homes and apartments and bring back strategies such as shading from nearby trees or overhangs, and windows that actually open. Also, it is possible to make our cities cooler, both literally and figuratively, by building more parks and green spaces and using reflective rooftops and roads.
The complex interplay between sleep, ambient temperature, and the health of older adults is an issue that deserves our attention. As we grapple with the broader implications of climate change, we must not overlook its potential impact on something as fundamental as sleep. Understanding the challenge is the first step. With awareness, adaptive strategies, community support, and investment in a climate-resilient built environment, we can navigate this issue and safeguard quality of life for older adults. In the face of climate change, these actions are not merely proactive measures, but necessary adaptations for our health and well-being.
For those interested in delving deeper into this topic, here are links to some original research articles, including my recently published article. Let’s continue to stay informed and adapt together, ensuring that we provide the best care and environment for our older adults, today and in the future.
- Nighttime temperature and human sleep loss in a changing climate
- Rising temperatures erode human sleep globally
- Climate change and sleep: A systematic review of the literature and conceptual framework
- Nighttime ambient temperature and sleep in community-dwelling older adults
Exploring senior living options in Massachusetts?
Hebrew SeniorLife offers a variety of senior living communities in the Boston area for people of all income levels and abilities, including independent living, supportive senior living, assisted living, and long-term chronic care. Our options cater to various incomes and abilities, offering independent living, supportive senior living, assisted living, and long-term chronic care. We likely have the ideal choice for you or your loved one. Furthermore, our communities are actively engaged in the effort to fight climate change through sustainability efforts and our new constructions adhere to Passive House standards, ensuring comfortable air temperatures all year round.
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Hebrew SeniorLife offers a variety of senior living options, including independent living, assisted living, and enhanced living. There are options for every lifestyle and budget. | Global Health |
A patients group representing several British victims has launched legal action against the Spanish government over claims it failed to safeguard people against the potentially fatal side effects of one of the country’s most popular painkillers, involved in a series of serious illnesses and deaths.
The drug metamizole, commonly sold in Spain under the brand name Nolotil, is banned in several countries, including Britain, the US, India and Australia. It can cause a condition known as agranulocytosis, which reduces white blood cells, increasing the risk of potentially fatal infection.
The Association of Drug Affected Patients (ADAF) says adverse reactions to the drugs have led to sepsis, organ failure and amputations. It has identified about 350 suspected cases of agranulocytosis between 1996 and 2023, including those of 170 Britons who live in Spain or were on holiday there.
The ADAF is examining more than 40 fatalities in which it considers the drug may have led, or contributed, to death. The patients group says that case reports, including a 2009 study, suggest the British population may be more susceptible to the drug’s side effects, but this has not been confirmed by independent scientific study.
The group is demanding an investigation into the drug and new controls. It filed its action on 14 November in the national court in Madrid. Cristina García del Campo, founder of the organisation, said: “This drug has destroyed people’s lives and it should now be withdrawn. One lady took three tablets and she had part of her feet amputated and several fingers. Even if it doesn’t kill you, once you’ve had sepsis your body is never the same.”
Metamizole was first produced commercially in Germany in 1922 and was available worldwide until it was found there was a risk of it causing agranulocytosis. It was withdrawn in about 30 countries, but is still widely available across the EU.
Studies have shown a dramatic variation in the estimated incidence of agranulocytosis in response to the drug, from about one in 2,000 to less than 1.1 per million users. A European Medicines Agency report in December 2018 suggested the “potential to induce agranulocytosis may be associated with the genetic characteristics of certain populations”.
García del Campo, a translator from Jávea in Alicante, started investigating when one of her clients, an Irishman, fell seriously ill, with infections racking his body. He was admitted to hospital in the city of Dénia and died on 18 November 2017 of sepsis and multi-organ failure.
She said: “I was the last person with him and held his hand. All the time I was with him, I kept asking: ‘Why is this happening? How could someone go from being fine to having this terrible infection?’”
She started compiling worrying recent reports she had heard locally involving agranulocytosis and sepsis. One night in December 2017, she spread out all the case files and medical notes she had gathered on six cases. It then struck her: all the people involved had been on metamizole.
One of the patients in García del Campo’s files, Paddy Clancy, 80, a British expatriate who lives in Jávea, said last week that he nearly died after he was given metamizole following a shoulder operation in September 2017. He became so ill that doctors put him into an induced coma to give his body the best chance of fighting the infection.
Clancy said: “My wife was told: ‘His kidneys are packing up and his organs are shutting down.’ They thought I might not last the weekend.” The family was told the white blood cells in his body, which usually fight infection, had been severely depleted.
Clancy came out of the coma after 39 days. He had lost 22kg and could not stand, but has gradually recovered. His records confirm the disorder that nearly killed him: “agranulocytosis associated with metamizole”.
García del Campo was finding many similar cases. An Irish holidaymaker, William Smyth, 66, died in April 2016 from multi-organ failure after being prescribed Nolotil for shoulder pain. Mary Ward, 59, who lived in Spain, died in March 2006 after she was given Nolotil following an operation in Marbella and contracting agranulocytosis and complications. In another case, a woman in her 60s required amputations after taking the drug and developing sepsis.
It is said that agranulocytosis is an extremely rare reaction to metamizole, but García del Campo was soon being inundated with reports. She said the cases appeared to show that the British and Irish community were more susceptible. A study in April 2009 had looked into 13 cases of agranulocytosis involving dipyrone (another name for metamizole) at the Hospital Costa del Sol in Marbella, with five cases involving Britons. It concluded: “Dipyrone-related agranulocytosis is an adverse effect more frequent in [the] British population, and its use must be avoided.”
The ADAF has submitted evidence in its case from a regional health official who says a local study in five health departments in Spain had “surprisingly” found that the British population had a susceptibility to metamizole in the order of “80 to 120 times higher” than the Spanish. That report has not been published and there is no comprehensive and robust epidemiological evidence to date to support the theory that British or Irish people may be more susceptible to the drug’s side effects.
In April 2018, Lorna Vincent, 75, who lived in Spain, went into hospital in Benidorm for an operation to repair a small hole in her bowel. Her daughter, Kim Glasby, 59, from Brixham, Devon, said the operation seemed a success and she was given metamizole as a painkiller but then fell seriously ill. Glasby said: “I was told by the surgeon she didn’t have enough white cells and she wasn’t responding to painkillers. They didn’t know what to do.”
Vincent died on 18 April; her family was told she suffered multi-organ failure. Glasby believes in the light of other cases that a reaction to metamizole was to blame and is now trying to obtain all her mother’s medical records.
In October 2018, less than a year after García del Campo had started her campaign, Spain’s medicines and health products agency, the AEMPS, brought out new guidelines for metamizole. It recommended its use be avoided in tourists (described as the “floating population”) and that patients should be advised of symptoms of agranulocytosis.
García del Campo says the new guidelines have been widely breached. She said patients were not being warned of the risks and that the drug could be obtained without the required prescription.
Carla Cardwell, 41, who is originally from the UK and now lives in Gibraltar, gave birth to her son, Caiden, in December 2019 by caesarean section just across the Spanish border in the town of La Línea. She was given a prescription of metamizole.
She fell so ill in January 2020 that she went to a nearby A&E unit in Gibraltar. “They thought I had cancer because I had no white blood cells at all,” she said. “The consultants said: ‘We don’t know what is wrong. You’ve got the blood results of someone with cancer, but you haven’t got cancer.’”
A senior doctor who looked at her case asked if she had recently been taking metamizole. She said she had, and was diagnosed with agranulocytosis. She was told she required injections of granuloctye colony stimulating factor (G-CSF) to regenerate her bone marrow.
She said: “My pancreas, liver and bowel were all infected. The injections had to be flown into the hospital and were the worst part. I could even feel the pain in my eye sockets. I will be for ever grateful to the consultant who saved my life.” She had therapy for post-traumatic stress after her ordeal. Her medical records state she suffered agranulocytosis, with metamizole the suspected cause.
The ADAF legal action, against the Spanish ministry of health and the AEMPS, says the drug is being offered to patients without proper controls. It calls for a ban on giving the drug to citizens from countries where metamizole has been withdrawn and a new analysis of the risk factors relating to agranulocytosis. It also says the information sheet for the drug needs to be revised.
Francisco Almodóvar, the lawyer representing the ADAF, said: “We have testimonies of British people telling their stories. We can support the evidence with clinical records. It is a very significant public health issue.”
The company that makes Nolotil, Boehringer Ingelheim, said: “Nolotil is a prescription drug. Its ingredient metamizole has been used by patients for almost 100 years, with an established and well known safety profile.
“Agranulocytosis is described as a very rare frequency adverse reaction in the current prescribing information. It is a known adverse reaction for decades and the available scientific information has confirmed the well known safety profile of metamizole.
‘The side effect of agranulocytosis is addressed in the current product information. Current prescribing information adequately addresses current knowledge about risks associated with Nolotil use. We welcome any information which helps us to improve the benefit-risk profile and the safe use of our medicines.”
The AEMPS referred the Observer to the Spanish health ministry, which did not respond to a request for comment. | Drug Discoveries |
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COLUMBUS, Ohio (AP) — Voters in Ohio will decide next week whether to legalize recreational marijuana, but people on both sides of the issue say more hangs in the balance than simply decriminalizing the drug.
Supporters of legalization say Ohio can reclaim tax revenue being lost to states such as Michigan, where marijuana is legal, and take power from illegal drug markets through government regulation. But opponents warn of increased workforce and traffic accidents by people under the influence, and argue much of the revenue will land in the pocket of the marijuana industry, not taxpayers.
Issue 2 on the Nov. 7 ballot would allow adults 21 and over to buy and possess up to 2.5 ounces (71 grams) of cannabis and 15 grams (about a half-ounce) of extract, and to grow up to six plants per individual through a government program. A 10 percent tax would be imposed on any purchases, with those proceeds going toward administrative costs and addiction treatment in the state and to municipalities that host dispensaries.
It would also create a social equity program to give a financial boost to people who want to start a business selling or growing cannabis and who meet certain criteria. They or a family member would need to have had a past run-in with the law for marijuana, and be part of a disadvantaged group based on race, gender, disability or economic considerations.
READ MORE: Abortion rights supporters far outraise opponents, out-of-state money flowing to Ohio
The program would fall under the Division of Cannabis Control in the state Department of Commerce, an office that will fashion the rules around licensing, testing and product standards, among other regulations.
If it passes, Ohio would become the 24th state to legalize recreational marijuana for adult use, a move that supporters say socially and financially makes sense for the state.
“We’re taking money away from drug dealers and Michigan dispensary owners and putting it back into the pockets of our local governments,” said Tom Haren, spokesperson for the pro-legalization campaign Regulate Marijuana Like Alcohol.
The measure also gives those with marijuana-related arrests and convictions, as well as their loved ones, a chance to benefit from the industry once possession of cannabis is no longer illegal. Haren said a marijuana charge can make life much harder for people and has a “downstream effect” on their families.
Issue 2, should it pass, would also create greater access for those who may not be able to afford medical marijuana through their insurance or get a doctor to sign off on it. This includes veterans, according to Haren, who usually get their insurance through the federal government — which has not cleared marijuana for medical or recreational use.
But even if it gets the needed votes Tuesday, the future of marijuana use will not be entirely set.
READ MORE: Georgia will be 1st state to allow pharmacies to sell medical marijuana
As a citizen-initiated statute, the measure went first to the Republican-dominated Legislature. Lawmakers had four months to pass it, under state law. But with many — if not all — GOP legislators heartily against it, the measure did not move.
After the election, if it passes, state law calls for the measure to return again to the Legislature, where lawmakers can tweak it to their liking. They can also vote to repeal it entirely, as GOP Senate President Matt Huffman has indicated could happen.
Opponents of Issue 2, including Ohio prosecutors and the Ohio Chamber of Commerce, are in line with Huffman.
“There’s legalization, which generally people have a live-and-let-live attitude about. And then there’s Issue 2,” said Scott Milburn, spokesperson for Protect Ohio Workers and Families, the main campaign against the issue.
The measure, opponents say, gives around one third of the revenue in that 10 percent tax revenue back to the marijuana industry — making it more of a benefit to marijuana corporations and small businesses than to taxpayers.
And according to Ohio Treasurer Robert Sprague, the portion allotted for costs such as addiction treatment and administration under the 10 percent tax isn’t enough, and the tax would at least need to be doubled to pay for what the measure says it would.
The Ohio Prosecuting Attorneys Association has also cautioned that legalization could lead to greater traffic and workforce accidents, as well as increased substance abuse among state residents.
Last year, a study by the by the National Highway Traffic Safety Administration found that 54 percent of injured or killed drivers had drugs or alcohol in their systems, with tetrahydrocannabinol (THC), an active ingredient in marijuana, the most prevalent.
The study looked at over 7,000 cases from seven different hospitals around the country from 2019 to 2021, but the authors of the study cautioned that it’s not indicative of drivers nationwide, especially when tracking data on marijuana use and traffic accidents is still so new.
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Aug 31 | Health Policy |
Kylie Jenner got real about battling postpartum depression twice as she offered advice to new mothers who are also struggling with the same condition.
Jenner, 25, who has daughter Stormi, five, and son Aire, one, with her ex Travis Scott, referred to her first bout with the condition as 'very difficult' in a candid interview with Vanity Fair Italy.
While her second time battling it was 'more manageable', she acknowledged just how 'painful' the condition can be as she advised other new mothers to stay present despite the discomfort.
'I have experienced it. Twice. The first time was very difficult, the second was more manageable,' she said.
'I would tell those women not to over-think things and to live all the emotions of that moment to the fullest. Stay inside that moment, even if it is painful. I know, in those moments you think that it will never pass, that your body will never be the same as before, that you will never be the same.
'That's not true: the hormones, the emotions at that stage are much, much more powerful and bigger than you. My advice is to live through that transition, without fear of the aftermath. The risk is to miss all the most beautiful things of motherhood as well.'
Kylie also reflected on the joys of motherhood and described bringing her children home for the first time as 'perhaps the most beautiful moment.'
'Finding myself in the hospital alone with a new and unknown creature in my arms,' she said when asked about exciting moments in parenthood.
'It's such a unique and special situation and it's all about building with these little beings that you're learning about.
'There is another magical moment, though: when you bring your children home. It is perhaps the most beautiful moment.'
On Wednesday, she gave fans a glimpse of the newest addition to her family - her son Aire.
She shared a sweet snap of the youngster snacking in his high chair and wearing a playful bib. 'I'm obsessed w this baby,' she wrote in the post.
Kylie has been candid with fans about her postpartum struggles, even opening up about suffering from the 'baby blues' on her family's reality show The Kardashians.
'It's been really hard for me,' Kylie admitted on a 2022 episode of the show. 'I cried non-stop all day for the first three weeks.
'It's just the baby blues,' she added. 'And then it kind of goes away.'
Kylie added she cried so much that even resting was painful: 'To the point where I'd be laying in bed and my head would just hurt so bad.'
In a confessional, she elaborated: 'I'm not a doctor but I read on Google, they call it "baby blues" when it doesn't last past six weeks. After about six weeks I started to feel better. But I definitely had the case of the blues.'
She also offered words of encouragement to other mothers as she got candid about her postpartum struggles last year.
'I just want to say to my postpartum moms that postpartum has not been easy. It's not been easy, it's very hard,' she said in her Instagram Stories. 'This experience for me, personally, has been a little harder than with my daughter.'
She added: 'It's not easy mentally, physically, spiritually... it's just crazy. I didn't want to just get back to life without saying that because I think we can look on the Internet and for other moms going through it right now, we can go on the Internet and it might look a lot easier for other people and, like, the pressure on us, but it hasn't been easy for me.
'It's been hard. And I just wanted to say that. I didn't even think I'd make it to this work out today, but I'm here and I'm feeling better, so you've got this.'
'And, it's OK not to be OK,' she said. 'Once I realized that, I was putting some pressure on myself, and I just keep reminding myself, I made a whole human.'
'A beautiful healthy boy, and we have to stop putting pressure on ourselves to be back - not even physically, just mentally after birth. So ya, just sending some love. I love you guys.' | Mental Health Treatments |
CHARLOTTE, N.C. — As covid-19 devastated communities across the nation in spring 2020, a group of Black ministers in this racially divided city made an urgent plea for more testing in their neighborhoods.
Testing at the time “was outside of communities of color,” said the Rev. Jordan Boyd, pastor of Rockwell AME Zion Church in Charlotte. For Boyd, pandemic losses were personal: Covid-related complications killed a brother-in-law who worked as a truck driver. “We saw what was happening with our folks.”
Mandy Cohen, who led the state’s pandemic response as secretary of North Carolina’s health department, had said widespread testing was one of “our best tools to keep our community safe and to protect our frontline workers.” But the state was failing to get tests to its most vulnerable people, with grim consequences: Black people in North Carolina were getting sick and dying from covid-related causes at far higher rates than white people, data show.
KFF Health News analyzed and confirmed publicly available data, including the location of testing sites that Cohen’s office directed the public to in mid-May 2020 in Mecklenburg County, home to Charlotte, the state’s largest city. Just 1 in 4 fixed sites stood in more disadvantaged areas with significant Black populations, including what is known as the Crescent, neighborhoods reaching west, north, and east of downtown that for generations have had elevated rates of diabetes, high blood pressure, lung disease, and other conditions that can cause life-threatening complications from covid. Far more testing was available in south Charlotte and suburban areas — the whiter, wealthier neighborhoods.
Life in the Crescent is marked by higher rates of poverty, crowded housing, and less access to health care, transportation, and internet service — factors that fueled transmission of the virus and created barriers to testing.
“There were a lot of hurdles that you had to go through,” said Boyd, who helped spearhead the effort to bring testing to Black churches.
President Joe Biden and others in political and health policy circles have praised Cohen’s pandemic leadership in North Carolina. Biden in June cited her “proven track-record protecting Americans’ health and safety” when elevating Cohen to run the Centers for Disease Control and Prevention, the nation’s top public health agency.
Those on the ground in North Carolina’s most vulnerable communities, including Cohen’s admirers, tell another story — about living with the downsides of the state’s emergency response. These include advocates for groups that were disproportionately harmed during the public health crisis, including minority and immigrant communities, people with disabilities, and families of nursing home residents.
Corine Mack, president of the Charlotte-Mecklenburg NAACP, recalled that in late 2020 she and others complained to Cohen about public money going to white-led organizations instead of Black-led ones working in minority neighborhoods.
“I said we had to send resources tomorrow, not next month,” Mack said. “She started crying. I was so passionate about our people dying. Once she understood the severity of the situation, she did what she had to do.”
The challenges Cohen faced in North Carolina were exacerbated by structural inequities in and outside the health care system, problems that are too large for any one person to fix. Still, Cohen now faces the same challenges on a national scale, as she’s charged with fixing the CDC after its pandemic missteps.
Cohen, through her spokesperson at the CDC, declined multiple requests for an interview.
A report in January called “Building the CDC the Country Needs,” which was signed by dozens of health policy experts, urged an agency overhaul. Among the priorities cited: more quickly collecting data on racial, ethnic, economic, and geographic factors that is “foundational to improving equity of access to services.”
For most of the pandemic, Black, Hispanic, and Native Americans fared worse than whites across the country.
In North Carolina, critics and allies alike say Cohen heeded concerns. She relied heavily on data and followed federal guidance closely, they said. And Cohen showed vigilance when she interpreted rules, like those on nursing home visitation and mask mandates, even in the face of criticism.
She also repeatedly urged personal responsibility to contain the spread of the virus, underscoring how public health messaging often focuses on choice rather than societal constraints, said Anne Sosin, a researcher at Dartmouth College who focuses on health equity.
“Many of the people and communities hardest-hit by the pandemic had little choice in their exposure” because they got covid where they lived or worked, Sosin said. “Limiting our focus on the choices that people make — rather than on the broader structural and social forces that shape risk — really will set us up for the same failures in the future.”
With more than 1 million residents, Mecklenburg County has become a symbol both of North Carolina’s economic rise and of its struggles to overcome a long history of racial discrimination and disparities. A short drive from the headquarters of Fortune 500 companies, such as Bank of America and Honeywell, sit minority neighborhoods plagued by poverty. A national study on social mobility found that, among the 50 largest cities, Charlotte was the hardest place for a child to move from poverty to the upper class.
Researchers from North Carolina’s health agency and the University of North Carolina found that access to tests during the first three months of the pandemic — between March and June 2020 — was not evenly distributed across racial and ethnic groups, with inadequate access for Black and Latino residents.
On May 14, 2020 — two months after the national emergency was declared — Cohen’s agency directed clinicians to prioritize testing for people from “racial and ethnic minority groups disproportionately affected by adverse COVID-19 outcomes,” and officials recommended using mobile testing for “vulnerable populations,” documents show.
The disparities persisted. In Charlotte, the difference in testing sites underscored the inequity people of color often face in health care, as they were left to depend on a few mobile units whose routes and hours varied by the day. Meanwhile, wealthier areas had an abundance of well-resourced, fixed sites with regular hours.
Critics say the state was slow to address glaring and predictable problems. Mecklenburg County Commissioner Pat Cotham, a Democrat, said it took authorities precious time to shift testing to the hardest-hit neighborhoods. Cotham said officials should have more quickly enlisted Black ministers and others who had established trust with residents. Instead, she said, even elected representatives of those areas were often locked out. “I remember getting information from press releases or TV,” she said.
North Carolina initially failed to prioritize testing for people who were exposed to covid because of where they live or work, said Jeanne Milliken Bonds, a professor of social impact investing at the University of North Carolina. She co-authored a white paper that criticized the national pandemic response, saying, “We are ignoring the critical impact of systemic racism in vulnerabilities to the deadly virus.”
Black people, immigrants, and ethnic minorities disproportionately hold jobs that governments deemed essential — in food processing plants, retail stores, and nursing homes — and they were unable to isolate and work from home, Milliken Bonds said.
Charlotte had one of the biggest disparities in access to testing in the nation, according to a study of 30 large cities by researchers at Drexel and Temple universities. Only Austin and Houston in Texas fared worse.
In 2020, Black people in North Carolina died from covid at a higher rate than white people, although the disparity was slightly less pronounced than in the U.S. overall. A KFF Health News analysis of CDC data shows that 112 of every 100,000 non-Hispanic Black residents in the state died, compared with 89 per 100,000 non-Hispanic white residents. North Carolina’s death rates for all racial and ethnic groups that year were lower than those nationally.
“The driving factor for testing and vaccination was, ‘Let’s get older people and let’s protect our health care workers,’” Milliken Bonds said. “You end up losing the health equity lens. There was a course correction later in 2020. They looked at the data and said, ‘Oh my God!’ They were missing people of color.”
Tensions Rose
In April 2020, when covid tests were scarce nationally and states had little federal support, Cohen’s Department of Health and Human Services convened a work group to increase testing. The initiative began as Democratic Gov. Roy Cooper indicated he would ease the restrictions he’d put in place in March to limit covid’s spread.
The group included state employees, consultants, local officials, and representatives from major hospital systems, community health centers, and commercial labs, North Carolina HHS news releases and state documents show. Officials set priority groups for testing, including hospitalized patients, health care workers and first responders, and people in long-term care or correctional facilities, according to meeting minutes from April 24. The last item: “additional emphasis on equity and ensuring communities of color have access to testing.”
The state also received guidance from experts focused on equity.
“We know that there’s more covid-19 out in our communities than gets captured by what’s in our lab data,” Cohen said April 30, during one of Cooper’s pandemic briefings.
Of the covid test results reported to North Carolina’s health department at that time, a smaller share were coming back positive relative to prior weeks, and covid hospitalizations were level — developments Cohen hailed as progress. But tensions were brewing.
By May 5, Disability Rights North Carolina filed a civil rights complaint with the U.S. Department of Health and Human Services about a proposed state emergency plan. The advocacy group said the plan — which determined who would get lifesaving treatments in hospitals if supplies were scarce — would put people with disabilities in the “back of the line” and lead to a disproportionate death toll among people of color or with low incomes.
As the state began reopening businesses in early May, officials knew testing levels were not adequate, according to a review of public documents, interviews, and Cohen’s public remarks. Hundreds of sites were up and running, “but there’s more to do,” Cohen said May 20.
In a letter in the North Carolina Medical Journal, North Carolina HHS employees and a consultant with Accenture said “testing was difficult to access outside of a hospital” that month. “Of the tests being performed early in the pandemic, the majority were in White populations even though we could already see differences in poor outcomes in Black/African American, American Indian/Alaskan Native, and Latinx populations infected with the virus around the country,” they wrote.
Kody Kinsley, who worked for Cohen and succeeded her as health secretary, said the state’s response was stymied by factors beyond its control, including supply chain shortages. “We were essentially riding the backbone of the existing health care network with inadequate supplies,” Kinsley said. The department tried to contract with outside firms to boost testing access in historically marginalized communities, but “resources weren’t available.”
Boyd, the pastor, said it was “difficult times.” To reach hard-hit communities across the state, “you have to be able to do that through connections on the ground,” he said. “Otherwise it’s not going to happen. But that takes time.”
In Charlotte, he said, fixed testing sites at hospitals and elsewhere, which required appointments, weren’t as accessible for those in the city’s poorest neighborhoods. “You had to go online and sign up,” he said.
Black residents were desperate for testing: When a mobile van run by Atrium Health, the dominant hospital system in Charlotte, arrived at Boyd’s church in early May, “Cars were lined up around the block at 4 or 5 o’clock in the morning,” he said.
Atrium’s mobile testing started in April, circulating in minority communities where data showed emerging hot spots. While people could walk up to get a test, locations shifted daily, according to internet archives, social media posts, and other announcements. Between mid-April and early July, the units stopped at many Black churches only once.
“We were last on the list. We lost a lot of people,” said Vilma Leake, a Democratic member of the Mecklenburg Board of County Commissioners. Leake said she never received a satisfactory answer when she asked why people of color were not prioritized for testing given the South’s long history of racial exclusion and wide disparities in health, education, and income. “History is repeating itself. It is always a fight for some people,” she added.
Kinsley said the state’s response “was intentionally designed to be conscious of class and race and ethnicity,” which he said informed its guidance for essential workers and efforts to push businesses to provide paid leave and on-the-job covid tests.
By late spring, the state’s testing data, which captured only a fraction of infections, painted a troubling picture. As of May 26, Black residents made up 31% of cases and 35% of deaths despite being 22% of the state’s population. Latinos made up 9.6% of the state’s population and 35% of covid cases.
That same day, Cohen stood at Cooper’s pandemic briefing. While she described the state’s efforts to improve safety for workers at meat processing plants, she again called for personal responsibility.
“Our ability to continue to ease restrictions and get back to work as safely as possible hinges on all of us working together to protect each other,” Cohen said, adding, “We want to save lives. And we can do that with simple individual actions.” By that time, North Carolina had allowed restaurants, pools, and personal care businesses such as barbers to open at 50% capacity.
The state’s response “was not adequate for protecting essential workers,” said the Rev. Rodney Sadler, the director of the Center for Social Justice and Reconciliation at Union Presbyterian Seminary.
“It was targeted toward those who had resources, who had a knowledge base, who had greater freedoms, who had the ability to work from home,” he said, adding that it’s important to “think about how this hits differently for poor Black and brown people in inner-city communities than it does for wealthier, white communities in the suburbs.”
The Rev. Greg Jarrell helps lead QC Family Tree, a social justice organization in Enderly Park, a Black neighborhood near downtown Charlotte that is gentrifying. He said people often waited hours for testing at a site near his neighborhood, even with appointments.
“We saw the severe limitations of the whole system,” he said. “Who has got time to sit in line for three hours? Not an hourly employee.”
If you don’t set up “race-conscious and class-conscious policy,” Jarrell said, “the system is always going to serve people who have more resources.”
Throughout June, as North Carolina’s covid infections and hospitalizations climbed, the state focused more intensely on Black, Latino, and Native American residents. It took until July 7 for officials to announce they would deploy 300 free temporary testing sites in underserved communities across the state.
The state’s covid death toll had reached 1,420 people, and 989 more were hospitalized. The trajectory, Cohen said, was “moving in the wrong direction.”
A Bigger Challenge at the CDC
Political leaders, public health experts, and advocacy groups say Cohen is well suited to run the CDC.
She has navigated vast government agencies — experience her predecessor, Rochelle Walensky, lacked. Cohen has political acumen, having worked effectively in a politically divided state “with a range of views about public health,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security and a former senior White House adviser on covid response. “She is super bright and a very clear communicator about the issues on the table.”
During the Obama administration, Cohen, a physician, climbed the ranks to become chief operating officer and chief of staff at the Centers for Medicare & Medicaid Services, which has more than 6,000 employees and oversees government programs like Medicare and Medicaid that insure millions of Americans. In 2017 Cooper appointed her North Carolina health secretary. She stepped down at the end of 2021.
Cohen’s time “in North Carolina will inform the practical, on-the-ground work that will make a big difference at the CDC,” Kinsley said, citing efforts to minimize racial and ethnic disparities in covid vaccination.
According to CDC data comparing covid mortality rates by state, North Carolina had the 12th lowest age-adjusted death rate in 2020. But the state’s fortunes changed in 2021, when it dropped to 30th place. North Carolinians said Cohen listened to their perspectives, but their calls for help were punctuated by a drumbeat of deaths.
Mecklenburg County Commissioner Mark Jerrell, a Democrat, said the pandemic exposed how North Carolina is still reeling from centuries of racial discrimination. Even as Cohen “became a trusted community voice,” he said, “there was a disconnect between the discussion of equity and the application of equity.”
He worries that painful lessons of those early pandemic months seem forgotten, saying, “We don’t even hear this conversation now.”
Data reporter Hannah Recht contributed to this story. | Epidemics & Outbreaks |
From hospitals to schools, courts to trains – Britons think the state of public services are ramshackle
YouGov asked Britons about 12 key public services, with a majority thinking that most are in a bad state. At 86%, the NHS is the service people are most likely to describe as being in a bad state, including almost half of the public considering it to be in a “very bad” state.
Given this, it’s hardly surprising that the more specific health services are judged to be performing similarly poorly – 81% for hospitals, 78% for social care and the same number for GPs.
Seven in ten say that trains (70%) and police (69%) are likewise in a bad way, with two thirds saying the same of prisons (67%). Around six in ten consider schools (63%) and the courts/justice system to also be in a bad state (57%).
Half of Britons say bus services are in bad shape (49% compared to 40% who think they are doing fine).
The public tend to think the armed forces are in good shape (by 43% to 31%), but the only public service we asked about that most Britons think is in strong form is the fire brigade, by 54% to 26%.
While Conservative voters have a slightly less outlook on public services than their Labour-voting counterparts, a majority of both groups still say that most of the public services we asked about are in bad shape.
Crime services, social care and the armed forces are particularly likely to be seen in bad shape by those more familiar with them
When we look at the answers among those who have actually interacted with each public service in the last 12 months the results in most cases are similar – but some services stand out.
Those Britons who have had to interact with crime-related public services – police, prisons, and courts and the justice system – in the last 12 months are particularly likely to say those services are in a bad shape compared to the wider public.
Fully 81% of those who have interacted with the prisons system say they found the system to be performing poorly, 14pts higher than the wider public. Likewise, 72% of people who have used or interacted with courts/justice system in the last 12 months say the service is in bad shape, 15pts higher than the wider public. For those who have had to deal with the police, that gap is seven points higher, at 76%.
The largest gap comes with the armed forces, however. Half (50%) of Britons who have interacted with the armed forces in some way in the last 12 months came away with the impression that things are not going well, a rate 19 points higher than the wider public.
Social care is also looking more rickety to those who have dealt with it in the last 12 months, at 88%, ten points higher than the wider public.
Photo: Getty | Health Policy |
At the centre of the UK's response to Covid-19 was a small cast of politicians and officials tasked with steering the country through the crisis.
But private messages aired during the public inquiry into the government's handling of the pandemic have laid bare the strained relations between key players - and in some instances, the contempt and animosity.
Here are some of the most eye-catching exchanges we've seen today.
This article contains language some readers may find offensive.
'He thinks it'll be like swine flu'
The inquiry has heard in recent days how then-Prime Minister Boris Johnson and other key figures inside Downing Street grappled with the size of the challenge facing the government between January and March 2020.
On 2 March, Mr Johnson chaired his first meeting of the Cobra emergency committee to discuss how the government would respond to the rapid spread of Covid-19.
But a day later, Dominic Cummings - the PM's then chief of staff - said he still didn't think Mr Johnson was convinced of the severity of the situation.
In a message to No 10 communications director Lee Cain, he said Mr Johnson "doesn't think it's a big deal" and "it'll be like swine flu", another virus which spread across the world in 2009, killing more than 450 people in the UK but not prompting a major public health crisis.
"His focus is elsewhere," the PM's closest aide said of his boss the day after that Cobra meeting.
'He's back to Jaws mode'
On 19 March 2020, Mr Cummings was in a meeting with Mr Johnson and then-Chancellor Rishi Sunak. During it, he messaged his frustrations to Mr Cain.
The exchange - which took place four days before the first UK-wide lockdown was announced - lays bare the vitriol Mr Johnson's closest advisers were privately sharing at the time.
Mr Cummings described the PM as "melting down" during a discussion about how government debt would be financed during the pandemic.
The PM is in "Jaws mode", Mr Cummings says - a reference to a joke Mr Johnson had previously made about his political hero being the mayor from the film Jaws, who keeps the beaches open despite warnings about shark attacks.
Both say they are "exhausted" with him. They then discuss a tweet from Times journalist Steven Swinford, saying Mr Johnson had sent a "confusing message" at a press conference.
Mr Cummings adds: "It's only a matter of time before [Mr Johnson's] babbling exposes fact he doesn't know what to say."
'Moronic'
The inquiry was shown September 2020 messages from a group containing three of the central figures in Downing Street - Mr Cummings, Mr Cain and Simon Case, who that month was appointed cabinet secretary, the country's most senior civil servant.
With the country through the worst of the first Covid wave but facing a second winter spike, the messages show the strained relationships between key figures at the heart of government.
Mr Cummings described unnamed ministers as "moronic" after one meeting, to full agreement from Mr Case.
Mr Cain characterised discussions as "embarrassing", and two days later Mr Cummings used a trolley emoji to denote the PM (the nickname "trolley" was used by some in No 10 to describe Mr Johnson, because of his supposed tendency to suddenly change direction on key decisions).
As well as despair at the PM's approach, then-Health Secretary Matt Hancock was also strongly criticised in the group.
Mr Cain dubbed him a "joker" who "has to go". Mr Cummings called him a "liar". Mr Hancock gave evidence to the inquiry in June and has previously denied lying to Mr Johnson.
'Get Covid and live longer'
As the second Covid winter wave built, messages appear to show Mr Johnson's faith was faltering in the ability of lockdowns to control the virus.
On 15 October 2020, Mr Johnson said he was "rocked" by analysis that the average age of those dying was over 80, adding: "That is above life expectancy. So get Covid and live longer."
The messages were sent one day after the three-tier system of restrictions was rolled out in England.
Mr Johnson goes on to say "I no longer buy all this NHS overwhelmed stuff". In other words, the PM seems to have been losing faith in the central argument for lockdown his government had been making for months - namely, that it was necessary to limit the number of cases to a level the health service could cope with.
When Mr Cain asks how his new outlook would change the government's policy, Mr Johnson says: "It shows we don't go for nationwide lockdown."
But on 31 October, just over a fortnight after the exchange, the government did announce another lockdown in England.
Mr Johnson has not responded to the evidence heard in the inquiry so far but is due to give evidence later this year. He is "co-operating fully" with the inquiry, his spokesman said this week. | Epidemics & Outbreaks |
Prices for gas, food and housing have skyrocketed in the last year. Less noticeable, to some, is the rising cost of health care. Medicare, the U.S. government's national health insurance program for Americans age 65 and over, imposed a 14.5% increase in premiums for Part B (outpatient care coverage) for 2022, a record high and nearly double the March reading of the annual U.S. rate for inflation as measured by the Consumer Price Index. Rising health-care inflation can have major consequences for current and future retirees, as medical expenses are expected to take up an ever greater share of retirees' income. "When you have to prioritize your living expenses versus health care, that's a major problem," said Kathy Martin, a 50-year-old resident of New York state, when asked what worries her most about health-care costs.Kathy Martin prioritizes her health care by taking time to exercise.Martin works out a few times a week with seniors who are part of the Silver Sneakers fitness program at her local gym in Somers, New York. Her classmate Laura Rodriguez, 67, shares her concern. "What's going to happen when I get older, you know?" she said. "How am I going to be able to pay for the care that I need?"What two years of health-care inflation might costStudies illustrate how increasing medical expenses can add up. If health-care costs grow at 2% above consumer inflation for the next two years, a healthy 55-year-old couple could face $267,000 in additional medical costs when they retire at age 65, according to an analysis by HealthView Services. That same couple could expect to spend more than $1 million on health-care expenses in their lifetime, nearly the same amount as they could expect to collect in Social Security benefits. More from Your Money Your Future:"Whether you're affluent or you're the average person … when you look at your Social Security check, you're paying for health care," said HealthView Services CEO Ron Mastrogiovanni. It pays to planAfter paying the premiums, Medicare covers about two-thirds of the cost of health-care services, with out-of-pocket spending making up about 12%, according to the Employee Benefit Research Institute. "Other than housing, food and transportation, [health care is] probably the most expensive item we're going to face in retirement," Mastrogiovanni said. "Know what it is; be prepared."The most important thing is that you start saving and you start saving early.Paul Fronstindirector of health benefits research at EBRIIncrease savings through retirement planHealthView Services estimates that a 55-year-old couple would need to invest an additional $53,000 to cover the $267,000 in added costs from inflation. Increasing savings now can add to security later. Experts say consider adding more money to your 401(k) plan or a Roth individual retirement account, if you qualify. "The most important thing is that you start saving and you start saving early; the earlier you do, the better prepared you're going to be," said Paul Fronstin, director of health benefits research at EBRI. Consider health savings accountsHealth savings accounts are another tool to save for future health-care costs, but they require a high-deductible health-care plan and have annual contribution limits. For 2022, the HSA contribution limit is $3,650 for single-insured and $7,300 for families. For people over 55 years old, each of those limits increases by $1,000, via "catch-up" contributions.Don't count on employer coverageThere was a time when employers offered health benefits to retirees, but EBRI found only about 4% of companies have those benefits, down from about 45% before an accounting rule change in the late 1980s required firms to put the liability on their balance sheets."When they had to do that, it just didn't look good on the balance sheet, so they started cutting back on the benefit to the point where very few workers are going to be eligible for this kind of benefit in the future," Fronstin said.Staying healthy Meanwhile, Silver Sneakers fitness instructor Melanie Scala, who turns 59 next month, said "I definitely feel like I'm heading people in the right direction to cut down on their health costs."Yet, while physical fitness may help control some health-care costs, experts say planning ahead for medical expenses over a longer life should also be factored into the equation. | Health Policy |
BURLINGTON, Vt. — “You can’t inject a horse tranquilizer and think nothing bad is gonna happen” to you, said Ty Sears, 33, a longtime drug user now in recovery.
Sears was referring to xylazine, a sedative used for animal surgeries that has infiltrated the illicit drug supply across the country, contributing to a steady climb in overdose deaths.
Sears divides his time between Burlington and Morrisville, a village an hour to the east. In Burlington, he visits clusters of drug users, offering water, food, and encouragement.
He has been there, been down, done time, struggled to adhere to treatment regimens. But this, he said, is different: first, fentanyl — estimated to be 50 to 100 times as potent as morphine — and now xylazine, and the life-threatening wounds and sores it can cause.
Sears implores those he encounters who suffer the effects of these drugs to look at what they’re doing to themselves. But to little avail.
“They say they’re unable to get out of it — that they don’t have a plan to get out of it.”
Worse, those who seek help breaking their addictions face treatment options rendered less effective by the prevalence of fentanyl, xylazine, and other synthetic drugs. Vermont’s pioneering efforts in establishing a statewide program for medication for opioid use disorder, known as Hub and Spoke, now face significant new challenges.
Launched in 2012, Hub and Spoke put prescription medicines at the center of the treatment strategy, which many addiction specialists say is the most effective approach. Vermont offers methadone treatment at regional hub sites for those with the most intense needs, while smaller community clinics and doctors’ offices — the “spokes” — provide care such as dispensing the opioid withdrawal drug buprenorphine.
But the rise of fentanyl, xylazine, and stimulants is undercutting the effectiveness of addiction medications.
Commonly administered doses of buprenorphine, better known as Suboxone — the brand name for a combination of buprenorphine and naloxone — have proved less effective against fentanyl, and commonly used doses can trigger violent, immediate withdrawal. Neither Suboxone nor methadone is designed to treat addiction to xylazine or stimulants.
The Centers for Disease Control and Prevention estimates that of the more than 111,000 drug-overdose deaths in the U.S. in the 12-month period ending in April, more than 77,000 involved fentanyl and other synthetic opioids. The nation has also seen a significant increase in overdose deaths from co-use of stimulants and opioids. Vermont has experienced a spike in the use of cocaine and, more recently, methamphetamine.
“There was a time when we couldn’t have pictured things being worse than heroin,” said Jess Kirby, director of client services for Vermonters for Criminal Justice Reform, which offers services to counter substance use disorder. “Then we couldn’t picture things being worse than fentanyl. Now we can’t picture things being worse than xylazine. It keeps escalating.”
In Vermont, the Hub and Spoke program is part of the statewide Blueprint for Health, with hubs in relatively populous areas of this largely rural state.
A patient enters the system for assessment and initial induction at one of nine hubs, and then, once stable, is transferred to a spoke. If that patient relapses or needs more intensive care, they can be transferred back to the hub. The spokes typically offer Suboxone — most effective for those with mild to moderate opioid dependence — but not methadone, which is more regulated.
Kirby — who began using opioids in her early teens, has been in recovery for about 15 years, and is Ty Sears’ longtime case manager — said a benefit of the hub-and-spoke model is that it offers support to primary care doctors and other practitioners who might otherwise be hesitant to prescribe medications to treat addiction. (Federal officials recently relaxed rules governing which doctors can prescribe buprenorphine.)
Erin O’Keefe, who runs the Burlington-based Howard Center Safe Recovery program, said the model’s flexibility has been key: from being fully integrated into primary care, whereby addiction is treated like any other chronic disease, to the other end of the spectrum, “making sure that people who are still in chaotic-use cycles receive harm reduction approaches” to keep them alive another day.
Vermont had the 10th-largest increase in fentanyl deaths for the 12-month period ending in April. Tony Folland, clinical services manager with the Vermont Department of Health’s Division of Substance Use Programs, said fentanyl is now implicated in about 96% of overdose deaths.
Meanwhile, xylazine, commonly called “tranq,” is causing extreme concern. State Department of Health records indicate that almost 1 in 3 opioid overdose deaths so far this year involved xylazine. And those working on the front lines report seeing a marked increase in the extreme wounds it often causes.
The challenges providers now face underscore the need to be prepared to respond in the moment. It’s essential, O’Keefe said, to capitalize on someone’s motivation for change, “and that motivation can be so fleeting — like, ‘I have enough in the tank to make one phone call, and if that phone call doesn’t go well, I’m back in the game.’”
Folland said Vermont now prescribes more medication for opioid use disorder per capita than any other state. He estimates between 45% and 65% of people with opioid use disorder receive medication.
But these challenges are unprecedented. “We have a drug supply that’s contaminated with xylazine, with fentanyl, and we know that people are struggling a lot more and are at a lot higher risk,” Kirby said. “It’s not just overdose to be concerned about anymore. It’s life-threatening wounds and infections.”
In response, advocates have asked state officials to fund more contingency management, a treatment approach that provides rewards to patients who refrain from illicit drug use. They also strongly encourage more widespread access to methadone as an alternative to buprenorphine, which is often proving less effective in countering the potency of fentanyl.
According to Folland, eight opioid treatment programs in communities throughout the state offer methadone, with one more soon to come. The goal, he said, is to prevent anyone from having to travel farther than a half-hour or so to access it.
Easier access to methadone would also require loosening federal restrictions.
“Methadone is probably the most regulated medication in the United States. We’ve got to figure out a way to make it more accessible,” said Kelly Peck, director of clinical operations for the University of Vermont Center on Rural Addiction. “We’ve got decades worth of data at this point, showing that methadone is safe and efficacious.”
For Kirby, O’Keefe, and their colleagues, more resources can’t come quickly enough.
“People dying — that’s what I’m seeing, every day,” Sears said.
Sears has been fortunate. What has served him in his recovery is the tolerance of those who’ve helped him along the way, and flexibility. There have been times when he was allowed to remain on Suboxone while still using stimulants. He is a recent graduate of a contingency management program administered by Vermonters for Criminal Justice Reform, the organization for which Kirby works.
“She counsels me,” Sears said. “She hears me out.”
Glimpsing a flicker at the end of the tunnel, advocates acknowledge, will require availing an arsenal of options to counter a shifting, and lethal, crisis.
“It’s almost like our understanding is changing from really seeing this, on a social level, as episodic to seeing it as chronic,” O’Keefe said, emphasizing that as the drug-supply landscape shifts, approaches to countering it must evolve as well. | Drug Discoveries |
The last few years have seen a significant rise in drug overdose deaths caused by counterfeit prescription pills, new research from the Centers for Disease Control and Prevention has found. The percentage of overdose deaths linked to fake drugs has more than doubled between 2019 to 2021, according to the study. Many of these deaths involved pills laced with illicit fentanyl that were mislabeled and sold as other opioid painkillers.
Drug overdose deaths in the U.S. have continued to climb year after year, with more than 105,000 estimated last year. At the same time, recent evidence from the Drug Enforcement Administration has suggested that counterfeit drugs are increasingly including fentanyl and other potentially fatal substances. To better understand these parallel trends, CDC scientists decided to analyze data from the agency’s State Unintentional Drug Overdose Reporting System (SUDORS), which collects information on recorded overdose deaths from across the country.
Between 2019 to 2021, there were about 100,000 overdose deaths documented through SUDORS. Only a small percentage of these deaths appeared to involve counterfeit pills, but it substantially increased over time. From July to September 2019, for instance, the percentage of overdose deaths that had evidence of counterfeit pill use was 2%. But by October–December 2021, it had risen to 4.7%. And in Western jurisdictions, the percentage of such deaths reached as high as 14.7%. All told, about 4.4% of overdose deaths recorded in 2021 had evidence of counterfeit pill use.
The findings, published this month in the CDC’s Morbidity and Mortality Weekly Report, appear to reflect changes in the illicit drug market. Suppliers now seem to be commonly passing off pills made with fentanyl as their legal, less potent prescription opioid counterparts. Notably, about 93% of drug overdose deaths that had evidence of counterfeit drug use involved fentanyl, either taken alone or in combination with other drugs (41% only involved fentanyl). More than half of these deaths involved pills sold as containing oxycodone. Another common target for these fake drugs are benzodiazepines, which are used to treat anxiety and insomnia but can be mixed with other drugs like alcohol to increase their euphoric effects.
The authors say that more has to be done to educate people about the dangers of these counterfeit drugs. They note that these deaths were more common among younger people, Hispanic or Latino people, and people with a history of prescription drug misuse. So prevention strategies might best be tailored to these groups. Other strategies like allowing people to test their drugs before they take them could save lives as well.
“Overdose deaths might be reduced with effective prevention messaging by federal, state, and local public health entities that 1) highlights the dangers of pills obtained illicitly or without a prescription, 2) emphasizes the importance of taking only pills that were prescribed, and 3) encourages drug product testing,” they wrote. | Drug Discoveries |
Youâve probably heard that âgetting your steps inâ can help you stay healthy. But for people with peripheral artery disease (PAD), walking even a few blocks might feel as challenging as a 10-mile run.
This common circulatory condition, which affects an estimated 8.5 million Americans, happens when the blood vessels that carry blood from the heart to the rest of your body become narrowed. This hampers blood flow to your limbs -- your legs, in particular. That can have a serious impact on your
legs and feet.
âYour feet are at the end of the totem pole,â says Jeff Ross, MD, DPM, an associate professor of surgery at Baylor College of Medicine. âBlood circulation will be impaired to begin with as you go down from the core of the body to the legs to the ankles to the feet.â
PAD limits blood flow even further, causing cramping, fatigue, numbness, and burning or aching pain in the legs and feet, particularly while walking or doing other activities that use the leg muscles. Some people with PAD also have whatâs known as rest pain.
âYouâve exercised and now youâve sat or laid down, and you still have that pain,â Ross says. âThe muscles are cramped because they arenât getting enough circulation.â
Changes You Might See
PAD may also change how your legs and feet look.
Poor circulation causes your skin to lose elasticity, making it appear dull or shiny. PAD can also slow or prevent the growth of hair or nails, so you may notice you donât have to shave your legs or clip your toenails as often. In serious cases, limited blood flow may make your legs feel cool to the touch, or the skin may change color due to a lack of oxygen.
Another major risk for people with PAD: infection. This is especially true if you also have type 2 diabetes, a condition that commonly goes hand in hand with PAD.
âThe majority of patients whoâve had diabetes for any period of time develop some degree of peripheral neuropathy. This makes it hard for them to sense what normal pain would be,â says John N. Evans, DPM, chief of podiatry at Beaumont Hospital in Dearborn, MI.
At the same time, âif you donât have adequate circulation, then your body canât heal itself the way it should,â Evans says.
PAD Foot Care Tips From Podiatrists
Good foot care is key to avoiding the most serious complications of PAD, which can even include amputation. Do these things to keep small problems from getting worse:
See a foot specialist every 3-6 months. A podiatrist can check for ulcers, ingrown toenails, abscesses, or skin issues that might cause a problem due to poor circulation. This is especially important if you have diabetes, Ross says.
Check your feet every day. Most of us only look at our feet if we feel thereâs something wrong, like a blister or splinter. After all, your feet are about as far from your eyes as you can get, and -- depending on your vision (or flexibility) -- it can be hard to get a good look. For people with PAD, though, even minor problems can quickly turn into major ones.
âIf you have a partner or someone around who can look at your feet for you, thatâs great. If not, you can use a small mirror on the ground and sit with your foot near the mirror so you can see the reflection,â Evans says. âIf you see something thatâs not quite right, let your care specialist know that thereâs something going on right away.â
Keep your feet clean and moisturized. Washing and drying your feet thoroughly every day can help prevent fungal infection. And smoothing on a lotion, gel, cream, or ointment that soothes, softens, and moisturizes will keep your skin hydrated and help prevent the skin from cracking or breaking. Just avoid moisturizers made with harsh ingredients like salicylic acid, Ross says.
Take good care of your nails. Cut your toenails straight across with the edges slightly rounded to avoid ingrown nails. If your nails are thick, deformed, or tend to rub or ingrow, donât try to deal with it yourself.
âThe risk is youâre going to cause more of a problem than if you had seen someone to take care of it,â Evans says.
The same goes for any other issues (like corns or calluses) that you might be tempted to self-treat. Although it may be tempting to head to a nail salon, particularly if itâs tough for you to reach your feet, getting a pedicure can be risky for people with PAD because of the risk of infection. Instead, see a trained medical specialist who can help you.
Always wear socks and shoes. Going sockless can lead to more rubbing, which can cause sores or blisters. Going barefoot (even indoors) can be dangerous because of the risk of cuts and infection.
Choose the right footwear. Itâs critical to find a shoe that fits the structure and function of your feet, and even the most fancy, expensive footwear may be a terrible choice for you.
âIâm a big proponent of custom insoles or prescription orthotics, or even custom-made shoes,â Ross says.
A podiatrist can do a pressure analysis to predict where ulcers or sores may show up. âThe right shoes can help you avoid breakdowns by taking the pressure off those areas,â Ross says.
Also, donât wear the same pair of shoes 2 days in a row. Letting your footwear air out can help you avoid fungal infection.
Stay active. If your muscles cramp with every step, keeping up your golf game or walking around the neighborhood may seem like a tall order. But research shows that exercise can improve the symptoms of PAD and slow down the disease from getting worse. By becoming more active, you can maximize how well your arteries work, Evans notes. | Disease Research |
Do you want a bigger penis? In one large survey a few years ago, about 45% of men said they did. And you can buy plenty of over-the-counter and even medical treatments that promise a larger penis. But do any of them really work?
Some of the things men use to try to increase penis size include:
- Vacuum penis pumps
- Penis weights
- Penis stretching exercises, called jelqing
- Supplements
- Creams
- Surgery
The truth is that these treatments tend to have modest, if any, results, experts say. And most don't do anything at all to increase penis size.
But some techniques, including weight loss, may improve your penisâs appearance or your confidence in bed, says Petar Bajic, MD, a urologist and head of the Menâs Health Center in the Glickman Urological and Kidney Institute at the Cleveland Clinic.
How can you figure out what might help and what's a sham? Talk to your doctor before you try any penis enlargement device or treatment.
âMany men still feel uncomfortable talking to their doctor about this issue, but they should seek advice from someone experienced in this area,â Bajic says. âPeople will do all sorts of things to try to make their penis larger.â
Most likely, your penis isn't really too small, experts say.
Men who want larger penises may have a poor body image, low self-esteem, or even a condition called body dysmorphia, says Michael OâLeary, MD, a professor of urologic surgery at Harvard Medical School and a urologist at Brigham and Womenâs Hospital in Boston.
âTheyâre basically just not happy with their body," he says. "I have also operated on men whose partners told them their penis wasnât large enough.â
What's 'Average' Size?
People often believe myths about the "average" or "normal" length of a penis.
âMany men donât have a realistic idea of what a normal size penis is, and we live in a society where pornography is pervasive. Some people believe that itâs normal to have a 12-inch penis,â says OâLeary. âThe average erect penis is between 5 and 6 inches long, and flaccid (not erect), between 4 and 5 inches long.â
Some men may think they need a larger penis to satisfy their partners, but that's likely not the case. About 85% of women in an internet survey of 52,000 heterosexual people said they were satisfied by the size of their partnerâs penis.
When men see Bajic to discuss penis enlargement options, he starts the discussion by making clear what ânormalâ means.
âSocietal perceptions of what is a smaller-than-normal penis arenât true," he says. "There are a wide variety of factors that may drive some men to feel that their genitalia just doesnât look as it should, including what they see in popular culture.â
Bajic notes that satisfying hetero sex, for most women, âdoesnât begin with male penetration and end with male orgasm. Sometimes, through talking it out, many men that I treat realize that they have other body image issues and that their expectations about penis size are out of line,â he says.
A few men do have medical conditions that result in a smaller-than-average penis:
Micropenis. About 6 in 1,000 men have a micropenis, or a penis that's less than 2.8 inches long when stretched. This can happen when a male baby doesnât get enough testosterone, the male sex hormone, before birth.
Peyronieâs disease. This condition causes scar tissue buildup on the penis, causing it to bend and, in some men, shorten. Men with Peyronieâs disease may have trouble getting an erection, but there are treatments that can help.
Is Surgery the Right Move?
Some surgical techniques change the appearance of your penis. That includes a procedure, recently approved by the FDA, called the pre-formed penile silicone block (Penuma).
Itâs not available everywhere yet, says O'Leary, who has done the surgery and says he's been happy with the results. Itâs a cosmetic procedure, so it isnât covered by medical insurance, he says.
âIt is a silicone implant, a silicone sleeve about two-thirds the length of the penis, which is implanted under the skin to make the penis thicker," he says. But studies show there's not as much impact on penis length.
You get this operation under general anesthesia in a hospital.
âThis surgery must be carefully controlled and should only be done by a urologist who has familiarity with the penile anatomy and the surgery itself, and who has the background and experience necessary to perform it,â O'Leary says.
In one study of 400 men who had this surgery, penis width improved by as much as 56%. Men reported that they were mostly satisfied with the results, including better confidence and more self-esteem.
Possible complications include infection and scarring after surgery, O'Leary says. The implant can also move out of place later on, he says.
Bajic says some men are âgrowers, not showers,â which means their penises may seem small to them when theyâre not erect. If they get the silicone sleeve surgery, âthe implant always holds the penis at the same length." So it may not look smaller when it's not erect.
Another type of surgery is suspensory ligament release. Doctors do this operation on men whose penises point straight down when they have an erection. The surgeon makes a cut in the ligament at the top of your scrotum to help your erection look normal. But it doesnât increase your penis's length or size when it's erect, says Bajic.
If youâre interested in surgery to treat penis size or your erections, make an appointment with a urologist, says Bajic.
He's treated some men who had penile enlargement treatments like injections of silicone or fat. âI assure you, they did not have the outcomes they signed up for,â he says. These treatments don't work and can sometimes be dangerous, he says.
What Works: Weight Loss, Workouts, Manscaping
Not keen to have penis surgery? Some simple nonmedical treatments, including grooming, or "manscaping," may improve your genitalsâ appearance, says OâLeary.
âSome men try shaving or waxing their pubic hair, and that may make your penis just stand out more,â he says.
Weight loss is another approach that improves your pubic presentation. When men put on a lot of weight as they age, they tend to gain fat in the area in front of their genitals. This can hide part of your penis and make it look smaller, he says. Losing weight can help your penis look larger by comparison.
Working out can help men look larger too, says OâLeary. Regular exercise can help cut the size of your âbeer belly,â so your penis looks better. Getting fit may boost your confidence in bed too.
Pumps, Weights, Stretching: Mixed Results
You may see these treatments pitched on TV, online, or in menâs magazines as ways to lengthen your penis:
Vacuum erection device. Vacuum pumps are used to treat men with erectile dysfunction (ED), a common condition in which you have trouble getting or keeping an erection. The device fits over your penis, and air is pumped out air to create a vacuum.
âYou need to use a penis ring with this device. It draws more blood to the penis to help it stay erect, but that wonât make your penis larger,â says OâLeary. Using a vacuum device too often can damage the tissue of your penis and make your erections weaker.
Traction weights. You can tie a weight or traction device, sometimes called a penile extender, to your non-erect penis to try to stretch it. Traction therapy can improve non-erect penis length in some men by up to 2 centimeters (a little more than ¾ of an inch). But itâs only approved for men with the early stages of Peyronieâs disease. These weights could also damage your penis.
Jelqing. This is an exercise where you place your thumb and index finger over your non-erect penis and pull on it repeatedly to increase the size. Thereâs no evidence that jelqing works.
Pills, supplements, creams, and lotions. Over-the-counter creams, as well as supplements, vitamins, or mineral pills that claim to increase penis size, simply donât work. They also could contain contaminants like pesticides.
See your doctor before you buy any over-the-counter treatment for penis enlargement, says OâLeary. âAll of the ads on TV that promise any treatment will add inches to your penis? None of them work. Theyâre a total sham,â he says.
If youâre unhappy with your penis size, consider sex therapy before you seek surgery or any other treatment, both urologists advise.
W. Myles Hassler, a certified sex therapist in Atlanta, treats heterosexual and LGBTQ men who worry that their penises aren't large enough.
âSome men have been socialized to believe that their penis is too small because of stories they heard in high school from their buddies talking about their penis size, or they may see other guys who are larger,â he says.
Hassler first reviews their sexual history to find out if bad experiences from their past, or criticism from a current sex partner, has triggered shame or guilt about their bodies.
âI work with them to help them realize that itâs not about how big your penis is, but your sexual function and quality of intimacy," he says. | Men's Health |
Adam Merritt had a very close bond with his father Rob, who was also his carer after he was diagnosed with schizophrenia as a teenager. But in June last year, Adam called 999 to confess he had killed him. Adam's sister says she is trying to move forward but will always wonder whether more could have been done to help them.
Sarah Merritt spoke to her father every day and remembers sending him a picture of family time at a pool, to which he replied, simply, "cool".
It would be the last message he would send to his daughter.
Sarah received a knock on the door the following morning, delivering the news which was "obviously the worst thing I've ever heard in my life".
Her brother Adam had stabbed their father 16 times at the home the pair shared in Peterborough.
"He cared for him from day one, since he was born and he never stopped caring," Sarah says about her father's relationship with Adam.
Adam was in his late teens when he started to show signs of mental health problems and he was diagnosed with schizophrenia in 2008.
He was sectioned around that time but managed to break out of the hospital more than once, leaving his family fearful of the future.
"That's when my dad thought 'OK, I'm going to do this on my own and take him in and look after him myself', and then at least he can be there with him and take care of him," says Sarah.
While the pair had a close bond, Sarah says her father was given no training, despite having never dealt with this sort of situation before.
"He felt like he understood and could do it, but I think there were ups and downs with Adam over the years when he did have a turn.
"It ended up making my dad ill as well, to the point where he ended up suffering and having to go to the doctors with depression and anxiety trying to deal with it."
He "would never give up" on his son, Sarah says.
Adam was known to the local NHS mental health trust, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), but not to adult social services.
However, social services knew Rob was an unpaid carer, receiving an annually-reviewed carers' direct payment.
- If you are affected by any of the issues in this article you can find details of organisations that can help via the BBC Action Line.
Sarah was concerned about how well Adam was being monitored in the community.
She feels her brother was "let down" because he was "not being seen by any professionals, not [having] regular visits or checks on him and how he was doing in his mind or taking medication".
As a result, Sarah believes her father's death could have been prevented.
"If Adam had the help from professionals, maybe he could have spoken to them, if he knew in his mind what he potentially could do, maybe then they could have helped him," she says.
Adam was originally charged with murder but was deemed unfit to stand trial.
That led to a trial of facts - used to determine whether or not someone committed an act and not whether someone is guilty - in April, after which he was given a hospital order.
The jury heard Adam had stopped taking his anti-psychotic medication two weeks earlier, but had taken a dose of medicine the day before the killing.
Adam and Rob were planning a move to Cumbria at the time. Sarah's partner James Knight believes the imminent move was stressful for Adam.
"I think maybe deep down it must have just brought on some anxieties for Adam and because there was no help from the NHS in that moment, which he had not had much help beforehand throughout the years, I believe that all of that contributed to the outcome.
"I feel like it's out of sight, out of mind. I feel like because this happened he's now getting the help he should have had years ago."
Sarah remains close to her brother, and does not blame him for what happened. "I'm not against him whatsoever. I'm not angry at him. I just feel really sorry for him," she says.
Asked if she forgives Adam, Sarah immediately responds: "I do, yes."
She believes her brother would never have meant to hurt their father "if he was in his right mind".
"He didn't mean to do it and I'm sure he would say the same thing, that he has a lot of regret," she adds.
Julian Hendy, from the mental health homicide charity Hundred Families, says there are 100 to 120 homicides by people with serious mental illness in the UK every year, with the majority of these happening within families.
"I've dealt with lots of families in this situation and often forgiveness of the person who's done it is there," he says.
"I think often the feeling we get from a lot of families is 'why has it taken a tragedy to get people the care and treatment they needed?'".
A small minority of people who have serious mental health problems are dangerous to others when unwell, he adds, and "often there's a failure to safeguard" them.
Both CPFT and the local integrated care system - a partnership of organisations aiming to provide joined up health and care services - said they were unable to comment on individual cases.
The Safer Peterborough Partnership said the case would be subject to a domestic homicide review, designed to see if lessons can be learned."This could not proceed prior to sentencing but is now under way and the independent chair will be in touch with family members to participate in this review as the contribution from family and friends is valuable to the process," the statement added.
Sarah hopes that by speaking out it will send a message to the authorities about how people with mental health issues are treated.
She talks to her brother regularly, but rather than speak about what happened, conversations focus on the every day, often about his hobbies which include painting and going to the gym.
"I try to keep it as normal as I can for his health and his sake. We are just trying to move forward," she says. | Mental Health Treatments |
You probably know that a good diet (less saturated fat, less sodium, more fruits and veggies) is important to heart health. But research is increasingly finding that eating the right foods can protect mental health, as well. A 2019 meta-analysis, the first study to evaluate the existing data on the effects of diet on depression and anxiety, found that diet may have a positive effect. For example, one study found that after three weeks on the Mediterranean diet, a group of young adults (ages 17–35) reported, on average, that their depression scores fell from moderate into the normal range. They also reported less anxiety. The control group, who continued to eat a typical diet low in fruits and veg and high in processed foods and refined carbohydrates, saw no reduction in depression scores. A change in diet has also been shown to potentially reduce the risk of dementia. These findings have led to the development of the MIND diet, a mash-up of the Mediterranean and DASH diets, combining an emphasis on healthy fats, fruits, vegetables, whole grains, and nuts along with dietary strategies to lower blood pressure. The evidence of dietary interventions for other mental conditions is less robust, but growing. It’s still not clear why eating well might help with mental illness, but researchers speculate that diet might influence mental health through its effects on inflammation, oxidative stress, and mitochondrial dysfunction. And, of course, the gut microbiome is very likely to be involved. A New Specialty This growing body of evidence has led to a new field of medicine: nutritional psychiatry. Although the field is still young (and you probably won’t find it easy to locate a psychiatrist who’ll incorporate food into your treatment plan), it is potentially game-changing for psychiatry. “Psychiatry has really struggled to be in the world of prevention,” says Drew Ramsey, assistant clinical professor of psychiatry at Columbia University College of Physicians and Surgeons and a pioneer in the field of nutritional psychiatry. Paying attention to nutrition may be a good way to maintain mental health and prevent mental illness. Still, Ramsey cautions, “There is no magic bullet to mental health.” Nonetheless, Ramsey, author of Eat to Beat Depression and Anxiety, believes that the field needs to do a better job of educating and empowering the public about the individual’s role in protecting mental health. Traditionally, mental health has been thought of as something passive: “You have it until you don’t,” he says. But we can’t sit around hoping we won’t get depressed. In 2020, one in five U.S. adults experienced some kind of mental illness. This makes the potential of diet as a key means of staving off trouble very exciting, he says. This does not mean the field of nutritional psychiatry is at the point where your doctor can give you a prescription for the farmers market, even if you managed to find a doctor on board with the new approach, explains Uma Naidoo, director of nutritional and lifestyle psychiatry at Massachusetts General Hospital, and another pioneer in the field. Though careful not to overstate the research, Nadioo says she's seen the evidence connecting diet and mental health firsthand. “I’ve seen it in my clinical practice; people start to make these changes, and they start to feel better.” Naidoo, author of This Is Your Brain on Food, is also a trained chef. She credits her training at culinary school with helping her develop discipline and the habit of planning. But her skills as a chef help her patients, too. In her practice, she actually walks people through planning meals, batch cooking, shopping for groceries, and other tasks that make eating well easier. While teaching patients how to eat better is crucial, the real challenge may be teaching doctors how to use dietary approaches in practice. Doctors get notoriously little training in nutrition, and it can take a while, even when the evidence is robust, for new approaches to trickle into routine practice. But Naidoo is on it. “It’s become my ambition to help train other providers to do this type of work, so that we can help more people,” she says. Good, and Good for You Meanwhile, there is no risk in eating well. While dietary approaches should never replace medication or other therapies advised by physicians, paying more attention to diet is a great way to maintain mental health. It can also be an adjunct to pharmaceutical or talk therapy. If you’re thinking you’ll be counting blueberries and weighing kale, or that you might be forcing down foods you don’t really like, you’ll be happy to know that eating well for health — mental or otherwise — is much simpler and far more adaptable than that. Ramsey suggests thinking in terms of categories rather than specific foods. “What really matters is our dietary pattern,” he says. And he shares a little rhyme to guide you: “Seafood, greens, nuts and beans — and a little dark chocolate.” What seafood and which greens are up to you. He also suggests what he calls “simple swaps.” You can make a huge difference in the quality of your diet by simply replacing soda with unsweetened tea or flavored seltzer or by ordering the guacamole instead of the cheese dip. Eating well is not as expensive as you may think, either. Seafood can be pricey, especially these days. But, Ramsey says, inexpensive canned tuna is just as healthy as a slab of sockeye salmon. In fact, it may be better — especially if you’re more likely to eat it three times a week. Frozen vegetables are good, too, and often more nutritious than fresh. The key, says Naidoo, is to tap into foods that you like to eat. “I'm a very big believer that in order to be healthy, we don't have to give up anything in terms of flavor or enjoyment.” | Mental Health Treatments |
A woman who lost the tip of her nose in a grisly dog attack is experiencing some hurdles in her recovery.
Trinity Rowles was attacked by her dad’s rescue dog in September of last year.
Rowles, 20, has had four surgeries so far and has to get up to six more on her face. But one operation — a skin graft — left her with a huge facial change.
The skin graft used skin from the top of her forehead and scalp, which means now Rowles has hair growing out of the skin of her reconstructed nose.
Her father’s pitbull and bully cross named Irish bit off the end of her nose, sunk his teeth into her arms and dragged her on the ground as though he were playing tug of war with her.
Rowles has been scarred by the attack and said it was “so out of character” for the dog.
“Irish was my dad’s rescue dog. He’d had him for about five years and he was like a great big teddy bear. He was so lovable and really soft. I would always go around and see him, and I even looked after him when my dad was out of town,” she said.
But before she left her dad’s house on the day Irish attacked her, she and her dad had gotten into an argument, and it was a “heated environment,” which may have triggered the attack.
“These kinds of breeds are very emotional, and putting them in high conflict and emotional situations isn’t the best for them. Animals can only communicate in so many ways,” Rowles shared.
When she started to walk away, Irish attacked. Rowles then started yelling that the dog was biting her nose.
Her dad put her in the fetal position and tried his best to protect her, but the dog kept on biting.
“He then latched on to my arm and began playing tug of war with it as if my arm was a toy, and dragged her across the yard,” Rowles remembered. “Then suddenly, like the flick of a switch, Irish just walked away and sat at the porch stairs.”
Rowles’ dad and neighbors came to help as they called the police and an ambulance. While they waited for help to come, her dad brought Irish inside.
“When the police arrived, I remember I was getting put on to a stretcher and heard my dad shout ‘just do it’ before the sound of gunshots being discharged,” Rowles recalled.
The attack only lasted a few minutes, but she said it felt like the longest time of her life.
“During the attack, it was like I was in and out of reality. My fight or flight kicked in but still knew what was happening to me,” she shared. “I knew I was getting attacked and being bitten, but only to a certain extent. I could feel the pain but I had no idea about the extent of the injuries.”
Rowles was left with injuries to her face, ears and arm. She lost a lot of blood from her arm, saying, “it was like a puddle in my hand.”
“I was taken to the hospital, and I don’t remember much after that. My mom met me there and she told me that the doctors were literally putting their hands inside my arms because of how extensive the wounds were,” she said.
She was in the hospital for four days to start, but after going home for a couple of days, she had to go back for her nose reconstruction.
The aftermath of the incident has affected Rowles’ confidence and it’s been hard for her to deal with the physical changes on her face.
“I know what dogs are capable of now. I never properly thought about it before or what damage dogs can do.
She’s also been dealing with the mental impacts of the attack.
“I don’t sleep well anymore because of my flashbacks and I have a really bad fear of dogs now too. I am on medication and go to therapy to help me deal with my PTSD,” she revealed.
Aside from the life-altering facial changes and the PTSD, the attack also changed Rowles’ outlook on life, and she’s focusing on the silver lining.
“Having a near-death experience has changed my perspective on life, and I am really grateful to still be here as it could have been a lot worse,” she said. “Although this has been a life-changing and horrendous experience, I am just so glad to still be here.” | Mental Health Treatments |
Most of us have had that unsettling sensation when our heart seems to flutter or "skip" a beat — but when heart palpitations start happening more frequently, you may wonder if it’s something to get checked out.
Dr. Bradley Serwer, a cardiologist and chief medical officer at VitalSolution, a Cincinnati, Ohio-based company that offers cardiovascular and anesthesiology services to hospitals nationwide, noted that palpitations are very common and almost everyone experiences them at some time.
"Palpitations can occur at any time, but how and when we feel them or sense them varies," he told Fox News Digital.
"Many people feel palpitations when they lie down to go to bed, when all the external stimulation has been removed and we are trying to fall asleep."
What causes heart palpitations?
Palpitations can occur for a multitude of reasons, Serwer said.
The most common reason is a premature heartbeat, also called premature ventricular or premature atrial contractions.
"The heart is constantly filling and then contracting to pump blood to the body," the doctor said. "When a premature heartbeat is experienced, it is typically a very weak heartbeat, as the heart hasn’t properly filled with blood."
"Following the premature beat, the heart resets with a slight compensatory pause. This extra time allows the heart to fill with more blood, and therefore the next normal heartbeat is typically a very vigorous contraction."
This is typically what gives people the sensation of a flutter in their chest, Serwer said.
In other instances, palpitations may be felt when the heart is racing.
"If you are exercising and your heart rate rises to 150 bpm, it feels normal and is expected given your physical exertion," Serwer said. "However, if your heart rate is going 150 beats a minute while at rest, it can be somewhat uncomfortable."
"These types of palpitations can occur with different types of abnormal heart rhythms, such as atrial fibrillation (an irregular and often very rapid heart rhythm) or ventricular tachycardia (a heart rhythm problem caused by irregular electrical signals in the heart)."
When are heart palpitations worrisome?
When extra heartbeats occur, they are almost always benign (non-harmful), the doctor said.
If you sense a sudden-onset rapid heart rate that does not resolve quickly, however, it may be a warning sign of some type of atrial fibrillation, Serwer said.
"I recommend that people seek a cardiac evaluation if they have sustained palpitations lasting longer than a few minutes," he told Fox News Digital.
"I also recommend they seek immediate medical attention — regardless of the duration of the palpitations — if they are associated with dizziness, passing out, chest pain or shortness of breath, as they may be indicative of more concerning abnormal heart rhythms."
How are heart palpitations resolved?
The first step in treating palpitations is to understand what’s causing them, Serwer said.
In his practice, Serwer said the team often places heart monitors on patients so they can identify what their heart is doing when they feel the sensation, which can help determine the sort of therapy they may require.
"If palpitations are from premature heartbeats, the patient often does not require any therapy," he said.
Serwer often recommends that patients avoid common triggers, such as stimulants of any kind — caffeine, sugar, decongestants, nicotine or many types of drugs.
"Stress is also a big contributor to palpitations," he added. "Often stress reduction helps decrease the frequency of palpitations dramatically."
If therapies are required, there are medications that can suppress the abnormal heartbeats or heart rhythms, the doctor said.
If those fail, more invasive procedures, called cardiac ablation, may be helpful.
"If palpitations are new — especially if they are associated with dizziness, passing out, chest pain or shortness of breath — I recommend seeing your health care team," Serwer said.
"It’s important to differentiate between the innocent palpitations and those that could be potentially life-threatening." | Disease Research |
June 12, 2023 -- Teresa Stull swears by her multivitamin formulation. Tired of taking pills, the 62-year-old esthetician and business owner in Frederick, MD, turned to a daily liquid formulation for skin health and inflammation. She was attracted to the product (which she also carries for her clients) because of its high absorption rate, the fact that the company shared data on its website, and mostly, its benefits for her skin and overall health.Â
âIâve been using it for 6 years,â she said. âIt helps the heart with the flaxseed oil, lysine, and all of the inflammation. And the side benefits are healthy skin, healthy nails, healthy hair with the biotin and collagen and how itâs delivered. I feel very balanced.â
Stull is one of the 70% of Americans who take multivitamins daily. But unlike Stull, many lack a clear understanding of their âwhys and whatâsâ -- that is, why am I taking this and what will it do for me? Questions abound whether these supplements do anything to help with disease prevention â namely cancer and heart disease âand many people wonder if they need to take a multivitamin at all.Â
One reason is that nutritional needs change over oneâs lifespan. As people reach middle and older ages, factors like slower metabolism, absorption and chewing issues, chronic low-grade inflammation, as well as multiple prescription medications can lead to vitamin and mineral insufficiencies.Â
Moreover, the food that we rely on to supply daily nutritional needs is unreliable. Today, commercial farming is plagued by overuse of fertilizers and pesticides and less frequent crop rotation, all practices that affect soil health. When you combine these factors with climate change, itâs likely that the nutritional value of many of the fruits and vegetables that we eat is compromised. Itâs even more likely that middle-agers and seniors who swear by healthy diets likely have important gaps in nutrition.
âThereâs been a significant deterioration in soil quality over the past 50 years or so and produce is not as nutrient dense as it was,â said Melina Jampolis, MD, an internist, physician nutrition specialist, and author in Valley Village, CA.
The quality of soil also differs from farm to farm.Â
âWhen we buy spinach or some other food, we really donât know how much magnesium, or vitamin K, or calcium is in things grown from ground as theyâre dependent on soil and soil varies,â said Christopher DâAdamo, PhD, director of research for the Center for Integrative Health at the University of Maryland.
Prevention vs. Preservation
In 2022, the U.S. Preventive Services Task Force concluded that there was not enough evidence supporting use of supplemental vitamins and minerals â alone, in pairs, or in a multivitamin format â for preventing cancer, heart disease, or related death. The task force also found a link between the use of beta-carotene and an increased risk for lung disease in certain high-risk populations. Vitamin E offered little benefit overall for heart disease or cancer prevention.Â
So why bother?
âIn a perfect world, everyone would get tested for their nutrient status. For example, I need magnesium but not calcium, and I need B1 but not B12. That would be ideal but thatâs just not feasible,â explained DâAdamo.
âThe reason that multivitamins can be helpful, if you look at the data, is that they can cover the bases.âÂ
They might also help preserve memory as we age, according to two studies conducted by Columbia University and Brigham Womenâs Hospital/Harvard University researchers.
The COcoa Supplement and Multivitamin Outcomes Study Web (known as COSMOS-Web) included roughly 3,500 adults older than 60 who were randomly assigned a daily multivitamin or placebo and given a series of cognitive tests annually for 3 years.
âWe were testing what I might call learning or immediate memory, our ability to encode or initially store information into memory so that later, we can access it more easily,â said study leader Adam Brickman PhD, professor of neuropsychology in the Taub Institute for Research on Alzheimerâs Disease and the Aging Brain.
By the end of the first year, the multivitamin group had significantly greater improvements in memory recall compared to when they started the study and compared to the placebo group.
âWe found that the memory effect was sustained on average over the 3 years of this study,â Brickman said.Â
This improvement was equal to roughly 3 years of age-related memory decline.
The study also reinforced findings of an earlier COSMOS trial (COSMOS-Mind) that showed the effects were more pronounced in people with heart disease, who, across the two trials, had lower baseline memory scores than healthy participants.Â
âThereâs some indication that people with vascular disease and vascular risk factors have lower levels of certain micronutrients than those without. So we think that the multivitamin is supplementing those relative deficiencies,â said Brickman.
There was a third group in the trials who received a cocoa supplement or placebo. A separate analysis showed that people with preexisting flavanol deficiencies who were assigned the cocoa supplement also had improvements in memory function.Â
Important Considerations
- Multivitamins might be the best option, at least for now. In the COSMOS trials, it was unclear if there was a certain element in multivitamins that led to the memory improvements or if flavanols derived from one source are more beneficial than others. Itâs also important to consider the potential role that individual vitamins like D3 play in helping preserve bone density and possibly prevent fractures, or the B vitamins (especially B6 and B12) in helping form red blood cells or the body make energy from food. Without widespread personalized nutrition and genetic testing, the one-size-fits-all approach suffices, so long as people take a food-first approach.
âThe idea behind multivitamins is that your diet isnât necessarily perfect so you add the multivitamin to give yourself a little margin of error,â said Adam Michaels, PhD, a research associate at the Linus Pauling Institute at Oregon State University in Corvallis, OR.Â
He pointed to newly published data from his organization that showed most older men with poor vitamin levels who were assigned a daily multivitamin showed improved blood concentration and overall status of one or more vitamins (but not minerals) by the end of the study. At the start of the study, most of the participants had shortfalls of at least one vitamin (most had shortfalls in three to five), which is where the largest improvements were seen. Multivitamin use also slowed a decline in a specific marker of how well cells use nutrients; this suggests that they might help preserve metabolism and immune health in aging adults.
- Absorption varies from person to person. Researchers are still working toward a better understanding of how well the body uses multivitamins. âThey do get absorbed but the amount may vary from person to person,â said Michaels.
Several factors are key:
- âA variety of medications can deplete nutrients,â said DâAdamo. Statins and acid blockers deplete certain nutrients. Aspirin can cause vitamin C to be quickly lost through urine, and other vitamins, like calcium, magnesium, and zinc, can reduce how certain antibiotics are absorbed. (The Linus Pauling Institute provides a comprehensive list of medication/vitamins/minerals interactions on its website.)
- Certain foods may also interfere with absorption. âSome of the really high-fiber foods may impair absorption. Fat-soluble vitamins like vitamin K absorb better when they are taken with fat. And people donât realize that tea can interfere with the absorption of iron,â said Jampolis.Â
- The data around the difference between vitamin pills or liquids is less clear. Michaels noted that itâs total speculation. âEvery supplement company believes that they have the answer and ⦠if they have the data, theyâre keeping them to themselves,â he said.Â
- Multivitamins are mostly safe. None of the experts we spoke with had concerns about the safety of multivitamins, but they all recommended that people read the label for quality and manufacturing certifications. NSF certifies supplements to NSF/ANSI 173, the only American National Standard for testing and certifying dietary supplements for contents and purity. Consumer Lab also provides access to their product testing and reviews. (Full access requires a paid subscription.)
- Middle age may be the best time to start. By the time a person reaches age 50, it might be time to start taking a multivitamin. âWe start seeing nutrient deficiencies like the mid-50s and above and there tends to be more and more issues with suboptimal nutrition as they age,â said DâAdamo. Jampolis advises that people start even younger â around age 45.
- Theyâre not for everyone. Before starting a multivitamin, check in with your doctor, especially if you are on medications or have other health conditions. Multivitamins are not appropriate for everyone, which is why your doctor can provide the best guidance to meet your needs. | Nutrition Research |
By Natalie Brown, as told to Kendall Morgan
When I was diagnosed with stage IV lung cancer at age 33, I had to make a lot of tough decisions quickly, including whether to freeze my eggs before treatment started or not be able to have kids. We decided to go ahead with treatment immediately. In the beginning of treatment, I felt awful. I was exhausted, and there was little I could do. It took time to come to terms with the diagnosis. How I feel mentally still changes day to day.
Overall, the emotional impact and experience hasnât been what I expected in the beginning. I didn't expect treatment to go the way that it is going. Itâs going surprisingly well for stage IV, so letâs start there. But I say emotionally, every treatment is completely different. Sometimes, I can go through treatment and it's like, âHey, I have chemo.â Sometimes, it's like, "Oh my gosh, I can't believe I have lung cancer. I canât believe Iâm having to put poison in my body.â
I have to alter my life around treatment. Iâll do as much as I can before the medicine kicks in. I still work and it is very difficult to try and work and be on treatment at the same time. If I have treatment on a Monday, Iâll do all I can because by Wednesday or Thursday, I might not feel like walking up the steps.
Emotionally, itâs all over the place. It's like a rollercoaster. Sometimes you are up and sometimes you are down. It's a complex combination of emotions with treatment every 3 weeks. I know Iâll be down for a week, so Iâll hurry and stress. Iâll make sure all the clothes are washed. My husband helps, of course, but I want a clean house when Iâm in treatment. I rush around, cooking, cleaning, or ordering food because I wonât feel like cooking. Itâs a lot of anxiety to make sure things are perfect before treatment. If I donât get it all done, then Iâll try and do it in the week of treatment and it makes me more fatigued. Thatâs when it gets frustrating.
Sometimes I just shut down. Two treatments ago, I cried and cried because I was so fatigued to the point where I couldnât believe I was having to deal with this. I cried the whole week. I didnât want to talk to anyone or get on social media. I went into a funk. It happens periodically. Youâre just so tired. The fatigue weighs on you the most, no matter how much you sleep.
To help with the emotions, I found support through a mentoring program and online. I started seeing a therapist for the first time in my life. I thought at first I could handle this without professional help, but I couldnât. Seeing a therapist has helped.
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A lot of friends got me books. I tried reading them, but Iâd read 20 pages and I just couldnât do it. I started listening to podcasts and thatâs better for me. Those seem to help. I listen to a lot of music, especially during treatment weeks. Slow, soft music seems to help a little bit. I take bubble baths, and I never did that before. Relaxing in a tub with candles. That helps a lot.
You have to give it time. I was not immediately able to talk about this the way I am now. I had to take the time to digest the fact of cancer and then I could share my story. Awareness is extremely important, especially in lung cancer.
Through it all, I find reasons to celebrate. Iâm turning 35 this year. Itâs another birthday, but itâs also another year celebrating that Iâm still here. I celebrate everybodyâs birthday. I celebrate scans. I had one a couple of weeks ago that was really good. I make sure to celebrate any little thing. Before cancer, I didnât do that. I celebrated birthdays but not to the extreme. Now, thatâs super important to me. It doesnât have to be anything big. Any small situation, I make it celebratory. This experience has turned me into a more positive human. It sounds crazy. Youâd think the opposite. But Iâm so much more positive in life than before.
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SOURCE:
Natalie Brown, Atlanta, GA, was diagnosed with stage IV lung adenocarcinoma, the most common form of non-small-cell lung cancer, in July 2020. She works full-time in software sales and serves as an advocate for lung cancer awareness. | Disease Research |
When it comes to managing your rheumatoid arthritis (RA), things can turn complicated pretty quickly. Trying to keep track of the pain (when, where, and how badly it hits), the many medicines you may need, and the triggers that cause your RA to flare -- all information thatâs crucial to your care -- can feel overwhelming at times.
But several apps for your smartphone or tablet can help. For many of the more than 1.3 million Americans who have RA, they can be a vital part of health care.
"We need to capture what's going on," explains Rajat Bhatt, a rheumatologist in Richmond and Pearland, TX. "Apps are very good at gathering historical data, how the patient is doing between doctor's visits -- not necessarily at the time of the doctor's visit. It's very useful."
A big part of what the apps do is keeping a daily âdiaryâ of your RA. Users put in information, which differs on various apps. But it may include things like the level of pain at any given time, where the pain is, and what medicine you're taking for it. And users share that data with doctors, sometimes directly from the app. That gives everyone a fuller picture of the disease, its effect, and the path forward.
"If we wait until the [doctor's] appointment, the patient could have been having flares but is already feeling better, but that does not mean that there wasn't damage done during the flares," Bhatt says. "If patients are having frequent flares, we might switch therapies to something that is more effective."
The Appeal of Apps
In the old days, before smartphones and instant access to the internet, people with RA had to go with a more old-fashioned way of monitoring their symptoms.
"I wrote it down. I documented it," says Sylvia Faircloth, who was diagnosed with RA in her late 40s and who has been an ambassador for the U.S. Pain Foundation for about 12 years. "They told me it was very important to document, especially with hands, knees, legs. When I saw a difference in this or that, I would document."
The advent of apps has made it easier. With the flash of a thumb or finger, users might be able to tap a graphic to show where the pain is or use a sliding scale to detail how much it hurts. Doctors now can get a much more complete picture of the disease's effect. People with RA, too, have a better understanding.
"It keeps you present to what's going on," Faircloth says. "One of the things I really like is looking back, how many days of the month I felt bad, compared to how many I felt good. I can go back and look at that sometimes and go, 'Wow, March was a bad month. Twenty-two days out of 30 were not good days.'"
Features vary from app to app. Some have medication reminders, some prompt you for an entry, some have links to educational resources and support groups, and others can connect with fitness devices or your doctor's office. But all involve you in your own care.
A few years ago, Ashley Newton was struggling with her RA during a hot, humid, walk-heavy trip to Mexico. The app she was using allowed her to add a note to describe what she was going through, which proved critical in her health assessment when she next saw her rheumatologist.
"When I came back to my doctor, we could kind of look at what my trend was over the past 3 months, and I could articulate, 'Here are the kinds of activities that really caused me these additional problems,'" says Newton, who was diagnosed with RA about 5 years ago. "I really think, because I was tracking and could start to see that pattern emerge ⦠we could make decisions more easily."
Now, before she travels, Newton may consult with her doctor to consider medications that could help prevent, or at least control, RA flare-ups. She says the app she uses -- ArthritisPower, created by the nonprofit group CreakyJoints and the University of Alabama at Birmingham -- has made it easier for her to manage her RA symptoms.
"It's impacted my care already, because it's giving me something hard and fast. It almost feels like I'm equipping myself with evidence," she says. "This gives [my doctors] an actual measure to look at and make a decision."
Faircloth, who uses a couple of apps for her care, also is a big believer in their power.
"With that app, I feel like I have a better grip on my health," she says.
Features to Weigh
Apps that help you deal with the day-to-day management of your RA offer a variety of features. Here are some you may want to look for:
Pain tracker. The most basic function of any RA app is to record pain accurately so your doctor can take the proper steps to manage it. For now, the record-keeping isn't automatic: On their own, apps can't tell where you hurt or how much you hurt. But the best ones have quick, accurate, intuitive ways to record this information, and they allow you to add things that may worsen your pain (like stress, overexertion, infection, and poor sleep).
Medicine tracker. Critical, too, in these apps is a list of the medicines you take. Pairing that info with your pain tracker can help doctors decide on treatments.
Education. Some apps have links to help you learn more about RA and its treatment. They may also offer tips and advice on how to handle flare-ups.
Support. Need a sympathetic ear -- someone who has been through what you have? Some apps can point you to local or national support groups.
Apps to Consider
Most RA apps are free to download and use, but some have ads. Most are available for both Android and Apple devices, through Google Play or the App Store. Here's a sample:
ArthritisPower. Track symptoms and meds, fill out surveys, take part in trials, and share info with doctors and researchers in a patient-focused app that aids in the overall fight against RA.
cliexa-RA. This graphic app allows you to map where your pain is, track your medicines, and get an accurate, complete report for your next trip to your doctor.
Manage My Pain. Describe your pain in less than 30 seconds (whatâs it like, where it is, how long it lasts, things that make it worse) for a complete report (with graphics) to share with your doctor.
My Pain Diary. This app tracks your pain history (including a color-coded calendar for good and bad days) and your medicines, fetches weather data, and prepares a PDF for your doctor. It comes only in iOS, an Apple operating system.
PainScale. This app has a searchable library of free content to help you find pain relief, along with a pain tracker, the ability to set reminders, daily health tips, and integration with Google Fit.
RA Monitor. In addition to pain and medicine tracking, and the ability to share with a doctor, this app can help connect you directly with your doctorâs office or support groups. | Disease Research |
Obesity is a medical condition thatâs found everywhere. Itâs nearly three times as common worldwide as it was in 1975, according to the World Health Organization.Â
In the U.S., almost 42% of U.S. adults have obesity, CDC data show. But itâs less common among Asian Americans. Some experts have suggested that the standard definition of obesity â having a BMI of 30 or higher â might not be the best fit for Asian Americans.
In this interview, Jennifer Ng, MD, a certified obesity medicine specialist in New York City and chair of the Obesity Medicine Associationâs Outreach Committee, discusses how obesity affects Asian Americans and what they need to know about this condition. This interview was edited for length and clarity.
WebMD: How did you get interested in obesity medicine?
Ng: When I started practicing medicine, many of the patients I saw had elevated BMI, and this was across different socioeconomic classes. I was very surprised. This wasnât something I was aware of when I was in medical school or residency. Medical school didnât equip me to handle this or tell me how to counsel patients. Itâs frustrating when youâre trained to be the person giving the answers and you just have no answers. I wanted to learn more.
WebMD: How do obesity rates within the Asian American community compare to other demographics?
Ng: The obesity rate among Asian Americans is roughly 11%, which is lower compared with many other ethnicities. Under the current criteria, a body mass index (BMI) of 25 and above is considered overweight and 30 and above is considered obesity, and thatâs applied across the board.
But thereâs concern that we may not be capturing the full spectrum of the issue because BMI and the standard for measurement for obesity and being overweight is based on people of European descent.Â
There are some differences between ethnicities that we need to be cognizant of. Some guidelines suggest that perhaps we should consider Asian Americans to be overweight and having obesity at a lower BMI â a BMI of 23 and above for being overweight and 25 and above for having obesity â because there seems to be an increased prevalence of cardiovascular disease and metabolic disease at a lower body weight among Asian Americans.Â
WebMD: Do overweight and obesity rates differ between different subpopulations of Asian Americans?
Ng: Different subgroups within the Asian community can have different rates of being overweight or having obesity. For example, Filipino Americans and South Asians tend to have a higher rate compared to East Asians. I will say that things change depending on how long youâve lived in this country. Higher BMI seems to be associated with living in the United States longer.Â
WebMD: When we use a standard like BMI thatâs based on one population of people like Caucasians or those of European descent and then generalize those findings across all populations, what do we potentially miss?Â
Ng: We want to make sure we donât apply one standard to everyone because people are different. People of different ethnic backgrounds are at different risks. When we use only one standard, sometimes we under-diagnose or under-screen certain populations or overdiagnose or over-screen other populations.Â
WebMD: How does this impact the Asian American population?
Ng: Thereâs a lot of misconception out there. I have a lot of Asian Americans that come into my office who donât think that being overweight and having obesity is an Asian problem because there is a tendency for Asian Americans to run on the thinner side, they donât have a family history, or they donât eat a Western diet. They may think they donât need to exercise or worry about their diet.Â
Primary care doctors may not be aware either and they may under-diagnose or under-screen Asian American patients.Â
WebMD: Why do Asian Americans experience cardiovascular and metabolic disease at a lower BMI compared to other populations?
Ng: You can gain fat in different ways. The size of the fat cell can increase, or the number of fat cells can increase. Thereâs genetic variation in how people store fat. It seems that, especially in the South Asian community, thereâs a tendency for fat cell size to increase, which appears to be more problematic than increasing the number of fat cells. The fat becomes âsickâ and starts to produce inflammatory markers and abnormal hormones, which can lead to a lot of the issues we see with metabolic disease.Â
Thereâs some thought that within the East Asian and South Asian community, thereâs an increased tendency to store fat as visceral fat too. Itâs the more dangerous fat that is stored in and around the organs. Our organs arenât equipped to store fat, so they then become dysfunctional. That can lead to increased cardiovascular disease, metabolic syndrome, diabetes, and cholesterol issues.
For example, if you store more fat in the liver, it leads to inflammation because the fat produces inflammatory markers and interrupts the functioning of normal liver cells. This can lead to problems metabolizing cholesterol, glucose, and fat. If your glucose control is impaired because your liver isnât working properly, your pancreas starts to release more and more insulin. That can lead to diabetes, and insulin itself causes fat cells to grow.Â
WebMD: Aside from genetics, what else seems to be driving the rates of overweight and obesity among Asian Americans? Do diet and exercise among Asian Americans play a role?
Ng: Diet and lifestyle certainly play a role, but so do environmental factors. If people work a lot, live far from work, donât have the opportunity to eat healthy food, and arenât physically active, it becomes problematic. The diet that may have worked for them before moving to America, where they were more active and less sedentary, might not be OK here.Â
There are misconceptions about exercise among my patients of Asian descent, especially the older ones who didnât grow up in America. They say, âThis isnât something that Asian people do. Itâs too much. Itâs too intense.â
WebMD: How do you counsel your Asian American patients?
Ng: Every patient is different. Iâm a primary care doctor, so when they come to me, I assess their overall health, diet, and exercise and see where they are. Regardless of BMI or weight, I educate them on healthy diets and exercise.Â
When I see patients of Asian descent in my office, I am more vigilant. I do use the lower BMI criteria to counsel my patients and to start checking symptoms to consider whether they could be at risk for cardiovascular or metabolic disease. I also use waist circumference to evaluate patients because BMI doesn't always accurately tell you about body composition. Waist circumference can be a better marker of visceral fat, which is a more concerning risk factor for cardiovascular and metabolic disease.
You donât want to alienate your patient. You want them to come back. I try to meet them where they are because you canât bulldoze over them and their culture. Iâll suggest tai chi, which is a gentle exercise that helps build balance and strengthen muscles, or bodyweight exercises like carrying their groceries. Iâll suggest trying brown rice or wild rice or cutting down on portions. Little changes are better than no changes.
WebMD: What do you want Asian Americans to know? What message do you have for them?
Ng: My main message is just because youâre thin or in the normal range of the standard BMI criteria, it doesnât mean that youâre not at risk. Itâs still important to eat healthy, exercise, and see your doctor regularly. Many conditions are reversible if you catch them early enough, even if you have a genetic predisposition. There are changes you can make to your diet or lifestyle that can impact obesity and other disease risks. | Nutrition Research |
President Joe Biden is facing opposition from both sides of the aisle as his administration nears a decision on a proposed menthol ban, with several arguing such a move would negatively affect the economy and disproportionately affect communities of color.
The Food and Drug Administration is expected to release its decision as early as this week on whether it will implement a ban on menthol cigarettes and flavored cigars, following through with a proposal that was first floated by the agency in spring 2021. Lawmakers and advocacy groups alike have criticized the proposal, arguing it would lead to an increase in illicit sales as well as inconsistent enforcement.
“Banning products does not curb consumer demand, but rather fuels illicit markets. Products made and sold without FDA oversight are much more likely to contain dangerous additives,” a group of more than 60 criminal justice and drug reform groups wrote in a letter to Biden on Tuesday. “The current fentanyl crisis is a perfect example of how an underground market puts the public in danger.”
Republicans have long pushed back against the proposed ban, with a handful of Democratic lawmakers also coming out in opposition as the FDA nears its decision. Rep. Jared Moskowitz (D-FL) joined Rep. Andrew Garbarino (R-NY) in a letter sent to the FDA, urging the agency to reverse course.
The pair of lawmakers cited concerns with national security that a proposed menthol ban would pose, arguing such a move could “open a massive revenue stream for this Hamas-allied foreign terrorist organization."
“It is well-documented that Hezbollah is a leader in the illicit cigarette trade — not halfway around the world but right here in the Western Hemisphere. There have been cases in which Hezbollah and Hamas cells have smuggled cigarettes into the United States to send the revenue overseas,” the two wrote. “It would be concerning to move forward with this rule without considering the potential for foreign terrorist and criminal organizations, such as Hezbollah or Hamas, to generate revenue and fuel their operations in the wake of a ban on menthol cigarettes.”
Opponents of the ban have argued such restrictions would negatively affect the economy at a time when businesses are already dealing with rising costs and inflation. Cigarettes account for nearly 30% of all sales in convenience stores and over 10% of those stores’ gross margins, according to data from the National Association of Convenience Stores. Those numbers have contributed over $54 billion to the industry.
Implementing a menthol ban could negatively affect those numbers, particularly hitting small businesses that are already reeling from high interest rates and supply chain challenges, according to U.S. Hispanic Business Council President Javier Palomarez.
“It's already been a very heavily regulated industry,” Palomarez said. “We believe in commerce, but commerce with a conscience. And so we believe that any product that is legally sold, responsibly marketed, and responsibly manufactured — any American should be able to buy a product that meets those requirements. And these products definitely meet those requirements.”
The council has also expressed concerns about how the ban would negatively affect communities of color, arguing a majority of those who smoke menthol cigarettes are Hispanic and black consumers.
“If this product is made illegal, it's those communities that become vulnerable to criminal charges or fines,” Palomarez said. “I'm a Democrat. I voted for Joe Biden, but I am beside myself at the sheer stubbornness and the arrogance of an administration that purports to know more and better about what's good for our communities.”
The emerging opposition could spell trouble for Biden as he seeks reelection next year, especially because Hispanic and black voters are two key voting blocs that Democrats typically rely on. Republican political operatives have signaled they plan to use the topic as campaign fodder during the 2024 cycle, planning to use the proposed menthol ban to compare it to the Biden administration’s softening on marijuana possession.
The Biden administration announced in October it would recommend the Drug Enforcement Administration to loosen federal restrictions on marijuana, which would mark the largest change in federal drug policy in decades.
“It’s incredible that Biden is spending massive political capital trying to ban cigarettes at the same time he’s legalizing weed and heroin injection sites,” a Republican Senate operative told the Washington Examiner. “Democrats up and down the ballot should expect to answer for this in their campaigns.”
It’s not clear when the FDA will release its decision, but it could come as soon as this week. Details on how the ban will be enforced are not yet known. | Health Policy |
- The drug company Danco Laboratories has asked the Supreme Court to take up the case challenging the legality of the abortion pill mifepristone.
- Danco, the distributor of the pill, wants the justices to reverse a lower court ruling that would impose restrictions on the pill.
- The company said the case is of "indisputable importance" to women's health.
- The lower court ruling is on hold until the Supreme Court makes a decision in the case.
The drug company Danco Laboratories has asked the Supreme Court to review the case challenging the legality of the abortion pill mifepristone.
Danco's request comes in response to a ruling by the U.S. Court of Appeals for the 5th Circuit that would impose major restrictions on how the medication is used and distributed to patients.
The drug company, which distributes the abortion pill, has asked the Supreme Court to reverse the lower court ruling, saying the case is of "indisputable importance" to women's health as well as the pharmaceutical industry.
"For the women and teenage girls, health care providers, and States that depend on FDA's actions to ensure safe and effective reproductive health care is available, this case matters tremendously," Danco's attorneys wrote in their filing.
"And for the pharmaceutical and biotechnology industry, permitting judicial second- guessing of FDA's scientific evaluations of data will have a wildly destabilizing effect," the attorneys wrote.
The appeals court ruling is on hold until the Supreme Court makes a decision about the case. The high court, in April, pressed pause on lower court decisions as litigation about the pill proceeds in response to a request from the Biden administration.
A three-judge panel at the 5th Circuit ruled that decisions the Food and Drug Administration took in recent years to make mifepristone more accessible to women failed to address safety concerns.
Should the Supreme Court take the case and uphold the appeals court decision, mifepristone will remain on the market in the U.S. but patients will face more barriers to accessing the medication.
If the high court declines to take the case, the appeals court restrictions will go into effect.
Mifepristone, used in combination with another drug called misoprostol, is the most common method to terminate a pregnancy in the U.S.
The appeals court order would end mail delivery of mifepristone and prescriptions via telemedicine appointments. Women would have to see a doctor in person to get a prescription and go to three follow-up visits as they take the course of medication.
The ruling also shortens the time when women can take mifepristone to seven weeks into their pregnancy, down from 10 weeks currently.
The litigation against mifepristone began last November when a group of physicians who oppose abortion called the Alliance for Hippocratic Medicine sued to overturn the FDA's original approval of the pill, which dates back more than 20 years.
U.S. Judge Matthew Kacsmaryk of the U.S. District Court for the Northern District of Texas issued a sweeping order in April that suspended the FDA approval of mifepristone.
The appeals court dialed back Kacsmaryk's order and kept the original FDA approval in place as well as the agency's authorization of a generic form of the pill. | Women’s Health |
On May 11, the U.S. will no longer officially be in a COVID-19 emergency for the first time since the pandemic began three years ago.
While hundreds of COVID-19 deaths are still reported each day in the U.S. -- adding to a toll of more than 1 million -- public health experts say the Biden administration is likely looking to end the national and public health emergencies related to COVID-19 because the U.S. has high levels of immunity from previous vaccinations or infections, and the omicron subvariants that are circulating are producing milder disease.
The threat of the virus has also receded for many Americans, thanks to testing, treatments and vaccines.
Jen Kates, senior vice president of the nonpartisan nonprofit Kaiser Family Foundation (KFF), called the end of the emergencies "symbolically a big change." But she and other experts also noted that it will still alter systems that people have come to rely on without realizing they were temporary, at the same time that experts caution it's unclear what the future will hold.
"I think the administration is hoping that we are clearly transitioning into an endemic period, and that the pandemic period is in the past," Dr. William Schaffner, a professor of preventive medicine at the Vanderbilt University Medical Center in Nashville, Tennessee, told ABC News.
"Now, that said, those of us in infectious diseases and public health are a little nervous. And the reason is, here we are at the end of January predicting what the circumstances will be in May," Schaffner added. "This is a very unpredictable virus."
Here are the biggest impacts of the public health and national emergencies ending, according to experts:
Millions could lose Medicaid
After three years of major enrollment increases for Medicaid, anywhere from 5 to 14 million Americans could soon lose their access to the government's health insurance program for low-income people and others, according to KFF, which focuses on national health.
And according to estimates from the U.S. Department of Health and Human Services, nearly 7 million of these people could still be eligible but will fall through the cracks of the renewal process and lose their health insurance.
For context, almost 20 million people enrolled in Medicaid during the COVID-19 public health emergency, an increase of nearly 30% since before the pandemic, and uninsured rates dropped to record lows.
That increase was fueled by a rule under the public health emergency that barred states from removing anyone from Medicaid while the pandemic was at its worst -- allowing people to avoid the bureaucratic renewal processes that experts said could often lead to people losing their coverage even when they were still eligible.
But a recently passed law in Congress returned the right to states to disenroll people from Medicaid beginning on April 1, ending the continuous enrollment afforded to people during the public health emergency.
"This is going to lead to people who are eligible for the program losing out," said Kates, a senior vice president at KFF. "And so I think this is a concern right now, because they would lose coverage for all of their health care during that period," she said.
In the year after the Medicaid rules change, KFF estimates that enrollment will decline between 5% and 13%.
There are efforts to catch some of those people who lose their Medicaid insurance, like a special open enrollment period through the Affordable Care Act.
And some Americans will be disenrolled from Medicaid because they get a job that offers health insurance instead -- or because they then are making too much money to qualify for Medicaid.
"As a person on the street, I understand where the government is going. But as a physician, I'm a little bit worried, because [losing Medicaid] makes a difference between the haves and have nots," Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, told ABC News.
"Particularly with a price tag of $500 for a Paxlovid course [to treat COVID-19], $130 for a shot, we already know how much testing costs for going to Walgreens and CVS," he continued. "So I think all of these things together makes it difficult for everyone to protect not only themselves but each other."
New COVID costs for tests and treatments
The end of the public health emergency will mean that Americans start paying more for certain COVID-19 health measures, but the increase likely won't all be felt at once.
One of the most obvious new costs will be at-home rapid tests, which have been free for most of the time they've existed. People can get eight free tests a month covered by their insurance, for example, or order free tests in the mail from the government.
But that ends with the public health emergency on May 11, Kates at KFF said. The same is true for walking into a clinic or doctor's office to get a test. That could come with costs in the future, whereas it is free under the emergency order.
As for treatments, like the antiviral Paxlovid, that will depend on when the federal government's supply runs out, at which point insurance companies will change their policies. Until then, people will likely not see a huge cost increase on treatments.
"The federal declaration has big implications, mainly financial, that many people don't even realize," Chin-Hong said. "All of a sudden, you have to be paying for copays and office visits, or even lab tests," he added. "And then people may not want to seek health care because they are afraid of paying some sort of copay or being saddled with a huge bill."
But vaccines will remain free for people with insurance. Because of work in Congress and by the Centers for Disease Control and Prevention, COVID-19 vaccines are mandated to be covered by insurance -- through the end of the public health emergency and even once the government stops buying and distributing them for free.
Telehealth access remains through Medicare
Congress moved to ensure telehealth access for all Medicare recipients for the next two years, so the audio and video visits that those patients have come to rely on are not threatened by the end of the emergency.
As for people on private insurance, telehealth access will depend on state laws and insurance company policies. People can check with their providers for more information, as there's no one-size-fits-all answer.
Pandemic data may be harder to track
The public health emergency mandated that states share certain data with the CDC, like COVID-19 case counts and deaths. Though a senior Biden administration official said that the CDC will continue to encourage states to voluntarily share that information with them, some states will choose not to.
The result could be a cloudier picture of the pandemic, including less insight into possible infection surges and slower responses from health officials.
"It means that we won't be able to track simple things like hospital capacity," Chin-Hong said.
"So there'll be less ability to sound the alarm before the storm comes essentially," he said.
Schaffner, the professor of preventive medicine, said that the end of all the emergency measures will signal to the public that the pandemic is over -- when infections and deaths continue.
"Somewhere between 300 to 500 people die of COVID in the United States daily, at the present time," he said. "So we're going to have to keep our guard up. But if we declare an official end, I think the general public will hear that as a message that they don't have to worry about it anymore and that may lead, as you can imagine, to an increase in COVID."
Title 42 is still up in the air
The end of the COVID-19 emergencies is linked to a very different issue -- immigration.
The public health emergency has allowed both the Trump and Biden administrations to cite Title 42 of federal law to quickly expel migrants seeking asylum from the border based on the threat of spreading COVID-19.
While the Biden administration is now seeking to end Title 42, a group of mostly Republican-led states wants to keep it in place, arguing they would be harmed from the resulting immigration.
The issue is before the Supreme Court. Their decision will come sometime before June, when the court's term ends.
Student loan debt cancellation may get more complicated
Ending the COVID-19 emergencies could legally complicate the position the Biden administration has taken while arguing it has the ability to cancel government-held student loan debt for some 40 million Americans.
That plan has been challenged in court and goes before the Supreme Court next month.
The administration has been using the COVID-19 national emergency as justification for the secretary of education's authority to change the status and terms of the student debt.
"There was a national emergency that impacted millions of student borrowers. Many of those borrowers still face risk of default on their student loans due to that emergency. Congress gave the Secretary of Education the authority under the HEROES Act to take steps to prevent that harm, and he is," an administration official said in a statement to ABC News.
Nebraska and five other GOP-led states challenging the plan argued in court filings that the White House can't have it both ways, pointing to President Joe Biden's remarks last year suggesting Americans could live with the virus going forward.
"The government has been undermining what the [Department of Education] said in the rationale memo. As to the COVID-19 justification, the president declared 'the pandemic...over' in September 2022. And as to the current economic conditions, the White House announced that 'household finances are stronger than pre-pandemic,'" the GOP states argued. | Health Policy |
July 13, 2023 -- About 20 out of every 100 adults with epilepsy may also have attention deficit/hyperactivity disorder, or ADHD, and new research shows the more un-controlled seizures a patient has, the higher risk that patient has of having ADHD as well.
Both conditions often begin early in life â itâs estimated that 30% to 40% of children with epilepsy have ADHD. Since epilepsy is so common -- it affects  about 50 million people worldwide -- researchers are striving to fgure out more about this connection.Â
A new study from Taiwan found that ADHD and epilepsy share a common genetic background and many of the same chromosomal abnormalities. Both genetic and environmental factors also appear to potentially play a role, the study authors suggest. For example, family history of both epilepsy and ADHD correlated for 40% of the risk of having both conditions. And the study authors cited research showing that the more air pollution you are exposed to as a child, the more likely you are to have a dual diagnosis of ADHD and epilepsy.Â
âAn adult diagnosed with epilepsy and/or ADHD could certainly be impacted by the same factors, though research is limited,â said Erin Fedak Romanowski, DO, a pediatric neurologist in the University of Michigan Health C.S. Mott Childrenâs Hospital Comprehensive Pediatric Epilepsy Program in Ann Arbor. âIt makes sense that many children with ADHD and chronic epilepsy grow up to be adults with ADHD and epilepsy. For the best outcomes, it is important to identify and treat both conditions early.â Â
Hereâs what to know about the two conditions and the possible connection between them.Â
Which Comes First, Epilepsy or ADHD?Â
We donât know for sure, but it is clear that the way epilepsy affects the brain may play a key role in the development of ADHD.Â
AÂ new study from Israel points out that although one direct cause as to why epilepsy and ADHD often go hand-in-hand has not yet been determined, many combined factors come into play.
In epilepsy, the electrical pattern of the brain becomes unbalanced, leading to seizures (either generalized, affecting the cells in two parts of the brain, or focal onset, affecting the cells in just one part). Patients who have seizures affecting the frontal lobe of the brain have a high rate of ADHD. Also, the more seizures a patient has that arenât effectively controlled by medication, the higher risk that patient has of having ADHD. This potential trigger for ADHD could be due to problems with the frontal lobe itself, electrical charges from the seizures, or undiagnosed brain lesions.
âFor some individuals manifesting seizures, there is underlying brain damage,â said Elissa Yozawitz, MD, director of neonatal neurology and assistant professor of neurology and pediatrics at Montefiore Health System and Albert Einstein College of Medicine in New York City. âSome of these individuals have predominant dysfunction of inhibitory neurons leading to excitatory predominance and cerebral hyperarousal with accompanying ADHD. Those with cerebral overarousal will manifest ADHD.â
A new study from British researchers also found that epileptic spasms in infancy can lead to ADHD symptoms later in childhood and adolescence. Severe epilepsy seizures in the first 2 years of a childâs life may open a pathway that causes ADHD symptoms to subsequently develop. This is through a connection with tuberous sclerosis complex (TSC), a condition that causes gene mutations.Â
âThere is a higher rate of psychological disorders in young people with epilepsy as compared to those with other chronic disorders, including ADHD,â said Romanowski. âThe exact mechanism linking the two disorders is not completely understood. The co-existence of other developmental disorders, poor seizure control, and use of multiple antiseizure medications can all play a role in ADHD and epilepsy.â
What Are the Symptoms of Epilepsy?Â
 Generalized seizures have six types:
- Absence seizures, which have the same symptoms as a focal onset awareness seizureÂ
- Atonic seizures, in which your muscles weaken, causing your body to droop or making you suddenly fall to the groundÂ
- Tonic seizures, in which your muscles stiffen
- Clonic seizures, in which your muscles making jerking motions
- Tonic-clonic seizures, in which you may lose consciousness and suffer convulsions
- Myoclonic seizures, in which your muscles jerk or twitch briefly
The symptoms of a focal onset seizure are different depending if youâre awake during the seizure or not. Signs of a focal onset aware seizure are:Â
- Changes in taste smell, or hearing
- Mood shifts
- Jerking of your muscles that you canât control
- Seeing flashing lights
- Dizziness
- Tingling sensationsÂ
A focal onset impaired awareness seizure symptoms include:Â
- Staring blankly
- Repetitive movements: blinking, rubbing your hands over and over, repeated mouth or finger movements
What Are the Symptoms of Attention Deficit Hyperactivity Disorder in Adults?
Signs of ADHD in an adult include:Â
- Acting impulsively
- Problems with organization
- Time management issues
- Poor concentration
- Multitasking problemsÂ
- Restlessness
- Trouble with planningÂ
- Getting frustrated easily
- Mood swings
- Problems following through on tasks
- Being quick to anger
- An inability to deal well with stress
Which Treatments Might Help Both ADHD and Epilepsy?
Recent research points to the drug methylphenidate as a possible treatment for attention deficit symptoms due to epilepsy, although more studies are needed to determine how effective it might be for most patients. Also, previous research found that the drug may increase the frequency of seizures.Â
For now, it's important to talk with your doctor about treatment options that can help you specifically. One very important strategy: if you have been diagnosed with epilepsy, make sure not to discontinue any medication that is already working to prevent seizures specifically, which can be dangerous. Stopping or switching medication should only be done with your doctorâs advice.Â
If you think you have symptoms of ADHD, get a proper diagnosis no matter what your age. You may be able to trace the root of your ADHD, which can expand your treatment options.Â
âADHD causes may include environmental trauma, many different developmental disorders, psychiatric disorders, endocrine disorders, and genetic disorders,â said Yosawitz.Â
And avoiding triggers of both epilepsy and ADHD can make a big difference. This means managing stress, getting adequate sleep, and eating regular, nutritious meals. Making healthy lifestyle choices can be a simple but powerful prevention tool and help you gain more control. | Disease Research |
Image caption, Victoria Andrews had to take daughter Niamh to hospital when she had a seizureA mum was forced to rush her child to hospital by car during a seizure because of uncertainty about when an ambulance might arrive.Niamh Andrews, five, had a seizure while practicing gymnastics. But when her mother, Victoria Andrews, phoned 999 the operator was unable to say when an ambulance crew would be available to help.The Welsh Government said they were implementing system changes to improve wait times. Victoria and her daughter Niamh Andrews, who live in Cardiff, were at a free-play session at their local gymnastics club when the incident happened. Niamh was playing on gymnastic bars when her lips turned blue and she began staring into the distance before slipping off the apparatus."I managed to grab hold of her and as she went to the ground I could see that her jaw had started to lock, she started to convulse and to have a seizure," Ms Andrews said. She feared autistic Niamh was choking."She went into a full-on convulsion," Ms Andrews said.On calling 999 the mum-of-one asked when an ambulance might arrive. The operator did not know. Ms Andrews put Niamh in the recovery position and stayed on the line until Niamh stopped convulsing.Image caption, The midwife feared autistic Niamh was chokingMs Andrews said: "I asked if it would be quicker if we drove ourselves. At this time Niamh was still lying on the floor, still completely out of it."'It was stomach-churning'She and a friend rushed her to hospital, with Ms Andrews dubbing the experience "debilitating".The 37-year-old said: "When your child is unwell, and something is happening to them that is completely out of your control, and that you know would normally need medical assistance, it's got to be the worst thing in the world."I've never felt stomach-churning like that. You're so out of your depth."Ms Andrews knew when she dialled 999 they could be waiting for a long time.But not getting an estimated time of arrival made it even more difficult."It's hard knowing when you make that phone call there's a chance that they won't be able to respond to you," she said.It made life "that little bit more scary".Ms Andrews said: "I avoid certain activities knowing there's a good chance something might happen and you may have to bundle your child into the car, or take them in [to hospital] yourself in a situation you never, ever want to be in."The average response time was 10 minutes in December - the slowest on record. The figures were released on a day in which 1000 ambulances workers were striking across Wales.The Welsh government spokesman said: "Whilst we acknowledge emergency care performance is not where we expect it to be, we are driving system improvements, including extending same-day emergency care services to open seven days a week, improving management of 999 patients on the phone, and recruiting more staff."Without all this the pressure on the system would be even greater." | Health Policy |
11/17/2023
PITTSBURGH — Researchers at the University of Pittsburgh and KU Leuven have discovered a suite of genes that influence head shape in humans. These findings, published this week in Nature Communications, help explain the diversity of human head shapes and may also offer important clues about the genetic basis of conditions that affect the skull, such as craniosynostosis.
By analyzing measurements of the cranial vault — the part of the skull that forms the rounded top of the head and protects the brain — the team identified 30 regions of the genome associated with different aspects of head shape, 29 of which have not been reported previously.
“Anthropologists have speculated and debated the genetics of cranial vault shape since the early 20th century,” said co-senior author Seth Weinberg, Ph.D., professor of oral and craniofacial sciences in the Pitt School of Dental Medicine and co-director of the Center for Craniofacial and Dental Genetics. “We knew from certain rare human conditions and animal experiments that genes play an important role in vault size and shape, but very little was known about the genetic basis for typical features we see in the general population, such as what makes someone’s head long and narrow versus short and wide. This study reveals some of the key genes driving variation in this part of the human body.”
According to the researchers, one application of better understanding the factors that drive natural variation in human head shape is informing paleoanthropology studies, potentially shedding light on the early development of modern humans.
Weinberg and colleagues used magnetic resonance (MR) scans from more than 6,000 adolescents to extract 3D surfaces corresponding to the cranial vault. After dividing the 3D vault surfaces into incrementally smaller anatomical subparts and quantifying the shape of these subparts, they tested more than 10 million genetic variants for evidence of statistical association with measures of vault shape.
“Previous genetic studies of the cranial vault involved a small number of relatively simple measures,” added Weinberg. “While such measures are often easy to obtain, they may fail to capture features that are biologically relevant. Our analysis used an innovative approach capable of describing 3D vault shape in much more comprehensive and nuanced ways. This approach increased our ability to find genetic associations.”
An important discovery was that many of the strong associations are near genes that play key roles in the early formation of the head and face and regulation of bone development. For example, variants in and near the gene RUNX2, a major player in coordinating development of the skull, were associated with multiple aspects of vault shape.
While some genes, including RUNX2, had global effects involving the entire vault, others showed more localized effects that only impacted a specific portion of the vault, such as the central forehead.
When the researchers compared the 30 genomic regions associated with head shape across participants with European, African and Indigenous American ancestry, they found that the majority of genetic associations were shared across these different ancestral groups.
Although the study focused on healthy participants, the findings may reveal important clues about the biological basis of diseases involving the cranial vault, according to Weinberg.
One of these conditions is craniosynostosis, which occurs when the bones of the skull fuse too early while the brain is still growing rapidly. Without neurosurgery, craniosynostosis can cause permanent disfigurement, brain damage, blindness and even death. The team showed that variants near three genes associated with vault shape, BMP2, BBS9 and ZIC2, were also associated with craniosynostosis, suggesting that these genes could play a role in the development of the disease.
“This kind of study is possible due to the availability of publicly funded resources,” said Weinberg. “The original study that generated these MR scans is focused on understanding brain development and behavior. By creatively leveraging these resources, we have managed to advance discovery beyond that original scope.”
Other authors on the study were Seppe Goovaerts, Hanne Hoskens, Ph.D., Meng Yuan, Dirk Vandermeulen, Ph.D., all of KU Leuven; Ryan J. Eller, Ph.D., Noah Herrick, Ph.D., and Susan Walsh, Ph.D., all of Indiana University–Purdue University Indianapolis; Anthony M. Musolf, Ph.D., and Cristina M. Justice, Ph.D., both of the National Human Genome Research Institute; Sahin Naqvi, Ph.D., and Joanna Wysocka, Ph.D., both of Stanford University; Myoung Keun Lee, Heather L. Szabo-Rogers, Ph.D., Mary L. Marazita, Ph.D., and John R. Shaffer, Ph.D., all of Pitt; Paul A. Romitti, Ph.D., of the University of Iowa; Simeon A. Boyadjiev, M.D., of the University of California, Davis; Mark D. Shriver, Ph.D., of Penn State University; and Peter Claes, Ph.D., of KU Leuven and Murdoch Children’s Research Institute.
This research was supported by the National Institute of Dental and Craniofacial Research (R01DE027023, R01DE016886, R03DE031061 and X01HL14053) and the Intramural Research Program of the National Human Genome Research Institute, National Institutes of Health.
PHOTO DETAILS: (click image for high-res version)
CREDIT: Seth Weinberg
CAPTION: Seth Weinberg, Ph.D., professor of oral and craniofacial sciences in the Pitt School of Dental Medicine and co-director of the Center for Craniofacial and Dental Genetics | Disease Research |
Tricia Terao-Murphy said her daughter Emma, who will turn 1 on March 17, appeared healthy at birth but was soon after diagnosed with biliary atresia, a condition in which the ducts, or tubes, that carry bile from the liver are blocked and bile continues to build up, according to the National Institutes of Health.
The cause of biliary atresia is not known, but it is often diagnosed after the infant develops jaundice, according to the NIH, as was the case with Emma.
"As far as we knew she was born healthy and everything was going well, but we kind of realized that she was looking a little jaundiced and she was having a little bit of trouble gaining weight," Terao-Murphy said in a video shared by Cleveland Clinic, where Emma was treated. "One day we just decided to take her into urgent care just to make sure that it was just the lighting in our house and, you know, a mother's mind, but unfortunately, it didn't pan out that way."
Because of the continuous accumulation of bile, biliary atresia can lead to liver damage, including permanent scarring of the liver, according to the NIH.
In Emma's case, doctors determined she would need a liver transplant.
Last November, an anonymous donor stepped forward and donated a piece of her liver to Emma, who was just 7-months-old at the time of the transplant.
Doctors at Cleveland Clinic performed the living donor surgery using a relatively new laparoscopic procedure that required only a few small incisions.According to Cleveland Clinic, only about 5% of people who undergo a liver transplant receive the organ from a living donor.
A living donor is able to donate just a part of their liver because the remaining liver regrows to its normal size and capacity within a few months, and the donated portion of the liver also grows and restores normal liver function in the recipient.
Terao-Murphy said that because Emma's donor was anonymous, she and her husband wondered who the person was who had saved their daughter's life.
"We had talked about who we thought it could be. Is it a male or female? Is it somebody who had a transplant recipient in their family?" she said. "We still are blown away by the fact that somebody out there, and there are many people out there now, that could just, out of the kindness of their heart, risk going under the knife to try to save another person's life."
Emma's donor was Lori Seitz, a stranger to the Terao-Murphy family who became a second-time donor when she gave a piece of her liver to Emma.
Two years prior, in 2020, Seitz donated her kidney to her brother, who needed a lifesaving transplant after doctors found a cancerous mass on one of his kidneys.
"I had no clue at that time what anything would be, what to expect," Seitz said in a video shared by Cleveland Clinic. "I just knew that my brother could pass away because of the issue that he had, and I would do anything and everything to make sure that was not going to happen if at all possible."
Seitz said that while she was in the hospital recovering from the kidney transplant, she decided she wanted to donate again.
"I got to see how well [my brother] was doing with the new organ and it was just an amazing experience for me and I said, 'Well, I'm going to try to donate my liver,'" Seitz said. "When I found out that I was able [to donate], it was a blessing to me, that I knew that I would be able to save another person's life with just mine."
Last month, Seitz got to meet Emma and her family for the first time, and Seitz was able to hold the infant who now has a piece of her liver.
One week after their first meeting, Seitz and Emma reunited again to celebrate Seitz's birthday, on Feb. 14.
Seitz shares a birthday with Emma's brother Brock; her birthday also falls on Valentine's Day and National Donor Day, a day to raise awareness of organ, eye and tissue donation, according to the Health Resources and Services Administration, the federal agency that oversees organ donation in the United States.
Currently, over 106,000 men, women and children are on the waiting list for an organ or tissue donation, according to the HRSA. | Medical Innovations |
Dr Ola Abbass takes a deep breath before telling the story of her last shift as an NHS consultant.
"It was a night shift. Intensive care," she says. "It felt empty. Walking down that corridor felt very alien. I put my coat on and took my bag.
"Removing my name sticker from my draw was like erasing my existence. I opened the door into a dark night. My career in the NHS had come to an end."
Her voice cracks as she tells this story. It marks the end of something Dr Abbass worked so hard for.
Her accent is an intriguing mix of Middle Eastern meets Lancastrian.
Dr Abbass was born in Iraq, but war forced her to flee and continue her medical training in Lebanon before coming to the UK to work in the NHS, in the North West of England.
A wall in her flat is adorned with certificates - medical science from the University of Baghdad, the Royal College of Glasgow, Faculty of Intensive Care, acute medicine speciality certificates.
But for the past few years, she has also been a very unhappy one.
"You don't go through all of that to resign," she tells me.
But in December last year, that is exactly what she did.
"I think the number one thing that was lacking was feeling valued. I just didn't feel valued."
But she says her doubts about continuing to work in the NHS set in just after the first wave of the COVID-19 pandemic.
"It's almost like you were invisible. It's almost like you were invisible after doing everything that you did.
"And you start to ask: 'Is there a way around this? Can we make this better? Where is this going? Can I carry on like this?'
"I've got this amazing skill. I'm highly talented. I can save a lot of lives and I can heal a lot of people and I can help them.
"But this is killing me."
The NHS is facing the greatest workforce crisis in its 74-year history and one that is creating a serious risk to patient safety.
Record numbers of doctors are resigning with twice as many leaving - saying they need a better work-life balance - than a decade ago.
There are now just over 9,000 doctor vacancies unfilled in the NHS.
It means junior doctors are bearing the brunt of the added pressure on the NHS with a growing number saying they want to quit the health service altogether.
Now, after a ballot of junior doctors by the British Medical Association, thousands of medics will join nurses and ambulance staff in a walkout.
It looks set to place even more pressure on the NHS.
Allesia Waller is a junior doctor working in central London and she has had enough of the NHS and is looking to move abroad to continue her career.
In her first nine months of working in the NHS, Dr Waller says she was burnt out and had to be signed off for a month.
"Burnout to me was not knowing why I was doing what I was doing anymore and not loving it and actually resenting the people that I'm coming face to face with every day," she said.
"I just hated going to work. I hated being at work. I didn't feel like I was doing my job well anymore. I was just disconnected and disillusioned with everything."
She says her first two years of training, which involved a rolling programme of four-month long placements, left her feeling disillusioned, often having to change hospitals, new departments and ID passes.
"That's complicated by the fact that the NHS is still using Internet Explorer 11 and these old Windows computers that take about 10 minutes to turn on and log in.
"You may not get your logins for the first two weeks. So, you turn up on the ward round, the consultant's annoyed because you haven't got a patient's blood results because you haven't got a login yet.
"And I think that contributes to burnout because you're like: 'Why am I breaking my back when I can't even do the basics?'"
A spokesperson for the Department for Health and Social Care told Sky News that there are record numbers of doctors working in the NHS.
But a record number are resigning too.
In England last year, 3,229 doctors resigned from the NHS, with 341 citing burnout as the reason - double what it was a decade ago.
The number of doctors leaving has accelerated rapidly since the pandemic - last year almost 13,000 doctors in the UK gave up their licence - up by 9% on the year before.
One solution to solving the staff shortage is to train more doctors.
The government caps medical student places. In England, 7,500 students got places this year.
Labour says it would double that if it came to power, taxing high earners to pay for it.
Read more:
How virtual reality wards could ease pressure on hospitals
See how your local NHS trust is performing
But for Dr Abbass, who left the NHS last December, it's too late.
"Losing one consultant is a massive loss for the NHS," she says.
"Because we are in a time where we are short-staffed across all disciplines, across all specialities and it is alarming when you have someone who has been so dedicated to the job for so long, but having been forced to leave because they just can't stay in that job anymore. | Health Policy |
A research team has discovered antibodies that could lead to a new approach to treating acute and chronic infections with the bacterium Pseudomonas aeruginosa. Due to its numerous resistance mechanisms, P. aeruginosa is associated with high morbidity and mortality and can cause complicated infections and dangerous cases of sepsis in severely ill patients. The team of scientists from the University of Cologne, University Hospital Cologne, the Helmholtz Centre for Infection Research in Braunschweig and University Hospital Hamburg-Eppendorf isolated the antibodies from immune cells of chronically ill patients and described their binding mechanisms. The study ‘Discovery of highly neutralizing human antibodies targeting Pseudomonas aeruginosa’ was published in the renowned scientific journal Cell.
Antibiotic-resistant bacteria are a crucial health concern worldwide not only to infected people, but also to our healthcare systems in general. Infections with the bacterium P. aeruginosa in particular are a threat due to numerous resistance mechanisms, often leading to complicated infections of the lungs and dangerous sepsis, especially in severely ill patients. In addition, the pathogen can permanently colonize organs such as the lungs, where it promotes progressive tissue damage. Often, so-called last-resort antibiotics must be used to treat infected patients, as the standard treatments no longer work. New therapeutic approaches are therefore urgently needed to ensure effective treatment for infections with multi-resistant pathogens such as P. aeruginosa in the future.
In their study, the researchers therefore investigated whether the approach of isolating broadly neutralizing human antibodies, which has been successful for viral infections, could also be used for the development of new therapies against bacterial infections. “Many of the therapeutic antibodies that are already being used against viruses have been isolated and developed from infected, recovered or vaccinated individuals,” said lead author Dr Alexander Simonis, resident physician at the Infectiology Department of Department I of Internal Medicine and head of the BMBF-funded junior research group ‘Immunotherapies against bacterial infections’ at the UoC’s Center for Molecular Medicine Cologne.
The research team isolated highly effective antibodies against this pathogen from immune cells of patients with cystic fibrosis who were chronically infected with P. aeruginosa. These antibodies block an important virulence factor of the bacterium, the so-called type III secretion system, which plays an important role especially in severe infections with P. aeruginosa. In extensive experiments using cell cultures and animal models, the researchers were able to show that the newly developed antibodies are as effective against the bacterium as conventional antibiotics. However, since the activity of these antibodies is independent of the mechanisms of action and resistance of antibiotics, these so-called pathoblockers can also – in contrast to many conventional antibiotics – work on highly resistant bacteria.
“The findings and the experimental approaches can also be transferred to other bacterial pathogens and thus represent a promising new approach for the treatment of infections with multi-resistant bacteria," concluded the last author of the study, lecturer (Privatdozent) Dr Jan Rybniker, physician at the Infectiology Department of Department I for Internal Medicine and head of the ‘Translational Research Unit – Infectious Diseases’ at University Hospital Cologne and the UoC’s Center for Molecular Medicine Cologne.
The study was conducted with funding from the Clinician Scientist Programme of the UoC’S Faculty of Medicine, the Career Advancement Program of the Center for Molecular Medicine Cologne as well as from the funding measure ‘Young Researchers Groups in Infection Research’ by the Federal Ministry of Education and Research, which has supported Dr Simonis since May 2022 with a junior research group.
The scientists are now planning to further develop the antibodies and to test them in clinical trials. In the long term, they plan to use the antibodies as part of a new therapeutic approach, especially in acute and severe infections with P. aeruginosa. According to the researchers, the antibodies also offer the possibility to protect patients with an increased risk of P. aeruginosa infections – especially in intensive care units or in the case of cancer – by means of passive immunization.
Media Contact:
Lecturer (Privatdozent) Dr Dr Jan Rybniker
Center for Molecular Medicine Cologne, Faculty of Medicine and Faculty of Mathematics and Natural Sciences of the University of Cologne
+49 221 478 89611
jan.rybnikeruk-koeln.de
Dr. Alexander Simonis
Department I for Internal Medicine of University Hospital Cologne and Faculty of Medicine of the University of Cologne
+49 221 478 89614
alexander.simonisuk-koeln.de
Press and Communications Team:
Robert Hahn
+49 221 470 2396
r.hahnverw.uni-koeln.de
Publication:
Alexander Simonis, Christoph Kreer,..,Florian Klein, Jan Rybniker et al., Discovery of highly neutralizing human antibodies targeting Pseudomonas aeruginosa; Cell, November 2023
DOI: https://doi.org/10.1016/j.cell.2023.10.002 | Disease Research |
There are many creatures on our planet with more advanced senses than humans. Turtles can sense Earth's magnetic field. Mantis shrimp can detect polarized light. Elephants can hear much lower frequencies than humans can. Butterflies can perceive a broader range of colors, including ultraviolet (UV) light.
Inspired by the enhanced visual system of the Papilio xuthus butterfly, a team of researchers have developed an imaging sensor capable of "seeing" into the UV range inaccessible to human eyes. The design of the sensor uses stacked photodiodes and perovskite nanocrystals (PNCs) capable of imaging different wavelengths in the UV range. Using the spectral signatures of biomedical markers, such as amino acids, this new imaging technology is even capable of differentiating between cancer cells and normal cells with 99% confidence.
This new research, led by University of Illinois Urbana-Champaign electrical and computer engineering professor Viktor Gruev and bioengineering professor Shuming Nie, was recently published in the journal Science Advances.
Small Variations
"We've taken inspiration from the visual system of butterflies, who are able to perceive multiple regions in the UV spectrum, and designed a camera that replicates that functionality," Gruev says. "We did this by using novel perovskite nanocrystals, combined with silicon imaging technology, and this new camera technology can detect multiple UV regions."
UV light is electromagnetic radiation with wavelengths shorter than that of visible light (but longer than x-rays). We are most familiar with UV radiation from the sun and the dangers it poses to human health. UV light is categorized into three different regions -- UVA, UVB and UVC -- based on different wavelength ranges. Because humans cannot see UV light, it is challenging to capture UV information, especially discerning the small differences between each region.
Butterflies, however, can see these small variations in the UV spectrum, like humans can see shades of blue and green. Gruev notes, "It is intriguing to me how they are able to see those small variations. UV light is incredibly difficult to capture, it just gets absorbed by everything, and butterflies have managed to do it extremely well."
The Imitation Game
Humans have trichromatic vision with three photoreceptors, where every color perceived can be made from a combination of red, green and blue. Butterflies, however, have compound eyes, with six (or more) photoreceptor classes with distinct spectral sensitivities. In particular, the Papilio xuthus, a yellow, Asian swallowtail butterfly, has not only blue, green and red, but also violet, ultraviolet and broadband receptors. Further, butterflies have fluorescent pigments that allow them to convert UV light into visible light which can then be easily sensed by their photoreceptors. This allows them to perceive a broader range of colors and details in their environment.
Beyond the increased number of photoreceptors, butterflies also exhibit a unique tiered structure in their photoreceptors. To replicate the UV sensing mechanism of the Papilio xuthus butterfly, the UIUC team has emulated the process by combining a thin layer of PNCs with a tiered array of silicon photodiodes.
PNCs are a class of semiconductor nanocrystals that display unique properties similar to that of quantum dots -- changing the size and composition of the particle changes the absorption and emission properties of the material. In the last few years, PNCs have emerged as an interesting material for different sensing applications, such as solar cells and LEDs. PNCs are extremely good at detecting UV (and even lower) wavelengths that traditional silicon detectors are not. In the new imaging sensor, the PNC layer is able to absorb UV photons and re-emit light in the visible (green) spectrum which is then detected by the tiered silicon photodiodes. Processing of these signals allows for mapping and identification of UV signatures.
Healthcare and Beyond
There are various biomedical markers present in cancerous tissues at higher concentrations than in healthy tissues -- amino acids (building blocks of proteins), proteins, and enzymes. When excited with UV light, these markers light up and fluoresce in the UV and part of the visible spectrum, in a process called autofluorescence. "Imaging in the UV region has been limited and I would say that has been the biggest roadblock for making scientific progress," explains Nie. "Now we have come up with this technology where we can image UV light with high sensitivity and can also distinguish small wavelength differences."
Because cancer and healthy cells have different concentrations of markers and therefore different spectral signatures, the two classes of cells can be differentiated based on their fluorescence in the UV spectrum. The team evaluated their imaging device on its ability to discriminate cancer-related markers and found that is capable of differentiating between cancer and healthy cells with 99% confidence.
Gruev, Nie and their collaborative research team envision being able to use this sensor during surgery. One of the biggest challenges is knowing how much tissue to remove to ensure clear margins and such a sensor can help facilitate the decision-making process when a surgeon is removing a cancerous tumor.
"This new imaging technology is enabling us to differentiate cancerous versus healthy cells and is opening up new and exciting applications beyond just health," Nie says. There are many other species besides butterflies capable of seeing in the UV, and having a way to detect that light will provide interesting opportunities for biologists to learn more about these species, such as their hunting and mating habits. Bringing the sensor underwater can help bring a greater understanding of that environment as well. While a lot of UV is absorbed by water, there is still enough that makes it through to have an impact and there are many animals underwater that also see and use UV light.
Story Source:
Materials provided by University of Illinois Grainger College of Engineering. Original written by Amber Rose. Note: Content may be edited for style and length.
Journal Reference:
Cite This Page: | Medical Innovations |
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