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Male sperm count has fallen by more than 50% globally in the last 50 years, leaving researchers scrambling to understand why. Could it be pollution, PFAS and other potential toxins in our food and water, an increase in obesity and chronic disease, or even the ever-present mobile phone?
A new study explored the role of cell phones and found men between the ages of 18 and 22 who said they used their phones more than 20 times a day had a 21% higher risk for a low overall sperm count. The men also had a 30% higher risk for a low sperm concentration, a less important measure of sperm count in a milliliter of semen. The study did not specify whether the men called or texted or used their phones to do both.
On the positive side, researchers found that as phone technology improved over the 13 years of the study, the impact on sperm count began to ease.
“I am intrigued by the observation that the biggest effect was apparently seen with older 2G and 3G phones compared to modern 4G and 5G versions. This is not something I am able to explain,” said Allan Pacey, deputy vice president and deputy dean of the faculty of biology, medicine and health at the University of Manchester in the United Kingdom, in a statement. He was not involved in the study.
Another plus: There was no decline in the shape and motility of the sperm, which refers to the way sperm swim to their destination, according to the study.
“Whilst sperm numbers matter, the ability of sperm to swim, have healthy intact DNA and be the right shape, is at least as important,” said Alison Campbell, chief scientific officer of Care Fertility, a network of fertility clinics, in a statement.
“This is a fascinating and novel study which should not cause alarm or drastic changes in habits,” said Campbell, who was not involved in the study. “Men looking to conceive, or wanting to improve their sperm health should exercise (but not overheat in their groin area), eat a balanced diet, maintain a healthy weight, avoid smoking and limit alcohol and seek help if they are having problems conceiving.”
An electronic field
Mobile phones have become indispensable parts of our lives. However, cell phones do emit low-level radiofrequency electromagnetic fields, or RF-EMF. If those cell phones are emitting at maximum power, the study said, surrounding tissue can be heated up to 0.5 degrees Celsius or about 33 degrees Fahrenheit.
“Cell phones are constantly sending and receiving signals and they are going to receive and send more intense signals when they’re in use,” said Dr. Alexander Pastuszak, an assistant professor of surgery and urology at The University of Utah School of Medicine in Salt Lake City.
“But especially with the modern cell phone, like that signal is going to vary depending on whether you’re talking or whether you’re sending data, said Pastuszak, who was not involved in the study.
Radiofrequency electromagnetic fields are greatly reduced when texting and highest when downloading large files, streaming audio or video, when only one or two bars are displayed, and when in a fast-moving bus, car or train, according to the California Department of Public Health.
The agency recommends keeping the phone away from the body and head — use the speakerphone or headphones instead — and carry the phone in a backpack in a backpack, briefcase or purse.
Whether those fields can actually damage male fertility, however, has been a source of controversy and debate for years in the scientific community.
Studies in mice have found RF-EMF fields at levels similar to cell phones do lower male fertility and contribute to sperm death and changes in the tissue of the testes. However, other animal studies have not replicated those effects, and there are huge differences between humans and mice in how sperm are created.
Observational studies in humans have also found that frequent use of mobile phones was connected to a decline in sperm viability as well as an impact on how the sperm swam. But those studies have been small and short. And they didn’t necessarily control for factors such as smoking and alcohol consumption, leaving many scientists unimpressed.
“I have been asked many times over the past decade whether there is any link between mobile phones and male fertility. However, I have been largely unconvinced by the data which has been published to date,” Pacey said.
“However, (this) study is a little step forward in the debate because this is a large epidemiological study which appears to have been very well conducted,” he said. “It is a study in the real world — and that is good in my opinion. However, we should be cautious about its interpretation as it only shows an association between mobile phone use and semen quality.”
Young military men
Men could choose whether they carried their cell phone in a trouser pocket, breast pocket, belt carrier or elsewhere, but over 85% of them placed their phones in their pants pocket when not in use.
Results showed that men who used their phones one to five times a day or less than once a week had much higher sperm counts and concentration. As cell phone usage climbed, sperm count dropped, with the lowest levels among men using their phone 20 or more times a day.
Researchers also evaluated the impact of cell phones over different periods of time. The greatest association between low sperm count and concentration and phone use were between 2005 and 2007. As companies moved from 2G up to 5G, the association weakened, in line with the “corresponding decrease in the phone’s output power,” the study said.
“It’s very, very difficult to draw a definitive conclusion from this type of study because it’s not controlled well enough to be able to do that,” Pastuszak said. “They can’t control for the day-to-day exposures of living in an urban environment, and those should not be understated. Even stress levels can impact spermatogenesis and hormone production.”
As an infertility expert who works daily with couples trying to conceive, Pastuszak points to the fascinating complexity of factors that impact infertility, for which sperm count and concentration are minor players.
“Total sperm count may not reflect actual decreases in fertility potential,” he said. “I can’t look a patient in the eye and say, just because you have 100 million sperm per milliliter with 50% motility and a sperm count of 500 million, that you’re going to be fertile,” he said.
“It’s the quality of sperm that counts. If you have quality sperm there is a good, decent or even great chance that you can have a child, even if you have just a literal handful of sperm.” | Men's Health |
Marie Osmond has maintained her 50-pound weight loss for 15 years — and the entertainer revealed it’s her secret to looking and feeling youthful."At this stage of my life, I can tell you that weight ages you," the 63-year-old told Fox News Digital. "It also takes away the joy out of being active with your children and grandchildren. It takes away your health, even mentally. It’s not healthy for you. And when you hear the world saying, ‘Love me however I am,’ I think you love yourself to be the best version of you… so that you can live your fullest, most beautiful life. That’s why I have continued this.’" Marie Osmond said she struggled with her body image over the years. (Nutrisystem)"I would never go back to who I was," she shared. "Never. I could never have done everything I’ve done. My last album, my current album, debuted at No. 1 on Billboard. I’m 63. That’s stupid, right?... Never could I have done that without the energy I have. And I just got off tour, the best, fun tour I’ve done. I just spent Disney World with my eight grandchildren. My 23-year-old son goes, ‘Mom, let’s shut down the park.’ Never could I have done that with 50 pounds on me." Marie Osmond lost 50 pounds 15 years ago - and has managed to keep the weight off. (Nutrisystem)Osmond was at her heaviest in 2007. At the time, she was 165 pounds and a size 14. That year, she tried Nutrisystem, the personalized meal delivery program, to help her slim down to a size 4. The singer previously told Closer Weekly that she never lets herself "get more than five pounds overweight," which typically happens during the holidays.MARIE OSMOND DEBUTS HER NEW LOOK IN RARE PHOTO WITH HUSBAND STEVE CRAIG AT DISNEY WORLDThe mother of eight noted how as a teen, her body was often scrutinized, making food "an issue." She also revealed how hurtful words had a profound impact on her over the years.Osmond achieved her first big hit at age 13 with her No. 1 country hit "Paper Roses." At 16, she and her brother Donny Osmond were headlining their own network television variety show. Marie Osmond recalled being bodyshamed as a teen. (Photo by ABC Photo Archives/Disney General Entertainment Content via Getty Images)"Growing up in entertainment, there was always body issues and dieting yo-yos and this and that," the TV personality explained. "I was just at KTLA here… in Los Angeles where we did the original ‘Donny & Marie’ show. I was like 15, and I was talking about how I was taken out to a parking lot and at 5’5" — I was like 103 pounds — I was told I was fat. [It] was an embarrassment… That was the era of Twiggy in the ‘70s and you know, lollipop heads and the whole thing."Osmond previously told Fox News Digital that she would "literally starve myself for three days before taping," by drinking lemon water and cayenne pepper with maple syrup. As she grew older, the pounds became more difficult to shed.CLICK HERE TO SIGN UP FOR THE ENTERTAINMENT NEWSLETTER "Women in my family don’t live much past 60," Marie Osmond previously told Fox News Digital. "They put weight around their stomach. They also suffer from strokes and heart attacks. That’s what took my mother’s life. And I’m the only daughter." (Robin Platzer/IMAGES/Getty Images)"When I got into my 40s, I think I just kind of said, ‘I’m gonna be my mom,’" said the star. "You just kind of think, ‘That teenage body’s gone. That 20-year-old isn’t there anymore.’ And it’s just not true. Long story short, my son, the oldest, came on behalf of all the kids. I was getting divorced and he goes, ‘Mom, we’re gonna lose you. You’re gonna die. You need to lose weight.’ That’s a really tough one. And women in my family don’t live long because of heart disease and weight. And so, it was kind of a wake-up — a big, scary wake-up call. They said, ‘Mom, you’re all we have.’ So that was kind of my a-ha [moment]. And then it was like, ‘How am I going to do this?’" Marie Osmond said that at her heaviest, she received a wake-up call from her son. (Photo by Albert L. Ortega/WireImage)In 2007, it was announced that Osmond would appear as a contestant on "Dancing with the Stars." The competition series pairs celebrities with professional dancers where they rigorously train for performances. Osmond shared that it was during her time on the show that Nutrisystem "found me.""I call it ‘Dancing with the Starved,’" Osmond joked about her time on the show. "Fifty pounds overweight and spandex was not beautiful. And so, I went on Nutrisystem. It literally was my last-ditch effort. And I learned for the first time in my life that food was not the enemy. I lost at least 10 pounds a month. That’s a dress size… And within four months, I was down to my weight. And I couldn’t believe that body was still inside me."Osmond insisted she was able to stick with the regimen because "it’s not a diet." Instead, it changed her relationship with food. For the New Year, Osmond teamed up with Nutrisystem once more to kick off Complete 55, a plan designed for women ages 55+.DONNY OSMOND ON SURVIVING CHILD STARDOM AFTER BEING CALLED A ‘HAS-BEEN’: ‘WASN’T GOING TO DO IT WITH SCANDALS’ Marie Osmond competed on ‘Dancing with the Stars’ in 2007. (Photo by Craig Sjodin/Disney General Entertainment Content via Getty Images)"When you hit 55, we’re talking the mean, terrible M – it’s not Marie, it’s menopause," she chuckled. "[But] food is not my enemy anymore. That’s the biggest thing it taught me. What is full and what is emotional?.… I’m 63 and I’m living my most fabulous life right now. I know who I am. I’ve been through the crazy stuff, the heartache, the parts where you’re on the floor going, ‘I don’t know how to take my next breaths.’… It’s really nice to be at a place where — look, I don’t have a 20-year-old body, but I certainly don’t have a 63-year-old body. And I believe the more you take care of you, the more your body takes care of you." Donny and Marie Osmond during their final performance at Flamingo Las Vegas on November 16, 2019, in Las Vegas, Nevada. (Photo by Denise Truscello/WireImage)During the coronavirus pandemic, Osmond had the energy to take her decades-long singing career in a different direction. In 2021, she released a 17-song album titled "Unexpected," in which she sang a mix of classical, opera and Broadway tunes backed by the Prague Symphony Orchestra. She also starred in her third Lifetime holiday movie "A Fiancé for Christmas."In 2019, she and Donny, 65, ended their 11-year Las Vegas residency. During the holidays in 2022, she led a sold-out tour. These days, she’s just happy to be grandma. Marie Osmond is seen here performing at Centre In The Square on December 1, 2022, in Kitchener, Ontario. (Jeremychanphotography/Getty Images)"I really love being a grandma," she gushed. "When you get down to this stage of life, the most important thing you have is your health and your family. And it’s truly in that order, too. You can have a family, but if you can’t participate in their lives because you’re sick... it’s why I’m a big advocate for getting weight under control. It makes such a difference. Believe me, it changed my life to get it off me. The best youth pill you can take is to just be healthy."MARIE OSMOND RECALLS HER WEIGHT STRUGGLES, BEING TOLD SHE NEEDED TO ‘KEEP THE FOOD OUT OF MY FAT FACE’ Marie Osmond said she loves being a grandma and having more energy to spend with her family. (Nutrisystem)"I spent the last 11 years at a Las Vegas residency," she shared. "You miss the football games, you miss the basketball games. You miss those things. And I don’t want to miss them anymore. I’m still doing the things I love. I’m still performing and I feel so blessed. On my Christmas tour, I had a bunch of 20-year-old girls in the front row. I looked down at them from the stage and said, ‘Do you guys even know who I am?’ And they said, ‘Yeah, we found you on YouTube!’… This whole new generation is finding me and they’re just so cute. There are three projects I’m looking at right now, but I just love being a grandma. I really love all of life." The Associated Press contributed to this report. Stephanie Nolasco covers entertainment at Foxnews.com. | Nutrition Research |
New research indicates that the traumatic memories of patients with post-traumatic stress disorder are represented very differently in the brain than “regular” sad autobiographical memories. A small study published November 30 in the journal Nature Neuroscience supports the idea that traumatic memories are a different cognitive entity than more routine bad memories. This may provide a biological explanation for why recalling traumatic memories can manifest as intrusive thoughts that are different from other negative recollections.
The study was conducted by a team from the Icahn School of Medicine at Mount Sinai in New York and Yale University. It examined patients’ real-life personal memories in an effort to link their lived experiences with the brain’s functioning.
“For people with PTSD, recalling traumatic memories often displays as intrusions that differ profoundly from processing of ‘regular’ negative memories, yet until now, the neurobiological reasons for this qualitative difference have been poorly understood,” study co-author and Icahn Mount Sinai neuroscientist Daniela Schiller, said in a statement. “Our data show that the brain does not treat traumatic memories as regular memories, or perhaps even as memories at all. We observed that brain regions known to be involved in memory are not activated when recalling a traumatic experience.”
Schiller told The New York Times that the brain can be in a different state in two different memories, depending on which type of memory is playing out. When recalling trauma, the brain looks like it is processing experiences of something in the present instead of the past.
What is PTSD?
Posttraumatic stress disorder may occur in people who have experienced or seen a traumatic event, series of events, or set of circumstances. The American Psychiatric Association says PTSD may affect mental, physical, social, and/or spiritual well-being. Some events that can cause PTSD are are natural disasters, war or combat, sexual assault, intimate partner violence, and bullying.
PTSD symptoms are generally grouped into four types, according to The Mayo Clinic. These include intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can be very individual and include things like flashbacks, avoiding specific places or people, and hopelessness. They can also vary over time.
According to data from the United States Department of Veterans Affairs, about six percent of people in the US will have PTSD at some point in their lives. Many with PTSD will recover and no longer meet diagnostic criteria for the disorder following treatment. Some treatments for PTSD include cognitive behavioral therapy and cognitive processing therapy. There are also four medications (sertraline, paroxetine, fluoxetine, and venlafaxine) that have a conditional recommendation to treat PTSD.
Where does PTSD affect the brain?
Earlier studies showed that a brain region called the hippocampus governs both the formation and retrieval of episode memories. PTSD is associated with structural abnormalities of the hippocampus, mostly a reduction of its volume. Impairments to the processes of the hippocampus are a focal point in studying how PTSD affects the brain.
A region called the posterior cingulate cortex is also heavily involved in both narrative comprehension and processing of our memories. The PCC is particularly involved in the imagery of more emotional memories. Alterations in PCC function and connectivity are also very focal to PTSD the way that the hippocampus is.
Differentiating between traumatic memories and sad memories
In the study, the team examined whether and how the hippocampus and posterior cingulate cortex differentiate a traumatic autobiographical memory from merely a sad one. They used functional magnetic resonance imaging to look at the brains of 28 participants diagnosed with PTSD.
They asked each of the participants a range of questions. These questions pertain to their traumatic experiences, sad events, and the moments when they felt relaxed. A team member wrote each person’s story down and then read it back to them while they underwent fMRI scans. The fMRI mapped the brain’s activity based on blood flow during the process.
Researchers found that the activity in the hippocampus followed similar patterns of activity among all of the subjects when they were reminded of sad or relaxing experiences. This suggests the memory formation here is more typical.
However, when the stories of their traumatic experiences were read, that similar activity in the hippocampus disappeared. The hippocampus of each subject showed individualized and disjointed activity. The activity was more disorganized and fragmented across the brain and did not look like the more in-sync patterns the brain exhibits during normal memory formation.
Additionally, if more PTSD symptoms were present, more activity appeared in the PCC.
How this could shape future PTSD treatment
The results may explain why PTSD patients have difficulty recalling traumatic experiences in a coherent way. It could also indicate why these past experiences can trigger disabling symptoms in patients with the disorder.
PTSD patients’ brains work differently when recalling traumatic experiencesudy co-author and Yale University clinical psychologist Ilan Harpaz-Rotem said in a statement. “However, when presented with stories of their own traumatic experiences, brain activity was highly individualized, fragmented, and disorganized. They are not like memories at all.”
Future treatments aimed at “returning” the traumatic memory to a more typical representation in the hippocampus may be beneficial. According to Harpaz-Rotem, this research could help psychotherapists guide PTSD patients to construct more helpful thought patterns that could help the brain eliminate the sense of immediate threat that trauma can cause. | Mental Health Treatments |
- Parkinson’s disease can have a profound effect on a person’s movement capabilities, leading to tremors, balance, and coordination problems.
- Scientists are exploring whether physical activity can slow down Parkinson’s or lessen the symptoms of the disease.
- Researchers recently found that tai chi may help slow the progression of disease and lower the doses of medications required over time in people with Parkinson’s disease.
Many of the main symptoms of Parkinson’s disease revolve around movement changes and issues. These include tremors, gait changes, coordination problems, and balance impairment.
Previous studies show
Now, researchers from Ruijin Hospital at Shanghai Jiao Tong University School of Medicine in Shanghai, China, say the Chinese martial art practice tai chi may help slow disease progression and lower doses of required medications over time in people with Parkinson’s disease.
This study was recently published in the Journal of Neurology Neurosurgery & Psychiatry.
For this study, Dr. Shengdi Chen, distinguished professor and principal investigator in the Department of Neurology and Institute of Neurology in Ruijin Hospital at Shanghai Jiao Tong University School of Medicine in Shanghai, China, and his colleagues monitored two groups of people with Parkinson’s disease for more than five years.
One group of 143 participants practiced tai chi twice a week through a class to improve their technique. The second group of 187 participants continued their standard medical care but did not practice tai chi. The groups were not randomized and were recruited from the Movement Disorder Clinic in Ruijin Hospital.
Disease severity for all participants was assessed at the start of the study, and disease progression — including increases in the need for medications — was monitored over five years.
The researchers found disease progression was slower at all monitoring points in the tai chi group when assessed by overall symptoms, movement, and balance, compared to the control group.
Additionally, the number of study participants who needed to increase their medication over the five years was significantly lower in the tai chi group at follow-up in 2019 and 2020 but not 2021. However, the levodopa equivalent daily dosage (LEDD) increase was significantly higher in the control group at each follow-up time point.
By 2021, the control group was taking more than double the daily dose equivalent of — 436.7 vs 203.99. Cognitive function deteriorated slower, and sleep and quality of life continued to improve in the tai chi group when compared to the control group.
“We [were] surprised to find the long-term beneficial effect [of] tai chi [as] there is no research focused on the long-term effect [of] sports [on] Parkinson’s disease. Doctors should emphasize the importance of physical activity, especially [that] physical activity could delay the need of increasing antiparkinsonian therapies,” Dr. Chen said.
“However, we studied early-stage patients in this research. The postural instability in early-stage patients is not severe. Thus, it should be cautious of tai chi in late-stage patients [as] there is a risk of falls. We plan to discover the application of tai chi in prodromal and late-stage Parkinson’s disease patients,” he added.
After reviewing this study, Ryan Glatt, senior brain health coach, and director of the FitBrain Program at Pacific Neuroscience Institute in Santa Monica, CA, who was not involved in the study, told Medical News Today that this builds upon the prior knowledge that tai chi is thought to be helpful for individuals with Parkinson’s by providing a longer follow-up period.
“It’s good to see that tai chi is becoming more of an evidence-based intervention for individuals with Parkinson’s. Any type of neuromotor exercise where you’re moving, thinking, and coordinating your body, a lot of those types of exercise modalities are recommended for Parkinson’s disease, such as dance, boxing, (and)
table tennis.”
— Ryan Glatt
Glatt said that most of the exercises recommended for Parkinson’s “may not always have a robust evidence base. So it’s good to see tai chi is one of those modalities that does.”
Dr. Eric L. Hargreaves, clinical assistant professor in the Department of Neurology and clinical DBS neurophysiologist and neuroscientist at the Movement Disorder Program at Hackensack Meridian Neuroscience Institute at Jersey Shore University Medical Center, who was also not involved in the study, said this also adds to the continually growing body of evidence strongly indicating the benefits of exercise in the amelioration of Parkinson’s symptoms.
“At the moment, exercise is the only known treatment that slows down the progression of Parkinson’s. Most of the exercise programs showing clear benefit for Parkinson’s patients have been those involving vigorous or extreme exercise, which [has] given rise to programs like
Rock Steady Boxingand the use of the Theracycle. In this regard, tai chi is quite different, involving slow and well-practiced movements that require balance and attentiveness to detail of movement.”
— Dr. Eric L. Hargreaves
“Consequently, we can now add the concept of mindfulness activity to the list of exercises that benefit Parkinson’s,” Dr. Hargreaves told MNT.
“This mindfulness can be brought to bear in many other instances of an individual’s behavior, such as navigating in tight spaces like the home kitchen while performing standard tasks, which can be especially challenging for people with Parkinson’s disease,” he added.
Dopamine is a molecule in the brain that carries messages between nerve cells. Because Parkinson’s disease damages dopamine molecules, people with the condition experience movement issues.
For this reason, exercise plays an important role in
The Parkinson’s Foundation, in collaboration with the American College of Sports Medicine, has physical activity recommendations that include:
Tai chi originated in China more than 1,000 years ago.
It is a type of moving meditation that uses a low-impact, slow-motion series of movements. Tai chi is considered a mind-body exercise because it combines mindful movement with meditation and deep breathing.
Tai chi requires no special equipment and can be performed by yourself or in a group, indoors or outside.
Previous research shows tai chi offers a variety of health benefits, including increased flexibility and strength, improved balance, and improved mood.
There has also been published research showing evidence that tai chi may help
According to Dr. Shengdi Chen, while the mainstream treatment for treating motor-related symptoms of Parkinson’s disease is drug-based, there are both motor and non-motor complications in the late stage of the disease.
“Besides, the side effects of drug therapies could worsen several symptoms, such as
Dr. Chen said that a study
“More research indicated that sports, including tai chi, could improve several non-motor symptoms and quality of life in Parkinson’s disease. We believe tai chi might improve neural networks and metabolomics and decrease the
Medical News Today also spoke with Dr. Daniel Truong, a neurologist and medical director of the Truong Neuroscience Institute at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, and editor-in-chief of the Journal of Clinical Parkinsonism and Related Disorders, about this research.
“The findings of this study suggest that regular tai chi practice may have long-term benefits for individuals with Parkinson’s disease. It appears to slow disease progression, reduce the need for medication, and improve both motor and non-motor symptoms, ultimately leading to a better quality of life for those affected by the disease,” he said.
Dr. Truong also pointed out that while research on exercise and Parkinson’s disease has consistently demonstrated positive effects, the type and intensity of exercise should be tailored to the individual patient’s needs and capabilities, and consultation with a healthcare provider is advisable before starting any exercise program.
“While tai chi may have unique advantages in terms of balance and reduced risk of falls, conventional exercises offer a wide range of options to target specific aspects of physical fitness. The choice between tai chi and conventional exercise may depend on individual preferences, physical conditions, and the specific goals of the patient, and consultation with a healthcare provider is advisable.”
— Dr. Daniel Truong
The authors point out that this is an observational study and, therefore, cannot establish causation since the two groups were not randomized. While they tried to minimize the differences by matching on disease severity and avoiding selecting people as controls who were not motivated to practice tai chi, they note that there could still be confounding differences between the two groups. They suggest that larger randomized control trials are needed to confirm. | Disease Research |
The death of a 43-year-old man is the first in the UK to be linked to the "zombie" drug xylazine, which is prompting overdose warnings in the US.
Normally used as a large-animal tranquiliser but now being found in heroin, it can cause a dangerously low heart rate and large open skin wounds.
UK experts are calling it "a really concerning drug".
They say drug users should be warned it is now present in the UK but there is no safe dose in humans.
'Bought heroin'
Karl Warburton, form Solihull, West Midlands, died in May 2022 at home and had a history of illicit drug use, according to the coroner's report. He had been referred to addiction services on a number of occasions.
An examination of his body detected heroin, fentanyl and cocaine in his system, as well as xylazine.
A report on his death in the Journal of Forensic and Legal Medicine says he was "likely to have bought heroin and not known it was laced with xylazine and fentanyl".
"To the best of our knowledge, this is the first death associated with xylazine use reported in the UK, and even Europe, and indicates the entry of xylazine into the UK drug supply," it adds.
Skin ulcers
Known as "tranq" or "tranq dope" when cut with heroin and fentanyl by drug dealers, xylazine has been causing huge problems in the US.
If injected directly into someone's bloodstream, it can can cause large open skin ulcers to form. These can start to rot and lead to amputation.
It also lowers breathing and heart rate to dangerously low levels, which has led to it being dubbed a "flesh-eating zombie drug".
Xylazine emerged on the illicit drug market in Puerto Rico in the early 2000s and has since been found in the US, mainly in the east, and in Canada.
The US government has called it "an emerging threat" because of its growing role in fatal overdoses across the country - about 7% of the total.
And in some states, the drug was found in more than a quarter of overdoses.
But until now, there has been no sign of xylazine in the UK.
The drug was detected only because the Birmingham lab that carried out tests after the man's death noticed some strange results and identified xylaxine.
Death certificate
"The drug is not included in standard drug screens in the UK, so we don't know how widespread the xylazine problem is," said Dr Caroline Copeland, King's College London lecturer and director of the National Programme on Substance Abuse Deaths.
"We need to find out how that person ended up with it in his system."
Xylazine was listed on the man's death certificate as contributing to his death but there was no way of recording it in the UK drug-deaths database.
The report highlights the need to monitor changes in illicit-drug markets and in emerging drugs.
"There is no safe dose to use", it concludes, because there is an overlap between fatal and non-fatal doses of xylazine reported in people. | Drug Discoveries |
Bear genes show circadian rhythms even during hibernation
The internal clocks of grizzly bears appear to keep ticking through hibernation, according to a genetic study. This persistence highlights the strong role of circadian rhythms in the metabolism of many organisms including humans.
The Washington State University-led genetic study confirmed observational evidence that bears' energy production still waxes and wanes in a daily pattern even as they slumber for several months without eating. The researchers also found that during hibernation the amplitude of the energy production was blunted, meaning the range of highs and lows was reduced. The peak also occurred later in the day under hibernation than during the active season, but the daily fluctuation was still there.
"This underscores the importance of the circadian rhythms themselves—that they give organisms the flexibility to still function in a state as extreme as a hibernating bear," said Heiko Jansen, a professor in WSU's integrative physiology and neuroscience department and senior author on the study in the Journal of Comparative Physiology B.
Other research has shown that circadian rhythms, the 24-hour physical cycles common to most living animals on Earth, have ties to metabolic health. In humans, major disruptions to these patterns, such as occur in night shift work, have been linked to metabolic problems like weight gain and higher prevalence of diabetes.
In some sense, bears are extreme shift workers, taking as much as six months off when they hibernate. Researchers like Jansen's team are attempting to figure out how they engage in seemingly unhealthy habits of gaining excessive weight then going without food and not moving much for several months—all without detrimental effects like loss of bone mass or diseases like diabetes.
Unlike hibernating rodents who are almost comatose, bears do move around occasionally during this dormant period. Through observation studies of grizzly bears at the WSU Bear Center, researchers found these movements tend to follow a circadian rhythm with more activity during the day than at night.
In the current study, the researchers looked to see if that circadian rhythm was expressed on the cellular level. They took cell samples from six bears during active and hibernating seasons, then cultured those cells to conduct an array of genetic analyses.
To mimic hibernation, the researchers examined the cells at the bears' typical lowered body temperature during hibernation at about 34 degrees Celsius (93.2 degrees Fahrenheit) and compared that to 37 C (98.6 F) during the active season.
They found thousands of genes were expressed rhythmically in hibernating bear cells. This translated into rhythms of energy through rise and fall of production of adenosine triphosphate or ATP, the body's cellular source of energy. ATP was still produced in a daily pattern under hibernation but the production had a blunted amplitude, lower peaks and valleys. The highest production point also shifted to later in the day under hibernation than under active season conditions.
Maintaining a circadian rhythm requires some energy itself. The researchers believe that by altering this rhythm some during hibernation may allow bears to still get some energetic benefit of the daily cycle without as much of cost—which likely helps them survive going without food for months.
"It's like setting a thermostat. If you want to conserve some energy, you turn down the thermostat, and this is essentially what the bears are doing," Jansen said. "They're using the ability to suppress the circadian rhythm, but they don't stop the clock from running. It's a really novel way of fine-tuning a metabolic process and energy expenditure in an animal."
Co-authors on the study include first author Ellery Vincent as well as Blair Perry and Charles Robbins of WSU and Joanna Kelley of University of California, Santa Cruz.
More information: Ellery P. Vincent et al, Circadian gene transcription plays a role in cellular metabolism in hibernating brown bears, Ursus arctos, Journal of Comparative Physiology B (2023). DOI: 10.1007/s00360-023-01513-5
Journal information: Journal of Comparative Physiology B
Provided by Washington State University | Disease Research |
Researchers have developed the prototype of a comfortable and flexible “soft smart hand exoskeleton,” or robo-glove, which gives feedback to wearers who need to relearn tasks that require manual dexterity and coordination, for example after suffering a stroke. The present study focused on patients who need to relearn to play the piano as a proof-of-principle, but the glove can easily be adapted to help relearn other daily tasks.
Stroke is the most important cause of disability for adults in the EU, which affects approximately 1.1 million inhabitants each year. After a stroke, patients commonly need rehabilitation to relearn to walk, talk, or perform daily tasks. Research has shown that besides physical and occupational therapy, music therapy can help stroke patients to recover language and motor function.
But for people trained in music and who suffered a stroke, playing music may itself be a skill that needs to be relearned. Now, a study in Frontiers in Robotics and AI has shown how novel soft robotics can help recovering patients to relearn playing music and other skills that require dexterity and coordination.
“Here we show that our smart exoskeleton glove, with its integrated tactile sensors, soft actuators, and artificial intelligence, can effectively aid in the relearning of manual tasks after neurotrauma,” said lead author Dr Maohua Lin, an adjunct professor at the Department of Ocean & Mechanical Engineering of Florida Atlantic University.
Lin and colleagues designed and tested a ‘smart hand exoskeleton’ in the shape of a multi-layered, flexible 3D-printed robo-glove, which weighs only 191g. The entire palm and wrist area of the glove are designed to be soft and flexible, and the shape of the glove can be custom-made to fit each wearer’s anatomy.
Soft pneumatic actuators in its fingertips generate motion and exert force, thus mimicking natural, fine-tuned hand movements. Each fingertip also contains an array of 16 flexible sensors or ‘taxels’, which give tactile sensations to the wearer’s hand upon interaction with objects or surfaces. Production of the glove is straightforward, as all actuators and sensors are put in place through a single molding process.
“While wearing the glove, human users have control over the movement of each finger to a significant extent,” said senior author Dr Erik Engeberg, a professor at Florida Atlantic University’s Department of Ocean & Mechanical Engineering.
“The glove is designed to assist and enhance their natural hand movements, allowing them to control the flexion and extension of their fingers. The glove supplies hand guidance, providing support and amplifying dexterity.”
The authors foresee that patients might ultimately wear a pair of these gloves, to help both hands independently to regain dexterity, motor skills, and a sense of coordination.
The authors used machine learning to successfully teach the glove to ‘feel’ the difference between playing a correct versus incorrect versions of a beginner’s song on the piano. Here, the glove operated autonomously without human input, with preprogrammed movements. The song was ‘Mary had a little lamb’, which requires four fingers to play.
“We found that the glove can learn to distinguish between correct and incorrect piano play. This means it could be a valuable tool for personalized rehabilitation of people who wish to relearn to play music,” said Engeberg.
Now that the proof-of-principle has been shown, the glove can be programmed to give feedback to the wearer about what went right or wrong in their play, either through haptic feedback, visual cues, or sound. These would enable her or him to understand their performance and make improvements.
Lin added: “Adapting the present design to other rehabilitation tasks beyond playing music, for example object manipulation, would require customization to individual needs. This can be facilitated through 3D scanning technology or CT scans to ensure a personalized fit and functionality for each user.”
“But several challenges in this field need to be overcome. These include improving the accuracy and reliability of tactile sensing, enhancing the adaptability and dexterity of the exoskeleton design, and refining the machine learning algorithms to better interpret and respond to user input.”
This article originally appeared at Frontiers Science News. | Medical Innovations |
Danish drugmaker Novo Nordisk on Friday surpassed French luxury powerhouse LVMH to become Europe’s most valuable company, buoyed by demand for its blockbuster obesity medicines.
Novo shares rose 2.1% in Copenhagen, boosting its market capitalization to the equivalent of almost $425 billion. LVMH fell 0.8% in Paris, valuing the company at about $420 billion. It was only this year that the French luxury conglomerate passed the milestone of becoming Europe’s first company with a market value exceeding $500 billion, only for the stock to slip back since.
The success of Novo’s Wegovy and Ozempic injectable drugs has sparked something of a gold rush in the pharmaceutical industry and some analysts predict such treatments could become among the best-selling medicines ever. About 40 companies are chasing after Novo for a share of the market, led by Eli Lilly & Co., which expects to get US approval this year to use its Mounjaro diabetes drug to treat obesity.
Behind the rapid emergence of the Novo drugs is the GLP-1 agonist, a molecule initially identified to help people with diabetes regulate their blood sugar, but whose appetite-suppressing effects were quickly found to also help people lose weight. The drugs have since become so popular that regulators around the world have raised alarm that Ozempic may not reach diabetics who depend on the injection.
Because of this, GLP-1 drugs may become the victims to their own success. On Aug. 23, regulators in Novo’s native Denmark proposed limits on subsidies for GLP-1 treatments.
Novo’s stock has more than quadrupled since the end of 2018, overtaking other European behemoths like Nestle SA, as well as pharmaceutical rivals Roche Holding AG and Novartis AG. The latest boost came in August when a landmark trial showed that Wegovy cuts the risk of heart disease by a fifth. The study may broaden access further by aiding Novo in reimbursement discussions with insurers who might otherwise balk at Wegovy’s cost.
Also in August, the Danish company raised its profit and sales outlook for the year, citing growth fueled by demand for Wegovy and Ozempic.
With the global market for obesity treatments expected to explode in the coming decade, Novo and Eli Lilly were in July tipped by Citigroup Inc. analysts to dominate what they described as a “structural duopoly.”
Still, it’s not all smooth sailing. Novo has also said the supply of Wegovy will continue to be restricted in the US as the drugmaker struggles to expand production. Reuters reported Aug. 23 that Novo hired US-based Thermo Fisher Scientific Inc. as its second contract manufacturer of the drug.
On Friday, Novo Chief Executive Officer Lars Fruergaard Jorgensen told Bloomberg TV that his company is “basically selling everything we can produce and when it comes to manufacturing, we’re ramping up significantly as we speak.” | Drug Discoveries |
The UK entered the coronavirus pandemic with public services "depleted" and health inequalities on the rise, the Covid inquiry has heard.
A decade of austerity leading up to 2020 meant the health of the nation was already in decline, two experts said.
A report from Prof Sir Michael Marmot and Prof Clare Bambra was filed as part of the public hearings exploring the UK's preparedness for a pandemic.
Poor regions and ethnic minority groups were disproportionately affected.
More attention should have been paid to reduce the added risks Covid brought to such vulnerable groups, their report said.
The inquiry also heard about increasing pressures in the NHS, with the number of people waiting for treatment twice as high before the pandemic as it was in 2009.
The number of vacancies for doctors and nurses were already climbing, with "great pressure" on existing staff.
And life expectancy around the UK was already on the decline.
Up to 2010, it had been steadily increasing but, from that point on, the improvements stalled - with the largest declines generally seen among the most deprived socioeconomic groups.
What is the UK Covid-19 inquiry?
- It is about going through what happened and learning lessons
- No-one will be found guilty or innocent
- Any recommendations made do not have to be adopted by governments
- The inquiry has no formal deadline but is due to hold public hearings until 2026
- Scotland is holding a separate inquiry in addition to the wider UK one
Sir Michael told the inquiry funding for social care and public health had gone down before the pandemic, particularly in the most deprived areas of the country.
And the impact was felt most by people living in poorer areas, people from ethnic minorities and other vulnerable groups, who experienced the most ill-health.
"In short, the UK entered the pandemic with its public services depleted, health improvements stalled, health inequalities increased and health among the poorest people in a state of decline," said Sir Michael.
Experts said there had been a forewarning from the swine flu outbreak, indicating which groups might suffer the most in a pandemic.
Prof Bambra said there was "little reflection" in previous government pandemic planning reports on which groups were most likely to be at risk.
Katharine Hammond, former director of the civil contingencies secretariat in the Cabinet Office, was also asked about the level of consideration given to vulnerable groups during pandemic planning.
She told the inquiry: "I don't think we did a piece of work to look at the totality of socio-economic disadvantage".
Sir Michael said that planning for better health and narrowing health inequalities was key.
He added it was his general view "that if you look at the evidence from previous pandemics, including the current one that we're considering, that the impact of the pandemic is very much influenced by pre-existing inequalities in society, including inequalities in health."
It was not just about "whether there was a report somewhere in Government about planning for a pandemic," he said, adding: "You've got to plan for better health and narrow health inequalities, and that will protect you in the pandemic." | Epidemics & Outbreaks |
A woman bled to death after it took the medical team looking after her 38 minutes to call for specialist help, an inquest has heard.
Rana Abdelkarim died at Gloucestershire Royal Hospital in March 2021 following a bleed after giving birth.
The inquest found there were "delays" in how her bleed was managed.
Gloucestershire Royal Hospitals NHS Foundation Trust apologised and said changes had been made to prevent further tragedies.
The inquest at Gloucestershire Coroners Court heard how Ms Abdelkarim, 38, was admitted to hospital two years ago to be induced at 39 weeks pregnant.
Her husband Modar Mohammednour, 44, did not go to hospital with her as he was at home looking after their other daughter.
He explained previously that the family did not understand Ms Abdelkarim was being induced but merely thought it was a check-up.
Witness statements submitted to the court said there were language barriers with Ms Abdelkarim, who left Sudan with her husband and made her home in Gloucestershire.
Staff said her English was "poor" but some felt they could "communicate effectively using simple words and hand gesticulations".
A Healthcare Safety Investigation Branch (HSIB) report into the death said: "There was no effective communication with Rana and the events that occurred traumatised staff."
Soon after giving birth to her daughter, Ms Abdelkarim started to experience a major bleed.
Senior coroner Kay Skerrett noted in her conclusion that, after the bleeding started, care "was not at this time escalated to the obstetric team" despite there being "immediate, heavy vaginal bleeding".
"The emergency call bell system was not used to call for help from the obstetric emergency team," the coroner said.
The coroner also noted there were "differences of understanding amongst staff of the code red process".
It was some 38 minutes later that the code red emergency call for a major bleed was made at 05:06 GMT.
Soon after, consultants started battling to save Ms Abdelkarim's life by inserting a uterine tamponade balloon - a balloon inflated inside the uterus to stop bleeding - and they performed a hysterectomy.
The court heard how the HSIB report found staff underestimated how much relative blood volume she was losing because she was small and thin, which contributed to the delay in calling for emergency help.
Despite extensive resuscitation efforts, her condition continued to worsen and she was pronounced dead two hours later.
Professor Mark Pietroni, medical director and deputy chief executive at Gloucestershire Royal Hospital NHS Foundation Trust said in a statement addressing the inquest: "We want to take this opportunity to apologise once again for the immeasurable distress that this loss has caused."
He added the death was "thoroughly investigated" through the HSIB report and the trust did a further investigation.
"The findings of these investigations have been shared with Rana's family and HM Coroner and we have implemented all 10 recommendations made in the HSIB report," he said.
Dr Christine Edwards, consultant obstetrician and gynaecologist, gave evidence about what steps the hospital had taken.
They included the trust updating their interpreter policy and installing a hands-free phone in each antenatal unit, so patients, doctors and a interpreter can be on the same call.
A video has also been made explaining what a code red is and what happens when it is called, which is being shown to staff on mandatory training days.
Dr Edwards also said that, during training days, staff are reminded to evaluate the relative blood loss to a patient's weight, and a specialist drugs trolley for major bleeds after childbirth is on the delivery ward.
Dr Edwards said a survey with staff was done in April 2022 on how comfortable they felt calling a code red, and one commented there was a "fear" and "shame" in pulling the bell, in case it was not needed.
The consultant said the "culture of leadership on the delivery suite has been looked at quite intensely" since then, and changes had been put in place.
Ms Skerrett said: "I've been taken through all the steps taken by the Trust since this tragic death and, with Dr Edwards' evidence in court, I'm incredibly reassured by a lot of the steps taken."
She added that a report to prevent future deaths will be looked at once the hospital has completed a new survey, to see if the changes are working.
'Sense of justice'
The family's solicitor Hannah Carr, from Novum Law, gave a statement after the inquest.
She said: "I cannot begin to imagine how terrified Rana would have felt, without access to interpretation services and without access to her husband by her side.
"For Modar, while the trust has taken steps to learn from Rana's tragic death, this does not change things for him and his family.
"That said there is a sense of justice for him, as he has always said he wanted to prevent this from happening to other families." | Women’s Health |
We were not prepared; we are not prepared - that is what expert witnesses and core participants of the UK's COVID-19 Inquiry have claimed in its first week.
As the hearings started, bereaved families of some of the 227,000 people who have died with COVID gathered outside the same Victorian-era Dorland House building in north London that heard from the families of Grenfell fire victims, grieving families once again calling for answers and accountability.
They came from across the UK, dressed in red and holding photos of their loved ones, united in their grief but each with their own heartbreaking story of loss.
Together, they reflected an unequal and at times unorganised response to an unprecedented threat.
Inside the cramped and crowded hearing room, inquiry chair Baroness Hallett paid tribute to the dignified vigil, and said she will answer three key questions: "Was the UK properly prepared? Was the response appropriate? Can we learn lessons for the future?"
The inquiry's lead counsel gave his own answer to the first of those.
Referring to the government's COVID-19 action plan published on 3 March 2020, which claimed the UK was "well prepared" in a way that "would offer substantial protection to the public", Hugo Keith KC said: "Even at this stage, before hearing the evidence, it is apparent that we might not have been very well prepared at all."
Mr Keith produced the government's workflow for pandemic preparedness and response - a muddled tangle of lines, arrows and instructions described by Sam Jacobs, representing the Trade Union Congress, as: "A visual and striking representation of a fragmented system which looks much more like a bowl of spaghetti than a clear and coordinated framework for a cogent national response."
In practice, regional health officials say that plan meant a top-down approach that left them in the dark, learning about new policies and guidance at the same time as members of the public, at the daily 5pm broadcasts.
The Association for Public Health Directors said: "It is widely felt that the local voice was not wanted or heard."
The Department for Health said that it would not say it did everything right or that it would make the same decisions again with the benefit of hindsight.
However, their legal representatives urged Baroness Hallett not to impose "retroscope" decision-making.
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Ministers said repeatedly during the pandemic that the government was "following the science", but the Government Office for Science said Sir Patrick Vallance's insistence that minutes and papers from SAGE (Scientific Advisory Group for Emergencies) were published meant: "SAGE was given particular prominence in the minds of the media and the public in relation to policy…This meant that other areas of advice not made public were not subjected to the same level of debate and scrutiny."
According to early expert witnesses, while the UK was once considered a world leader in planning for a potential influenza pandemic, it hadn't adapted to the increasing threat of emerging infectious and zoonotic diseases.
A situation detailed in UK Health Security Agency chief executive Professor Jenny Harries' written statement to the inquiry: "In 2018 on a UK national level, Public Health England identified there had been a gap in national strategy across governments focusing on infectious diseases…The gap had been apparent since 2002.
"Having recognised this gap, work was then started in 2018 to address that issue of a strategy for infectious diseases."
That report was published in the autumn of 2019 just months before the start of the pandemic.
Katherine Hammond, the former director of the Civil Contingencies Secretariat, was asked whether she agreed that we were blindsided by the appearance of coronavirus, she replied: "I don't think blindsided is the word that I would use, it certainly… the pandemic that happened in 2020 was different from the reasonable worst-case scenario produced by experts which focused on a flu pandemic."
As COVID-19 reached our shores, the UK was left with an outdated plan for the wrong virus.
Cambridge University epidemiologist Dr Charlotte Hammer said: "Any plan for a respiratory outbreak will be better than none, a dedicated plan is better than one for something else, but I think... there were certain difficulties with this."
Professor Jimmy Whitworth who appeared alongside Dr Hammer at the inquiry agreed: "By the middle of January 2020 people in the international public health community were aware that this was out of the ordinary.
"This outbreak wasn't just a small cluster that was going to die away…The UK was very strong in influenza, because that was on the top of the risk register in the UK."
One of the impacts of this policy, when combined with increasing health inequalities and decreasing health standards in the UK before the pandemic, was that attempts to mitigate the most vulnerable parts of the population suffering disproportionately weren't successful.
A joint report by Professor Clare Bambra and Professor Sir Michael Marmot found that people from lower socio-economic backgrounds, higher rates of deprivation, and people from ethnic minorities were more likely to be severely impacted by a respiratory pandemic.
Those declining health standards had been kick-started by a decade of austerity measures and increased demand on the NHS, which has nearly doubled between 2009 and the pandemic.
Preparations for a no-deal Brexit, Operation Yellowhammer, also side-tracked Cabinet Office resources which would have been looking at pandemic preparedness and resilience.
Read more:
UK 'prepared for the wrong pandemic', COVID inquiry told
COVID inquiry: Everything you need to know
Baroness Hallett: Who is the chair of the inquiry?
Bereaved families call for greater transparency
Other expert witnesses have been more blunt.
Professor David Alexander who specialises in risk and disaster reduction said current civil contingencies and emergency planning structures do not keep the population safe: "I think the bottom line of all of this is do you think that the British government, within the limits of his competency, keeps the public safe? I fear my answer to that is no, or not sufficiently."
With regards to the government's "Resilience Framework" published in December 2022, he said: "There is no mention of gender... disabilities... elderly... or ethnic and cultural minorities, and yet all of these are essential issues that need to be dealt with."
A criticism supported by those who have helped shape government preparations. Bruce Mann who led on Civil Contingencies in the Cabinet Office until 2009 was asked if radical innovation and change is required: "Yes in structures, and yes in the detail in which plans, procedures…especially from central government are followed through in detail to make sure that they will work."
There will be bigger headlines and more attention on the inquiry next week when key names like former prime minister David Cameron, Chancellor Jeremy Hunt MP, and Chief Medical Officer Sir Chris Whitty appear before the inquiry.
However, a senior lawyer at the inquiry told Sky News he believed these first four days have been the most important for highlighting failures in pandemic preparedness, resilience, and forward planning - the key focus of this first module, ahead of what they described as the "inevitable political mudslinging". | Epidemics & Outbreaks |
If youâre a polite person, you probably say âthank youâ several times a day without giving it much thought. But when was the last time you truly felt grateful for something or someone and took a moment to reflect on it?Â
Some people are naturally inclined to focus on the good in their lives, but thatâs hardly the norm, says Cortland J. Dahl, PhD, a research scientist at the University of Wisconsin-Madison Center for Healthy Minds. âIt goes back to our biology and evolution,â he says. âWeâve evolved not to be happy but to survive, and focusing on the negative is whatâs helped us to survive in the past.â But today, stress-related problems -- including insomnia, depression, digestive disorders, heart disease, and many others -- are among our greatest threats. Practicing gratitude may help.
So what does gratitude actually mean? Definitions vary, but experts typically define it as the affirmation of goodness in our lives as well as the ability to attribute those positive things to a source beyond ourselves (such as other people or a higher power). Practicing gratitude means recognizing gratitude, either by noting it silently or expressing heartfelt thanks to others.Â
If youâre not particularly spiritual or reflective, the notion of intentionally practicing gratitude might seem silly or unimportant. But thereâs good reason to give it a try. Studies have shown that grateful people tend to be happier, sleep better, and have lower levels of inflammation. Theyâre also less apt to be depressed and more resilient after a trauma. Research has even found that people with a type of heart disease (asymptomatic heart failure) who started keeping a daily gratitude journal had lower levels of CRP, an inflammation marker, just 8 weeks later. These studies donât directly prove that gratitude caused those benefits, but the link is clear.Â
There hasnât been a lot of research on how gratitude impacts the brain. But in one small study, researchers watched participants' brains through an fMRI scanner during a gratitude exercise. The scans showed that when people were feeling grateful, there was a boost in activity in brain areas that are also linked to empathy and social bonding.Â
A larger study included nearly 300 people who had reached out to a university-based psychotherapy service. Some of them only did psychotherapy, others did psychotherapy plus expressive writing, and a third group did psychotherapy plus writing gratitude letters to other people. Those who wrote gratitude letters in addition to psychotherapy reported better mental health, a change that was still present 12 weeks after the study ended.Â
Practicing gratitude doesnât require maintaining a sunny disposition at all times, Dahl says. In fact, he notes that people who are struggling are among those who may benefit most from cultivating gratitude. âGratitude and a sense of connectedness are precisely what help us get through difficult times,â Dahl says.
Remember that you can be grateful for things that most people would agree are significant -- perhaps a loving family or a job you can rely on -- as well as those that might appear relatively minor. âFor example, you can appreciate that someone has a sense of humor. If you take it a step further and acknowledge that that person made you laugh and cheered you up, thatâs gratitude,â Dahl says.Â
Ways to Boost Gratitude
You can aim to be more grateful as you go about your day, but most people find that it helps to devote a specific time to engaging in a gratitude exercise. âGratitude is a skill you can turn into a habit,â Dahl says.Â
To get started, try one or more of the following approaches.
Name three things youâre grateful for and why.Â
Dahl and his wife recently started doing this before bed, and theyâre already reaping the benefits. âWe noticed we were going through a stressful period at work, and we used to lay down and go into complain mode,â he says. âNow we take turns picking a different focal point and naming three things about it that weâre grateful for. Itâs the simplest thing, but it puts us in a better mood before going to sleep.â
Write a letter to someone youâre grateful for.
Pick up a pen and write a note to somebody youâre grateful to have in your life, suggests Amy Morin, LCSW, a psychotherapist and author of 13 Things Mentally Strong People Donât Do.Â
Be as specific as possible. âShare that you appreciate they took the time to do something kind for you, or that you appreciate the times when theyâve really helped you in life. If youâre brave, read them the letter; it will benefit them too.âÂ
Not feeling so bold? Write the letter anyway but keep it to yourself.
Soak up stories about gratitude.Â
Many books have been written about gratitude, and there are podcasts and TED Talks, too, Dahl says. Spending a few minutes each day reading or listening to them may help shift your mindset. Try reading a book like The Gratitude Project or watching a TED Talk on the power of âliving eulogies.âÂ
Create a bulletin board of things youâre thankful for.
Think of it like a mood board focused on gratefulness. Pin up pictures of people, experiences, and things youâre grateful for and keep it somewhere visible, like your kitchen or home office. âJust seeing that bulletin board every day can give you a boost,â Morin says.Â
Reflect as a ritual.
âI think daily rituals are really helpful, and I meditate every day,â Dahl says. You can develop your own gratitude meditation; all you have to do is sit quietly and devote a few minutes to reflecting on whatâs good in your life, big or small. | Stress and Wellness |
An adolescent mental health unit where the treatment of vulnerable young people was described as "worse than animals" has shut down after a Sky News investigation.
Former patients at Taplow Manor in Maidenhead, Berkshire, claimed there was overuse of restraint, and former workers said inadequate staffing and training put people at risk.
Police are also investigating the death of a patient at the unit and an allegation of child rape involving staff.
Active Care Group, which ran the unit until its closure, said on Thursday it had taken "the difficult decision" to close the facility "due to a change in strategic direction".
The group said in a statement: "We wish to thank our dedicated staff for the care and support they have provided to patients at Taplow Manor over the years.
"Active Care Group has now entered a period of consultation with staff and will take every step to ensure that those impacted are retained within the business where possible.
The group's statement added it is working with "patients' families and their relevant multidisciplinary teams to assist in the safe transfer or discharge of all Taplow Manor patients".
The Huntercombe Group, which previously ran the unit and is now part of Active Care Group, received £190m since 2015 from NHS England to operate Taplow Manor and other hospitals.
In a joint investigation with The Independent, more than 50 former patients told Sky News they were failed by the care they received at units run by the Huntercombe Group, one of several independent providers the NHS uses to provide specialist in-patient care for children and teenagers.
Read more:
Decade of mistreatment revealed in care of more than 20 teenagers
30 new patients of Huntercombe Group tell their stories of mental health units
Taplow Manor had been threatened with closure by the health watchdog, the Care Quality Commission, in March if it failed to make improvements.
The Department of Health and Social Care also launched a national investigation into the safety of all mental health inpatient services in England after the investigation was released. | Mental Health Treatments |
A new Gallup survey found more than half of teenagers in the U.S. spend an average of 4.8 hours on social media each day. The responses came from 1,591 people ages 13-19 years old, and the survey’s findings show that as teens got older, they stayed on social media even longer.
Gallup also surveyed the children’s parents, asking about their parenting practices, parent-child relationships, and youth activities, among other things. The results looked at the data from 6,643 parents and found that social media usage was most prevalent among girls, noting that 55% spent an average of 5.3 hours online. Meanwhile, 48% of teenage boys were shown to spend 4.4 hours on social media, with the usage peaking for both genders at 17 years old.
The poll looked at social media usage across YouTube, TikTok, Instagram, Facebook, X – formerly called Twitter – and WhatsApp. Gallup found that out of all platforms, teens spend minimal time on WhatsApp, X, and Facebook in favor of YouTube (1.9 hours), TikTok (1.5 hours), and Instagram (.9 hours).
Gallup questions whether social media addiction is a contributing factor to the number of hours teens spend online every day saying, “Studies have pointed out how technology companies manipulate users into spending more time on the apps through their designs.” The report references a 2022 article published in the journal American Economic Review that says 31% of young adults are affected by the way social media companies design the platforms which reportedly creates “self-control problems” and excessive screen time use.
“Social media platforms drive surges of dopamine to the brain to keep consumers coming back over and over again,” Dr. Nancy Deangelis, the director of behavioral health at Jefferson Health said in an article for the health system. “The shares, likes, and comments on these platforms trigger the brain’s reward center, resulting in a high similar to the one people feel when gambling or using drugs.”
Teenagers are more susceptible to these triggers, Deangelis says, because they are accessing social media during their second-largest period of brain development.
“The overuse of social media can actually rewire a young child or teen’s brain to constantly seek out immediate gratification, leading to obsessive, compulsive, and addictive behaviors,” DeAngelis said.
The addictive nature of social media can worsen mental health disorders, she warns, including symptoms of anxiety, depression, ADHD, body dysmorphia, and others.
The Addiction Center, owned by Recovery Worldwide, identifies youth who overuse social media as having a social media addiction, saying they fall into the category if they spend a lot of time planning to use social media or thinking about online platforms, use it to forget their problems, and if they find it has a negative impact on their job or studies.
The center said that 27% of teens who have mental health issues were found to spend three hours or more on social media and reported that adolescents who excessively use social media were found to have “severely stunted social interaction skills.”
Earlier this year, the U.S. Surgeon General and the American Psychological Association issued health advisories regarding the potential harm social media has on youth, noting the effect it has on brain development but said more research is needed to see the overall impact social media has on teens. However, “there is growing evidence that social media use is associated with harm to young people’s mental health,” U.S. Surgeon General Dr. Vivek Murthy said in a U.S. Department of Health and Human Services news release in May.
“Children are exposed to harmful content on social media, ranging from violent and sexual content to bullying and harassment,” he said. “And for too many children, social media use is compromising their sleep and valuable in-person time with family and friends. We are in the middle of a national youth mental health crisis, and I am concerned that social media is an important driver of that crisis – one that we must urgently address.” | Mental Health Treatments |
Image source, Getty ImagesMore than 650,000 deaths were registered in the UK in 2022 - 9% more than average. This represents one of the largest excess death levels outside the pandemic in 50 years.Though far below peak pandemic levels, it has prompted questions about why more people are still dying than normal.Data indicates pandemic effects on health and NHS pressures are among the potential explanations. Is it Covid?Covid is still killing people, but is involved in fewer deaths now than the start of the pandemic. Roughly 36,000 deaths involved Covid in 2022 compared with more than 95,000 in 2020.We are still seeing more deaths overall than would be expected based on recent history. The difference in 2022 compared with 2020 and 2021 is that Covid deaths were one of a few, rather than the main explanation for this excess. So what else might be going on?The crisis in healthcareA number of doctors are blaming the wider crisis in the NHS.At the start of 2022, death rates were looking like they'd returned to pre-pandemic levels. It wasn't until June that excess deaths really started to rise - just as the number of people waiting for hours on trolleys in English hospitals hit levels normally seen in winter.On 1 January 2023, the president of the Royal College of Emergency Medicine suggested the crisis in urgent care could be causing "300-500 deaths a week". It's not a figure recognised by NHS England, but it's roughly what you get if you multiply the number of people waiting long periods in A&E with the extra risk of dying estimated to come with those long waits (of between five and 12 hours).It's possible to debate the precise numbers, but it's not controversial to say that your chances are worse if you wait longer for treatment, be that waiting for an ambulance to get to you, being stuck in an ambulance outside a hospital or in A&E.And we're seeing record waits in each of those areas. In November, for example, it took 48 minutes on average for an ambulance in England to respond to a suspected heart attack or stroke, compared to a target of 18 minutes. Lasting effect of pandemicSome of the excess may be people whose deaths were hastened by the after-effects of a Covid infection. A number of studies have found people are more likely to have heart problems and strokes in the weeks and months after catching Covid, and some of these may not end up being linked to the virus when the death is registered. As well as the impact on the heart of the virus itself, some of this may be contributed to by the fact many people didn't come in for screenings and non-urgent treatment during the peak of the pandemic, storing up trouble for the future. We can see that the number of people starting treatment for blood pressure or with statins - which can help prevent future heart attacks - plunged during the pandemic and, a year later still hadn't recovered. No evidence of vaccine effectThe rise in cardiac problems has been pointed to by some online as evidence that Covid vaccines are driving the rise in deaths, but this conclusion is not supported by the data. One type of Covid vaccine has been linked to a small rise in cases of heart inflammation and scarring (pericarditis and myocarditis). But this particular vaccine side-effect was mainly seen in boys and young men, while the excess deaths are highest in older men - aged 50 or more.And these cases are too rare - and mostly not fatal - to account for the excess in deaths.Finally, figures up to June 2022 looking at deaths from all causes show unvaccinated people were more likely to die than vaccinated people. While this data on its own can't tell us it's the vaccine protecting people from dying - there are too many complicating factors - if vaccines were driving excess deaths we would expect this to be the other way around. | Epidemics & Outbreaks |
Two New Jersey dentists and other oral care professionals have teamed up to give a first responder the gift of a gorgeous new smile.
Dr. Jason Auerbach, CEO and founder of Riverside Oral Surgery practices, joined forces with Dr. Dayna Cassandra of DC Cosmetic Dentistry to form the Riverside Oral Surgery First Responders Initiative, which aims to "donate" restorative and cosmetic dental services to first responders.
Johnnie Ramos, a detective with the Passaic County Sheriff's office in New Jersey, was the first recipient chosen to receive a new smile.
"We’re very fortunate to be in a position to help people," Auerbach told Fox News Digital in an on-camera interview. "And it made sense that if we were going to do something like this, that we would do it for people who put themselves in harm's way to be there for others."
He added, "Those are the people who deserve it the most, in my opinion."
Auerbach and Cassandra, who have been practicing in the same neighborhood for 20 years, set out to organize a team of people who had complementary skill sets and a desire to help others.
Those included Dr. Jonathan Mendia, an anesthesiologist, and donation partners Straumann and Kuwata Pan Dent Laboratory, which manufacture dental implants.
When it came time to choose the first recipient for the initiative, Auerbach posted announcements on his Instagram accounts, @bloodytoothguy and @riversideoralsurgery.
"It’s really an art and a science."
"We basically set out to seek interest and we found a lot of deserving people," said Auerbach, who is also CEO and founder of MAX SSM, an innovative platform for oral and maxillofacial (jaw and facial) surgery.
"The unfortunate reality is that we can't help everybody. So we kind of looked at the big picture and understood what was important about Johnny's case, both the dental needs and who he is as a human being, and he was the one we selected."
Ramos has been a detective with Passaic County for nearly 31 years. He had a long history of poor dental health, which stemmed from not taking care of his teeth as a child.
"Since I was a little kid, I would eat a lot of junk food and not brush my teeth after every meal the way I should have," he told Fox News Digital in an email. "I was also a smoker, which I now know was another problem."
After having a bad experience early on, Ramos had a longtime fear of going to the dentist — so he admittedly "never went back."
When he heard about Auerbach’s initiative to offer restorative dental work for members of law enforcement, he entered and was nominated for the SMILE program.
Through MAX SSM, Ramos received a full mouth reconstruction using several tooth implants.
The dentists started by performing a full analysis and 3D dental imaging of Ramos’ mouth and facial structures.
"The cosmetic aspect is dependent on the foundation," Auerbach said. "The foundation needs to be strong in order to get to a point where the esthetics and function are good."
Cassandra said she also likes to use regular photography and "old-school" techniques to complement the new digital technologies.
"It’s a combination of old and new," she told Fox News Digital in the interview. "We marry those two things together in the laboratory and then deliver the treatment."
"It made sense that if we were going to do something like this, that we would do it for people who put themselves in harm's way to be there for others."
"It’s really an art and a science," Auerbach said.
Regardless of the cutting-edge technologies that are used, Auerbach pointed out that patients are still human beings — and that these procedures require a precise skill set and significant attention to detail.
After Ramos’ implants were placed, he received temporary teeth that are made of plastic and supported by tiny metal cylinders, Cassandra said.
Once the implants are fully integrated and stable, the final restoration will be a milled piece of metal or titanium that's made in Switzerland by the manufacturers of the implant.
"The precise fit of the teeth to the implants is what determines how successful they will be over the long term," Cassandra said.
The quality of the implant is also important, the dentists noted.
Straumann, the Swiss dental company that donated the implants for Ramos, exercises "incredible attention to detail and precise connection, which is paramount to everything," Auerbach said.
"It's not really just implants — it's the type of implant and the person placing the implant."
Ramos is thrilled with the results so far, he told Fox News Digital.
"The process has been long yet comforting, and the doctors and staff made it very easy and smooth for me," he said.
"Everyone was professional and did a great job in making me feel comfortable."
Tips for maximizing dental health
To prevent tooth loss, decay and other major dental issues, Auerbach stressed the need to go back to the basics — following proper brushing and flossing protocol at home and regularly visiting a dental professional so that any issues can be caught and treated when they're small.
"Little things don't really cost that much if they’re caught and treated early," he said.
If a cavity is left untreated, for example, it could eventually lead to a root canal or a crown — and if a tooth becomes infected, it may need to be extracted, which could then require a bone graft, implant and crown.
"The longer you wait to treat any problem, the more expensive and more burdensome it becomes," Auerbach said.
It’s also important to choose the right provider, the experts agreed.
"The right dentist will be compassionate, skilled and knowledgeable," he said.
One of the main reasons that teeth break down, said Cassandra, is that people tend to breathe through their mouth — especially when they’re asleep.
Open-mouth breathing can dry out the gums and mouth tissue, which can increase the risk of gum disease and tooth decay, experts say.
"Mouth breathers often have periodontal disease and lots of decay," she said.
"And once somebody has pain from gum disease or broken teeth, and then they have a bad experience, they don't want to go to the dentist," she said.
"They don't even want to brush their teeth because it hurts. So it's like a snowball effect. And I think that's where it started with Johnnie."
Much of dental health has to do with awareness, Auerbach said.
"A lot of that comes from socioeconomic issues — patients who don't have the best access to good health care or dental care when they're younger tend to have less than optimal experiences," he went on.
"It’s a privilege to be able to make a difference in people's lives."
In hindsight, Ramos agrees that prevention is key.
"You should brush your teeth after every meal, and floss, and see your dentist as often as possible," he recommended.
"I wish I had taken better care of my dental health when I was younger and that I had regularly seen the dentist."
‘Reason to smile’
Ramos said that his new teeth give him a "younger look, which gives me an actual reason to smile."
He told Fox News Digital, "The benefits have been amazing throughout my daily life — I’m able to smile more and feel more confident about myself."
In terms of how humans relate to one another, said Auerbach, "the smile is really everything."
"When you meet somebody, you look either in their eyes or at their smile, or a combination of both," he said.
"The smile is a universal language," Cassandra added.
"Restorative dental work contributes to the physical health and well-being of patients — everything from eating and sleeping properly to reducing headaches and neck pain to helping with good posture and balance," she said.
These types of procedures can provide a big mental health boost as well, she said, helping people live happier, more confident lives.
Looking ahead, Auerbach and Cassandra plan to perform one transformation each year through the SMILE initiative.
"We take it seriously," Cassandra said. "It’s a privilege to be able to make a difference in people's lives." | Medical Innovations |
The news last week that the drugmaker Eli Lilly will cap out-of-pocket costs for its insulin at $35 per month brought relief to some. But what remains are systemic problems with insurance coverage and misdiagnosis that continue to challenge many with diabetes.
Mila Clarke, 33, is among the 12% of Black Americans who have been diagnosed with diabetes, the second-highest rate behind Native Americans.
After she was told by her doctor that she had Type 2 diabetes, Clarke familiarized herself with insurance copay cards and patient programs that provide assistance from insulin manufacturers. If she hadn’t, “I would have walked out of the pharmacy paying $2,000 for a 30-day supply of insulin, which is like rent or a mortgage,” she said. “Like, nobody can pay that every single month just to stay alive.”
The price cap by Eli Lilly, the country’s largest manufacturer of insulin, will have an outsize effect on Black people, who are not only more prone to diabetes but are also more likely to struggle to pay for the drug. Without the caps, most people with diabetes who are uninsured or under-insurered can spend upward of $1,000 per month or more on insulin out-of-pocket.
But beyond the cost of insulin, larger structural inequities contribute to poorer health outcomes for Black Americans as a whole, especially those with diabetes. “When you look at communities of color, particularly African Americans, they’re more likely to be in a job without insurance,” said Otis Kirksey, a pharmacist from Tallahassee, Florida, and a board member of the American Diabetes Association. He also said that Black people are more likely to live in food deserts and have fewer healthy food options, which means their chances of “developing diabetes are significantly higher.”
Black people may experience an overdiagnosis for prediabetes or Type 2 diabetes, according to a March 2021 report by the Centers for Disease Control and Prevention.
Clarke struggled with being misdiagnosed as having Type 2 diabetes. After countless doctor’s visits and failed treatments, a visit with a Black female doctor revealed that she actually has Type 1 diabetes.
“It shouldn’t have taken four years for me to get a proper diagnosis,” Clarke said. Whenever she went to her previous doctor, she said, “because I was a young Black woman, I did not ever feel listened to.”
Now, Clarke said she takes a long-acting insulin called Tresiba, which costs approximately $150 for a 90-day supply. She also takes Lyumjev, a short-acting insulin, which costs $300 for a 90-day supply.
With both diagnoses, Clarke had the benefit of commercial insurance to help with the costs.
Serena Valentine, 39, meanwhile, was misdiagnosed with Type 1 diabetes instead of Type 2. During a nine-month stretch starting in 2017, she started losing vision in her right eye due to diabetic retinopathy. Three days after having retinal reattachment surgery in 2018, she completely lost vision in that eye.
Then in 2019, she started losing vision in her left eye and rejected having surgery again because she was “traumatized” from what happened to her right eye, she said. She chose not to undergo surgery, and now only has 35% vision in her left eye.
At the time, Valentine said, she did not have insurance, and could not afford to see an eye doctor. Finally, she qualified for Medicaid following the birth of her son, and learned from an ophthalmologist that her severe vision loss could have been preventable.
“I was very upset,” Valentine said. “And not only that, I was only offered one type of treatment, which was surgery.”
Kirksey, who is also a retired pharmacy professor at Florida A&M University, said one of his students was misdiagnosed at a walk-in clinic with having high blood pressure when he actually had diabetes. That error was rooted in bias by the medical professionals involved, Kirksey said.
“He was obese. No one ever thought to test his blood sugar. When he finally ended up at the hospital, his blood sugar was over 1,400” mg/dL, Kirksey said, which is 10 times higher than normal. “He died.”
Data from 2019 found that Black people were twice as likely than white people to die from diabetes and were 2.5 times more likely to be hospitalized with diabetes and experience long-term complications, according to the U.S. Department of Health and Human Services’ Office of Minority Health.
“In the ICU, I have cared for patients who have life-threatening complications of diabetes because they couldn’t afford this life-saving drug,” Dr. Adam Gaffney, a critical care physician at the Cambridge Health Alliance in Massachusetts, told NBC News last year.
Close to 1 in 5 adults in the U.S. with diabetes skipped, delayed or used less insulin to save money, a 2021 report by Annals of Internal Medicine found. It also said that insulin rationing was more common among Black Americans.
“I’ve had patients who actually, literally, changed their dosing recommendations to ensure that they at least have a little bit of insulin, you know, to make it throughout the month,” Kirksey said.
After grappling with their misdiagnoses and finding solutions to pay for their insulin needs, Clarke and Valentine have become advocates for their own health and others with diabetes.
Through her YouTube channel, which has more than 36,000 subscribers, Clarke answers viewers’ questions about living with the disease, including how to self-administer insulin. Valentine runs a health and wellness nonprofit organization in Houston called CORE Initiative, which provides diabetes self-management courses and peer support groups. Valentine also encourages patients to visit the doctor when “they see something that’s not right,” she said.
Clarke said she would like to see the stigma of diabetes reduced and more open conversations between patients and doctors.
“I think if physicians were better prepared to have those conversations and to lend those resources to people with diabetes at diagnosis, it would change the way that people manage diabetes,” she said, “and ultimately, it would reduce those numbers of complications and frustrations and diabetes burnout.” | Drug Discoveries |
How bad does it need to get?
Understanding the NHS Crisis
Back in January, at the peak of the 2022/23 winter crisis, I wrote a post asking “whether the NHS is in a death spiral”? It was gloomy. I didn’t see much evidence that the government had grasped the severity of the situation or were focusing on the right levers.
I’m not feeling any less gloomy now. If anything this year is going worse than I expected. We are now in the summer, when things should be quiet, and from the lack of media coverage you might think they were, but sadly not. In May over half a million people waited more than 4 hours in A&E. Not much more than a decade ago that number was negligible. Tens of thousands are waiting 12 hours or more. There can be no doubt this is killing many thousands of people. Excess mortality in 2023 is running above the 5 year average, which includes the pandemic years.
Meanwhile elective waiting lists continue to rise with over 7.4 million people now waiting for treatment, 220k more than when Rishi Sunak pledged to bring numbers down in January. What happens next winter will depend, in part, on how bad covid and flu seasons are, and whether they coincide. But there is no reason to believe 2023/24 will be any better than last year, and it could well be even worse.
Despite the relative lack of attention in Westminster it remains a key issue for voters, only narrowly behind the cost of living. Patient satisfaction with the NHS is the lowest it has ever been. Worsening health outcomes are also harming economic growth and at least partly responsible for the extremely constricted labour market. The number of people who are economically inactive due to ill-health is now at a record high of 2.55 million. Fixing the NHS should be a top priority for the government, and Labour.
Since the start of the year I have been working with colleagues from the Institute for Government, and my co-author Rachel Wolf, on a project to figure out what’s going on. What follows is my own interpretation of the key findings, and should be taken as a personal view and not that of anyone else who worked on the project. (All stats are taken from the report and not linked to separately).
What’s Going On?
Since the pandemic there has been a big increase in funding and staffing in the NHS. Over 16% more junior doctors and 11% more nurses are employed than in December 2019. This is not widely appreciated, even within the system. Many of the practitioners we spoke to were surprised to hear that staffing had increased. And you’d be forgiven for not realising given activity levels – in terms of patients seen – are more or less the same as they were in 2019. Given the size of the backlog built up during covid this is nowhere near enough. NHS England estimates its needs to be operating at around 130% of the 2019 level to make significant inroads.
Our exam question was why hasn’t activity increased? We couldn’t find much evidence for some of the potentially plausible explanations. There is no data to support the idea that patients are now sicker on average. Covid protocols that caused delays have been largely, though not completely, abandoned. Instead we ended up with a three part explanation:
1. There is simply not enough physical capacity to support an increase in activity
2. Even though overall staffing has increased, many experienced doctors and nurses have left; and
3. The system is catastrophically undermanaged, both in terms of quantity of people and the operational constraints they face.
Physical Capacity
I noted back in January our lack of hospital beds compared to other countries. Germany has six for every thousand people, Belgium has five, we have two. This helps explain why our system was so vulnerable to the pandemic. It was already running on the edge of capacity before it was hit. This is exacerbated by having 10% of beds taken up by people who have no medical need to be in hospital. They are mostly there because of capacity problems beyond any hospitals’ control, such as the lack of social care provision or the fall in community nursing numbers. Lack of management is also a factor with discharge processes often taking much longer than they should.
But even if you invested in, and improved, social care, which is a huge and expensive task in itself, we would still be seriously short of beds. The calculations on which historic bed reductions were made have simply not come true. Since 2010/11 available beds have fallen by 5% but admissions have risen by 15%. Improved surgical procedures and so forth are being counteracted by an aging population. The resistance to accepting this basic and obvious fact across both main political parties, and much of the NHS hierarchy, is genuinely baffling. It’s almost as if people don’t want to accept such a boring and old-school solution is the answer. Surely technology will intervene to mean we don’t need to build more hospital space? Surely there must be a cleverer answer?
I really don’t think there is. Health Foundation analysis suggests we will need somewhere between 23,000 and 39,000 beds by 2030/31 just to maintain 2018/19 levels of care – a 15-25% increase on now. There are no plans to build anything like this number. Nor is using private capacity the answer. We already do and there isn’t much of it in the UK.
Beds aren’t the only physical capacity constraint. A large part of the outpatient waiting list is caused by lengthy delays for diagnostic equipment. Some of this is due to vacancy rates in key roles – like radiology – but much is just a lack of machines. The UK has the fifth lowest number of CT and PET scanners and MRI units per capita in the OECD: 16.5 per million people, compared to an OECD average of 44.8. It’s the same story on IT. I was astonished to find that well over 20 hospital trusts are still using paper records in 2023. Elsewhere doctors and nurses are wasting inordinate amounts of time on computers that should be in museums.
The root cause of all this is that we have never invested enough in physical capital. Our day to day spending is around the OECD average, and has been higher in recent years, but our capital spend has been around half the average. Even the budgets that have been allocated to capital have been raided for emergency needs. The basic laws of economics will tell you that if you put all your investment into labour and little into capital then productivity will get worse and that’s what is happening. It’s an appalling misuse of taxpayer funds and classic short-termism. As a result we are employing more doctors and nurses and then wasting their time while they try to free up a bed; or sit with an A&E patient for whom a bed cannot be found; or spends hours trying to book a diagnostic test; or wait for the agonisingly slow computer to wake up.
Staffing
Data on NHS staffing is limited. We can see overall numbers are up a lot. We can see churn has increased, with more people leaving than ever. Naturally this means many more staff are relatively inexperienced. For instance there are 35% more registered nurses with less than 5 year experience than in September 2017, but slightly fewer with over 20 years’ experience. Increasingly the most experienced consultants are not working full time – up to a quarter now according to a Royal College of Physicians survey.
This all means that capacity problems are made worse as the lack of experienced staff creates bottlenecks. For instance experienced ward nurses are needed to manage bed flow in extremely constrained circumstances. A&E consultants told us they were having to spend time on triage and routine tasks like blood tests as there were not enough experienced nurses to do them, which stopped them from treating patients. There are shortages in key diagnostic roles. Moreover the big increase in use of agency staff is not only very expensive but also leads to people who don’t know the systems and processes of that particular hospital having to fill in gaps.
There are several other hypotheses around staffing for which the data is not good enough to address properly. One is that an increase in recruitment from outside the EU – more than 50% of nurses and doctors recruited last year came via this route – is causing more churn. It certainly feels like a risk given higher salaries available in other countries, and we heard anecdotally this was causing problems. We are, in any case, going to be dependent on international recruitment for some time, even if the government adds more training places for UK staff, given the lag time.
It was also hard to quantify the impact of falling morale on discretionary effort. That it is falling is clear enough from the NHS staff survey, with pay being the fastest growing cause of unhappiness. This is why we are seeing more people quit. Nuffield Trust analysis has shown that “in the last decade, the numbers pointing to work-life balance, promotion and health as reasons to leave have all roughly quadrupled.”
What is less clear is whether the staff that have stayed are doing less than they did before. The NHS is hugely dependent on unpaid overtime, which is a problem in itself, but it’s not clear if this is falling as it’s not measured. It’s certainly the case that the doctors and nurses we spoke to remain committed to the job despite their frustrations.
But given the high leaver rates, and falling morale, at a time of crisis, it remains utterly baffling to me that the government are continuing their industrial dispute with doctors (and the Royal College of Nursing). Against tough competition this has to be the most astonishingly myopic public spending decision I have ever seen. It is already costing us dearly.
Management
It is well known within health policy circles that the NHS is severely undermanaged compared to other systems. The UK spends less than half the OECD average on management and administration, which is why I bang my head against the nearest wall whenever I see a newspaper splash bemoaning fat cat managers, or yet another politician promising to get more resources to the “frontline”. It is, of course, the case that if frontline staff are not properly supported they end up becoming expensive admin staff themselves (see also policing). Meanwhile the number of managers per NHS employee has fallen by over 25% since 2010 due to deliberate policy decisions from the centre of government, particularly Andrew Lansley’s disastrous “reforms”.
But simply adding more managers is unlikely to work. They also have to have the powers to make a difference, and the right incentives to follow from the centre. Over the past decade managers have become considerably more constrained. One obvious example is in the ability to invest in capital, which, as we have seen, is a big problem. More and more bureaucratic constraints have been put in place to allow the centre to manage limited resources, costing a huge amount of management time and limiting effectiveness.
There has also been a big increase in the range of targets hospitals have been responsible for – including many “quality” targets which are essentially about process rather than outputs. This has led to hospital analysts spending a lot of time providing information to the centre rather than supporting the needs of management within their hospital. It is has also created confusion as to what trusts are supposed to be doing. Activity targets, which have remained, albeit heavily watered down, from the New Labour era, have been competing with quality targets, creating contradictory objectives and limiting autonomy. The Blairite targets, like the 4 hour one for A&E, were criticised for being too simplistic, but setting a minimum standard is all such targets can do. And they achieved that, a success that has now been completely undermined.
Meanwhile the central bureaucracy has grown to manage all this complexity. There are fewer managers but more managers managing the managers. The latest approach – integrated care systems – designed to bring different parts of the health system into the same regional structures – makes some sense in theory but risk adding to this complexity. The lack of clarity as to what they are supposed to be achieving is concerning, and we’ve already seen the Secretary of State slash their funding, which can hardly help.
It’s hard to untangle the reasons for the relative success of the NHS during, and just after, the New Labour years. How much was it due to large annual funding increases and how much was a simple focus on a handful of indicators backed up by strong financial incentives in the form of payment-by-results? It’s certainly the case that simultaneously keeping to very tight spending increases (as was true from 2010-2019) and significantly increasing the complexity of the system, while also reducing management capacity, was a very bad idea.
The Death Spiral
In my January post I asked if the NHS was now in a death spiral. Writing this report has in some ways made me more positive. There are some obvious things that could be done to alleviate the crisis, even if they would take some time to have an impact. While the NHS is a complex system many of the problems described above are plain to anyone paying attention, and have been well documented. Moreover, staff commitment is, despite the workload and the strikes, stronger, I think, than I gave it credit for.
But, and it’s a big but, I remain extremely depressed at the refusal of the government to engage properly with these issues. There have been some small improvements, such as reducing the number of targets and re-focusing attention on activity; investment in some diagnostic centres; and growing use of virtual wards (where patients are treated at home), which might help with bed capacity, though there is not yet any evidence of their effectiveness.
Overall though we are drifting further into crisis due to a stubborn refusal to accept the obvious. Doctors need to be paid more. There needs to be significantly greater capital investment – in beds, equipment and IT. We need more managers, with greater autonomy. Yes this all costs money but at the moment we are wasting enormous sums on a low productivity system.
Labour have been little better, desperate to avoid committing to more resources given their fear of being seen as big spenders. It is deeply frustrating hearing people talking about reform versus more funding as if they were opposites. Yes, the system needs reform but that can only be achieved with investment. In the long run it will save money (though let’s not kid ourselves that the NHS is ever going to get cheaper given demographic change) but not over the next few years.
We wrote this report to satisfy our own curiosity but also in the hope it might help create a better conversation about the NHS during the election campaign. We don’t need a completely different model. This one can work. It did very recently. But we desperately need honesty about what it will take. I would say that what’s coming this winter should focus minds, even if nothing else does, but the last one doesn’t seem to have done so, and that was horrific enough.
Comment is Freed is a reader-supported publication. You can sign up for a free or paid subscription here. A paid subscription is £3.50 a month or £35 a year and gets you at least four extra posts a month (usually more). | Health Policy |
Doctors couldn't operate on my tumour, but this robot did — and it may have saved my life
Glenn Deir has special thanks for the robot who operated on his tonsil cancer
This is a First Person column by Glenn Deir, who lives in St. John's. For more information about CBC's First Person stories, see the FAQ.
Long before I had cancer, and long before I lived in Japan, the rock band Styx released a synthesizer-drenched song with the hook "Domo arigato, Mr. Roboto."
Forty years later I, too, found myself thanking a robot. Its name is da Vinci.
Da Vinci resembles a giant spider with four arms, and my journey to lying beneath those arms began with a niggling problem: I was having discomfort swallowing. Even sipping water sometimes stung.
A flexible scope up my nose and down my throat revealed an apparent ulcer on my tonsil, the right tonsil, my one remaining tonsil. But given my history, my doctor couldn't ignore it.
Ah, my history.
Sixteen years ago, I contracted cancer in the left tonsil thanks to the human papillomavirus. That's the same virus that causes cervical cancer. Most folks shed the HPV virus with no harm done, but I had crappy luck. The subsequent radiation had me retching into a toilet for weeks. I turned into an advocate for the HPV vaccine.
"Sex gave me cancer," I used to say. "You don't want your little boy to grow up and go through what I went through."
What I wanted to ask Dr. Boyd Lee was, "So, what's involved with this biopsy?" A sensible, open-ended question which made no assumptions and should have laid the groundwork for serious discussion. Instead, what came out of my mouth was, "So, what's involved with this autopsy?" We both burst out laughing. The "autopsy" meant taking a snip of the tonsil for the pathology lab.
In the meantime, we both had travel plans. I was off to Brooklyn for my 11th Bruce Springsteen concert. Dr. Lee was bound for France. Three weeks later, vacation stories took priority over the pathology report. He had sought writing inspiration in cafés. I had yelled "Bru-u-u-u-ce" from the nosebleeds in Barclays Center.
My wife and I weren't done travelling. We were a week away from a European vacation. "Are you going to f@#% up my holiday?" I asked. He nodded yes, said he was sorry and told me I had a new cancer in familiar territory.
"You owe me a beer," I told him.
"I owe you more than that," he replied.
New cancer, old nemesis
The cancer diagnosis wasn't the worst part. The worst part was knowing I was going to make my wife cry, again. Sixteen years ago, Deb's eyes were often red and wet. I remembered her fear that I might die on the operating room table. Her helplessness as the doctors made me sicker and sicker before I could heal. All that despair came rushing back. What kind of husband makes his wife sob?
The apartment in southern Spain — gone. The walking holiday in England's Yorkshire Dales — gone. All cancelled and traded for a 20-minute stroll to the cancer centre. The patient room might have had a coat of paint since I was last there. I told the medical team, "I love what you've done with the place."
My new cancer was caused by my old nemesis — HPV. We discussed whether removing the right tonsil 16 years ago would have prevented the cancer today. Not necessarily. Cancer can set up in the tonsil area even after a tonsillectomy. What if I had taken the HPV vaccine after my first cancer? Too late. It was already in my DNA.
The next step was a PET scan. The cancer lit up the tonsil like a Christmas tree bulb.
The peanut-shape extended to the back of my tongue. Apparently, the back of the tongue is where we taste bitter flavours. Deb held out hope I might lose some of my bitterness. Not a chance.
Given removing the cancer involved delicate cutting of the tonsil, tongue and throat, Dr. Lee offered to refer me to a surgeon in Halifax who used a robot named da Vinci. There is no da Vinci in Newfoundland and Labrador. It's an expensive piece of equipment. Halifax's cost just over $8 million.
Da Vinci's "fingers" can go where the human hand cannot. The surgery is less invasive, the complications fewer, the recovery quicker. But da Vinci is not R2-D2. It does not act autonomously. It does what its master directs, and in my case its master was Dr. Martin Corsten. He sits behind a console controlling da Vinci's arms while peering through high-definition cameras.
The reporter in me couldn't be held back. I asked Dr. Corsten if someone could take photos.
Not a problem. He'd probably get a medical student to do it. I wasn't even the first patient to ask. Happens all the time. So much for my scoop. Deb snorted, "And you thought you were so special."
July 13. 7.30 a.m. I'm first up on the table. A nurse shows me one of da Vinci's arms. The robot is so popular Dr. Corsten only has access every second Thursday. It's also used for urologic and gynecological procedures. "I hope somebody gave that thing a good scrubdown," I said.
The operation took 2½ hours. It was more complicated than Dr. Corsten anticipated. The previous radiation had made the tonsil stiff; it didn't pull away easily. The tumour on my tongue was the size of a large cherry. He also had to rotate a muscle to close a gap in my throat. I woke up with a feeding tube up my nose and an incision that ran the full length of my neck. I was a cross between the Elephant Man and Frankenstein.
The feeding tube is gone now, but I was over five weeks on a strictly liquid diet. I'm still retraining my throat to swallow and my tongue to speak. The latter challenge was particularly evident while I was watching an episode of Star Trek Discovery. Klingon warlords were pontificating about blood oaths and honour, all in the guttural sounds of Klingon, of course. Deb came into the room, listened for a few moments and declared, "They don't speak any better than you."
After all this, why am I grateful to da Vinci?
When I asked Dr. Corsten what the surgery would have looked like without da Vinci he replied, "In the good old days, we would have cut your jaw in two." That's how they got their access. The image of my jaw being split like a turkey wishbone was deeply unsettling. Radiation treatment has made even a simple tooth extraction impossible. The jaw won't heal properly. Without da Vinci, I had no surgical option.
I have thanked all my doctors profusely. But I reserve a special thank you for da Vinci.
Domo arigato, Mr. Roboto.
Get the news you need without restrictions. Download our free CBC News app. | Medical Innovations |
Image caption, Abigail Wooding was still shielding after restrictions were lifted because her body didn't produce Covid antibodiesA woman who shielded from Covid for two-and-a-half years has spent more than £2,000 getting a drug to improve her immunity.Abigail Wooding took Evusheld because she has a weak immune system and is less protected by Covid vaccines.There have been calls for the Covid prevention drug to be made available for free on the NHS.The Welsh government said it was awaiting guidance from the medicines regulator.Evusheld is an antibody treatment taken twice a year to protect people like Abigail who have a weaker immune system.The 50-year-old from Narberth, Pembrokeshire, has common variable immunodeficiency which puts her at a higher risk of getting seriously ill from Covid. The treatment is currently only available privately after the UK government said it would not supply Evusheld due to a lack of evidence over how well it works against the Omicron variant.Abigail had six Covid vaccines but her body failed to produce the antibodies needed to fight the virus. So she and her family remained cautious, even after restrictions ended."You're seeing people go out about their business and wanting to do the same and wanting to see your friends and family," she said. Image source, Getty ImagesImage caption, The antibody treatment boosts protection against Covid for those whose immune systems do not respond well to vaccines"If you are still the one shielding or wearing a mask, maybe [people may think] you're a bit hysterical, which is quite hard."Ms Wooding's teenage daughter started home-schooling because she was was anxious about bringing the virus into their home."It wasn't fair to her more than anything else. It's just too difficult, it's too restrictive. So, I didn't really feel I had much of an option," said Ms Wooding, who said it prompted her to pay for Evusheld in November.Image caption, Abigail felt it was not fair to her family to continue shielding so she bought a dose of Evusheld on her credit cardAs well as the cost of the dose she had to pay for a private consultation, for the drug to be administered, and for her own travel to London, costing her around £2,000 in total.She said: "I didn't have the money, I had to put it on credit card. And I will have to with the next dose again."'Pay for normality'Testing after the Evusheld jab showed she had Covid antibodies for the first time, and she said the impact on her and her children's lives has been huge."Going in and out of friends' houses, having friends over for lunch, going to restaurants, cafes, the pub," she said. "It's normality. But I shouldn't have to pay for normality" she said. Image source, Family photoImage caption, Abigail says not having to shield is "normality" something she thinks she should not have to pay forEvusheld was approved for use in March, but was reviewed after the Omicron variant emerged.Data published in July last year showed people who had taken it were half as likely to get Covid-19 as those who did not take the drug.Its manufacturer AstraZeneca said there was "ample real-world data" that it worked. It is currently available in 32 countries, including the United States, France, and Canada.Richard Stanton, professor of virology at Cardiff University, said: "Having these kinds of drugs available is really important to provide immunocompromised people with some confidence that, if they catch the virus, there's a way of treating it and a way of preventing them ending up in hospital."'Completely unacceptable'The UK government announced in August that it would wait until Evusheld had been appraised by the National Institute of Clinical Excellence (NICE) before deciding if it will be made available on the NHS.NICE began evaluating whether Evusheld is clinically and cost effective in July, with the full appraisal expected to take around a year.People who take immunosuppressants, including leukaemia, kidney, and pulmonary fibrosis patients, could also benefit from Evusheld.Steve Jones, chair of Action for Pulmonary Fibrosis, said: "We are in a situation now where even if it NICE are positive, it is unlikely that Evusheld will become available until after Easter. One full year after America and other developed countries. This is completely unacceptable to patients."Image source, Getty ImagesImage caption, The Welsh government said there are no plans to offer Evusheld on the NHSA Welsh Government spokesperson said: "There are no plans to procure Evusheld at this time. There has been no significant new evidence to suggest it is effective against omicron variants and recent research suggests its effectiveness is compromised against newer variants this winter."NICE is currently considering the evidence for Evusheld and we will review the position once the guidance is published." | Drug Discoveries |
Bioengineers send cardiac muscle samples into space to study heart cell biology in microgravity
Mount Sinai's Cardiovascular Research Institute is sending bioengineered human heart muscle cells and micro-tissues into space for the first time on NASA's 29th SpaceX commercial resupply services mission, which launched Thursday, November 9. The "SpaceX CRS-29" mission is sending scientific research to the International Space Station (ISS), where the samples will stay for approximately 30 days before returning to Earth.
Through this experiment, Icahn School of Medicine at Mount Sinai researchers aim to gain a better understanding of how cardiac muscle cells, or cardiomyocytes, adapt to extreme biological stresses and how microgravity and other features of space travel impact cardiomyocyte function. The findings will help scientists find better ways to study heart cell biology in future space experiments.
Understanding the capabilities and limitations of such heart cells to survive is not only important for the health of astronauts but also a first step toward future efforts in space-based tissue engineering, organoid fabrication, and bioprinting, which are all important players in the emerging economy of biomanufacturing in the microgravity environment known as low Earth orbit.
Mount Sinai is partnering with Space Tango to run this experiment. Space Tango provides access to microgravity for research and development purposes on the ISS. Space Tango will manage Mount Sinai's tissues, which will be sealed in individual small-scale experimental containers called cryovials and placed in a larger containment unit known as a CubeLab.
These one-milliliter vials also contain cell culture media and additives to help keep the cardiac muscle cells alive for an extended period, with some beating and some chemically arrested to reduce their metabolism and see if their survival is impacted. Once the cargo capsule carrying the research arrives at the ISS, astronauts will place the CubeLab in a dedicated Space Tango facility. After approximately 30 days, astronauts will return the samples to Earth, and Mount Sinai researchers will begin their analyzes.
Astronauts commonly experience signs of heart failure during space missions due to extreme conditions that seem to accelerate the aging process. Their symptoms mimic what happens to people on Earth as they age or are bedridden but at an accelerated pace and a younger age. Results from this experiment could help researchers identify new ways to protect the heart health of astronauts while in space and to develop new therapies for cardiovascular disease among aging populations on Earth.
"This project will help us understand the impact of microgravity and space flight on engineered human heart muscle cells and micro-tissues and will test for the first time how these highly active beating heart muscle cells adapt to a month of exposure to such extreme conditions. One of the exciting aspects of the experiment is that the samples will be shipped to Mount Sinai alive after they return to Earth, so we can test how the tissues perform when they come back," explains Kevin Costa, Ph.D., the project leader and an Associate Professor of Medicine (Cardiology) at Icahn Mount Sinai.
"As we gain a better understanding of how these engineered cardiac cells and tissues function, we can find new ways to help protect astronauts so they can stay in space longer to complete more in-depth exploratory missions. This will also provide clues about how to better protect the hearts of people on Earth from the detrimental effects of aging and inactivity."
Mount Sinai generated these human heart muscle cell samples from induced pluripotent stem cells from a healthy adult donor. The cells are cultured in three distinct configurations: 2D monolayers, 3D spheroids, and 3D elongated cardiac tissue formats. This will test whether the 3D culture conditions, which are more physiologic than 2D cultures, offer a biological advantage for the heart cells.
"The goal of the experiment is to assess the ability for our engineered cardiac cells and micro-tissues to survive in a sealed environment in microgravity for 30 days, and to compare the survival characteristics to equivalent samples cultured in our laboratory at Mount Sinai's Cardiovascular Research Institute. We are testing to see if microgravity will alter the cardiomyocyte's ability to adapt to this enclosed environment and to see if there are differences in the biology of the cells that are returned from the ISS," adds Dr. Costa.
"We hope to learn more about the effects of microgravity on human heart cell and tissue biology, and to explore the possibility of performing such studies in a sealed environment that does not require the usual fluidic exchange systems that significantly add to the complexity of doing cell biology in space."
"As the cost of space flight continues to drop, and more and more people begin to live and work in space, it will be important to understand how that environment impacts their bodies. Miniaturized bioengineered tissues are great tools for learning about this while minimizing launch costs. We're excited to be able to apply our tools towards the new field of space medicine and to use microgravity as a model of human aging," says researcher David Sachs, Ph.D., Assistant Professor of Genetics and Genomic Sciences at Icahn Mount Sinai.
Provided by The Mount Sinai Hospital | Medical Innovations |
Knocking on doors to check on people's health and catch problems before they escalate is common practice across Brazil. But could that approach work in the UK?
Comfort and Nahima are on their regular beat around Churchill Gardens, a council estate in the Pimlico neighbourhood of London.
Dressed in blue fleeces with logos, they steadily climb the concrete staircases of each block on the estate.
Comfort, a retired nurse, is off to see 88-year-old Stanley Smithson. He says "loneliness is a very frightening aspect of old age" which he had not anticipated until one of his daughters moved to New Zealand. He jokes Comfort's visits are exactly that - a comfort.
"She's keeping an eye on me. I notice she's discreetly taking notes because she's making her own observations," he said.
"And then - before I know it - I'm being asked to go into the surgery for a blood test or something."
Comfort and Nahima are two out of four door-knockers on this small patch, visiting residents as part of a proactive community healthcare pilot.
They can help with anything from housing issues which impact health, such as overcrowding, or pick up the early signs of diabetes by chatting informally to residents about their lifestyle.
It is an approach to healthcare which has been successful in the poorer parts of Brazil.
Comfort can give practical assistance too - she once helped Stanley get handrails fixed in his bathroom after he had a hip operation.
She points out the job is supposed to have a broad remit.
"We're not just talking about health. We go beyond health. We can liaise with housing and we'll talk about anything and everything," she said.
Above all, she has time to listen which she says GPs do not always have given the strict time limit on appointments.
Nahima is also going house to house and is not deterred by sometimes having the odd door slammed in her face.
She says it is a job that requires patience but she has already seen a concrete way her role can make a difference to community health after she solved the puzzle of why the estate had low take-up of cervical screening tests.
"We had a number of women who, because they come from different ethnic populations, thought that a smear test would cost them money," she said.
"When we started there were quite low numbers coming for smear tests but since then they have shot up."
These community health workers are partly funded by the local authority and partly by the NHS so they can co-ordinate between the local GP surgery and other social services.
The National Institute for Health Research helped crunch the data from the pilot. Households which had been visited regularly were 47% more likely to have received immunisations and 82% more likely to have taken up cancer screening, compared to other areas.
The idea to import this model to the UK came from Dr Matthew Harris, a public health expert at Imperial College London who worked as a GP in Brazil for four years. There, community health workers have been credited with achieving a drop of 34% in cardiovascular deaths.
"In Brazil they have scaled this role to such degree that they have 270,000 community health workers across the whole country, each of which looks after 150 households, visiting them at least once a month," Dr Harris said.
"They've seen extraordinary outcomes in terms of population health in the last two or three decades. We think we've got a lot to learn from that."
At the local surgery in Pimlico, Dr Connie Junghans-Minton is convinced the pilot is having an effect as there are now fewer requests for appointments which do not really need the doctor, such as requests for housing letters.
She says she likes the fact that the community healthcare workers are her eyes and ears on the estate.
"They have discovered real medical problems in the community which wouldn't have come to our attention otherwise," she said.
"In the olden days it used to be the village GP who knew everyone, but we don't have that anymore and we can't go back to that. This initiative feels to me like it could be a natural way forward."
Already, other areas of the country are copying the project - similar schemes have already been implemented in Calderdale, West Yorkshire, and Warrington, Cheshire, by local primary care networks.
Parts of Norfolk and Cornwall are also interested in following suit.
It would cost £300m to roll it out in the poorest areas of England, according to Imperial College London, but advocates point out it could save lots of money down the line. | Global Health |
Noise levels in the emergency department (ED) of a major metropolitan public hospital consistently exceeded recommendations from the World Health Organisation, with high noise levels found throughout the area.
These discoveries arise from a study into hospital noise conducted by the Australian Institute of Health Innovation (AIHI) at Macquarie University, which measured noise levels in six locations inside the ED over a 24-hour period.
The average person is likely to find a noise level of 70 decibels unpleasant, and hearing protection is required for prolonged exposure over 85 decibels.
As might be expected, the ambulance bay, with its accompanying sirens and engine noise, recorded the highest peak level of 102.81 decibels. This is equivalent to the noise level on a construction site, or that produced by a jackhammer or chainsaw.
In the ED waiting area, noise peaked at just 3 decibels lower than the ambulance bay, reaching 99.6 decibels. Average noise levels in all six areas were also consistently high, averaging 60.01 decibels and 59.4 decibels in the two treatment rooms and 59.96 decibels in the waiting room.
Noise pollution in hospitals is more than an issue of comfort. This is about healthcare safety.
Corey Adams, AIHI Clinical Research Officer and Registered Nurse, is lead author on the paper, which was published in the latest edition of Australasian Emergency Care.
“ED noise in Australian hospitals was measured in a study more than 10 years ago, and our findings show it has not improved since then,” he says.
“The previous study identified that the acute and resuscitation areas were the loudest, which you might expect with urgent activity surrounding the most critically ill patients. However, now we are seeing worsening noise levels, particularly in the ED waiting room areas.”
Why is noise a problem?
Previous research has linked noise to detrimental effects on both patient outcomes and staff wellbeing, contributing to both physiological and psychological issues.
For patients, exposure to high noise levels can result in raised heart rate and blood pressure, an increase in stress and anxiety, and a worsening of their perception of pain, which is particularly concerning for critically unwell patients.
Excessive noise also has the potential to have a negative effect on the patient’s overall experience of hospitalisation and their perception of care quality.
Mr Adams highlights the impact of noise on ED staff, noting that long working hours coupled with high cognitive load can make hospital noise a catalyst for workplace stress and burnout.
“Noise can also cause difficulty in concentrating, a reduced ability to make quick decisions, and impaired communication, all of which can have serious implications for patient care,” Mr Adams says.
“Noise pollution in hospitals is more than an issue of comfort. This is about healthcare safety.
“And while we carried out this study in one public hospital, this is by no means an isolated problem.”
Human noise the biggest contributor
While equipment and machinery certainly contribute to the noise in waiting and treatment rooms, Mr Adams says previous research suggests that the biggest source of noise is human-related.
“If you think about the ED environment, multiple conversations are taking place, people are in pain, patients and their loved ones are stressed and upset, and people are making phone calls and talking about their health issues with clinicians,” he says.
“In addition to this, people naturally respond to noisy environments by raising the volume of their own voices as they try to make themselves heard. This creates a negative and perpetuating cycle which further increases noise levels in the hospital.”
Small reductions, big wins
As awareness of the adverse effects of hospital noise grows, Mr Adams says that small reductions in noise can have substantial positive results.
Sound levels increase exponentially, making seemingly minor decreases significant. A 10-decibel drop can result in a 50 per cent reduction in the amount of perceived noise.
As part of its ongoing research into hospital noise, the team has also carried out noise testing in wards and looked at ways to improve patient sleep quality in hospitals.
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“We need to remember that hospitals are not just places to receive treatment,” Mr Adams says.
“They are also therapeutic spaces for people to recover. Patients need adequate rest and sleep during their hospital stay because it is essential for their health and safety.”
Mr Adams believes there are immediate steps that hospitals can take to reduce noise disruptions, such as addressing slamming doors and providing earplugs to patients.
“We all know instinctively that noise is a problem in hospitals,” he says.
“There’s almost an acceptance that hospitals are noisy and there’s nothing we can do about it, but that is not true.
“Hospitals should be places that increase our health and wellbeing, not worsen it.”
Corey Adams is a Clinical Research Officer and doctoral candidate at the Australian Institute of Health Innovation at Macquarie University. | Stress and Wellness |
"Why didn't anyone tell me about this virus?" is a frequent response I hear from parents upon learning their newborn is infected with cytomegalovirus, or CMV. Although more than half of the U.S. population will be infected with CMV by the age of 40 and the disease is common worldwide, few people have ever heard of it.
CMV belongs to the same virus family as cold sores and chickenpox and, like those viruses, lives in the body for life. Most children and adults experience very mild or even no symptoms with their initial infection. A healthy immune system is typically able to keep CMV under control so people don't become sick or even know the virus is living in their body.
So if most people are unlikely to get sick from CMV at any age, then why is the virus so important to understand? As an infectious disease and immunology specialist, I have focused on this question for most of my two-decade career. One major reason is that CMV – unlike the other viruses in its family – can pass from mother to fetus during pregnancy.
Congenital CMV, or cCMV, is the most common infection before birth and the leading infectious cause of birth defects. About 1 in every 200 infants – typically 20,000 to 30,000 infants in the U.S. – are born with cCMV per year, and nearly 20% of them have permanent neurodevelopmental disabilities such as hearing loss or cerebral palsy. Every year, more children are affected by cCMV than several familiar childhood conditions like Down syndrome and fetal alcohol syndrome. Compared to later stages of pregnancy, CMV infection in the first trimester carries the highest risk of stillbirth or severe effects when the immune system and organs like the brain are developing.
Rates of cCMV differ significantly by race, ethnicity and other demographic factors, with Black and multiracial infants twice as likely to have cCMV compared to other groups. Black and Native American infants also have a higher risk of death from cCMV compared to White infants.
Looking for CMV during pregnancy
Screening for rubella, HIV and syphilis is routine for early prenatal care in the U.S. Counseling to avoid kitty litter to prevent toxoplasmosis is also common. If CMV can infect a fetus and cause birth defects, then why aren't pregnant people tested and treated for this virus too?
Prenatal CMV screening is not standard of care due to several limitations of the current testing approach. Some available tests can be difficult for health care providers to interpret. Testing provides information about whether the parent has CMV, but it does not sufficiently predict the risk of fetal transmission or severe symptoms.
Prenatal screening for a healthy person with a normal pregnancy does not usually offer useful information. That's because anyone can have a baby with cCMV regardless of whether they tested positive or negative for it before or earlier in pregnancy. CMV testing may be useful for pregnant people who are experiencing acute illness, such as prolonged fever and fatigue, or who have an abnormal fetal ultrasound.
Even if more accurate tests were available, there are currently no medical interventions approved by the Food and Drug Administration to reduce the risk of fetal CMV infection. Biweekly antibodies against CMV seem to reduce fetal transmission when given around conception or during the first trimester, but CMV is rarely diagnosed that early in pregnancy.
Researchers are currently evaluating the drug valacyclovir as a potential treatment to prevent fetal transmission. Valacyclovir is commonly used to prevent or treat genital herpes during pregnancy. Findings from a recent clinical trial in Israel suggest that valacyclovir may reduce the risk of CMV transmission to the fetus.
In general, valacyclovir does not work as well as other CMV drugs that people cannot take during pregnancy. As a result, a much higher dose is required to reduce the risk of fetal CMV infection, which may cause significant side effects for pregnant people.
Although the use of valacyclovir to prevent cCMV is not standard in the U.S., and research on its effectiveness remains limited, the drug is used for this purpose in some areas of the world.
Screening newborns for CMV
Like pregnant people, babies are screened for many potentially serious conditions. An accurate CMV test for newborns is available, and many studies support the benefit of early CMV diagnosis. So why isn't there universal CMV screening for infants?
While some birth centers provide early CMV testing, most U.S. states do not mandate newborn CMV screening. My team and I surveyed 33 hospitals in Massachusetts from late 2020 to early 2021 and found that less than half are consistently screening infants for cCMV infection. Of those, only a few have a written testing protocol. Only two hospitals performed cCMV screening on all infants admitted to the newborn nursery.
Standardizing public health education and CMV screening guidelines could help reduce the incidence and burden of cCMV disease on children and their families. In July 2013, Utah became the first state to pass legislation mandating a CMV public education program and testing for infants who do not pass the newborn hearing screen. In February 2022, – and remains the only – state to require CMV screening of all newborns, although and Indiana have pending universal screening bills. So far, 17 states have enacted laws requiring cCMV education or targeted screening of newborns who meet certain criteria, and many others are considering similar options.
On the other hand, designing, funding and implementing a new infant screening program is complex and time-consuming, and may potentially divert resources from other equally important health initiatives. Most newborns with cCMV appear physically normal at birth and develop normally over their lifetime, leading some to question the benefits of CMV screening for those children.
However, infants may have abnormalities that are not visible at birth, and there isn't a reliable way to predict whether they will have progressive health problems. Without screening all newborns for CMV, those who appear normal at birth will not be fully evaluated, considered for treatment or monitored for effects that develop later, such as hearing loss.
Spreading CMV awareness, not infection
Decreasing the incidence of cCMV infection is unlikely without increasing awareness. Most people have not heard of CMV or are unwaware of what they can do to reduce their chances of getting CMV during pregnancy.
Many adults are repeatedly exposed to one of the major risk factors for CMV infection: a young child who regularly attends large-group child care. Infections like CMV spread easily among children in settings where group play, meals and diaper changes become daily opportunities for transmission. Children can appear quite healthy but carry CMV in their saliva and urine for weeks or even months after infection. When an unsuspecting pregnant caretaker comes into contact with those body fluids, they can become infected as well.
For people who are pregnant, simple behavior changes such as kissing a child on the head instead of the lips, not sharing food or utensils, and frequent handwashing can significantly reduce the risk of getting CMV.
Educating the public, policymakers and health care providers will improve the diagnosis, prevention and treatment of cCMV, so no parent suffers the thought "If I had only known…"
This article is republished from The Conversation under a Creative Commons license.
for more features. | Disease Research |
Elizabeth Amirault had never heard of a Narx Score. But she said she learned last year the tool had been used to track her medication use.
During an August 2022 visit to a hospital in Fort Wayne, Indiana, Amirault told a nurse practitioner she was in severe pain, she said. She received a puzzling response.
“Your Narx Score is so high, I can’t give you any narcotics,” she recalled the man saying, as she waited for an MRI before a hip replacement.
Tools like Narx Scores are used to help medical providers review controlled substance prescriptions. They influence, and can limit, the prescribing of painkillers, similar to a credit score influencing the terms of a loan. Narx Scores and an algorithm-generated overdose risk rating are produced by health care technology company Bamboo Health (formerly Appriss Health) in its NarxCare platform.
Such systems are designed to fight the nation’s opioid epidemic, which has led to an alarming number of overdose deaths. The platforms draw on data about prescriptions for controlled substances that states collect to identify patterns of potential problems involving patients and physicians. State and federal health agencies, law enforcement officials, and health care providers have enlisted these tools, but the mechanics behind the formulas used are generally not shared with the public.
Artificial intelligence is working its way into more parts of American life. As AI spreads within the health care landscape, it brings familiar concerns of bias and accuracy and whether government regulation can keep up with rapidly advancing technology.
The use of systems to analyze opioid-prescribing data has sparked questions over whether they have undergone enough independent testing outside of the companies that developed them, making it hard to know how they work.
Lacking the ability to see inside these systems leaves only clues to their potential impact. Some patients say they have been cut off from needed care. Some doctors say their ability to practice medicine has been unfairly threatened. Researchers warn that such technology — despite its benefits — can have unforeseen consequences if it improperly flags patients or doctors.
“We need to see what’s going on to make sure we’re not doing more harm than good,” said Jason Gibbons, a health economist at the Colorado School of Public Health at the University of Colorado’s Anschutz Medical Campus. “We’re concerned that it’s not working as intended, and it’s harming patients.”
Amirault, 34, said she has dealt for years with chronic pain from health conditions such as sciatica, degenerative disc disease, and avascular necrosis, which results from restricted blood supply to the bones.
The opioid Percocet offers her some relief. She’d been denied the medication before, but never had been told anything about a Narx Score, she said.
In a chronic pain support group on Facebook, she found others posting about NarxCare, which scores patients based on their supposed risk of prescription drug misuse. She’s convinced her ratings negatively influenced her care.
“Apparently being sick and having a bunch of surgeries and different doctors, all of that goes against me,” Amirault said.
Database-driven tracking has been linked to a decline in opioid prescriptions, but evidence is mixed on its impact on curbing the epidemic. Overdose deaths continue to plague the country, and patients like Amirault have said the monitoring systems leave them feeling stigmatized as well as cut off from pain relief.
The Centers for Disease Control and Prevention estimated that in 2021 about 52 million American adults suffered from chronic pain, and about 17 million people lived with pain so severe it limited their daily activities. To manage the pain, many use prescription opioids, which are tracked in nearly every state through electronic databases known as prescription drug monitoring programs (PDMPs).
The last state to adopt a program, Missouri, is still getting it up and running.
More than 40 states and territories use the technology from Bamboo Health to run PDMPs. That data can be fed into NarxCare, a separate suite of tools to help medical professionals make decisions. Hundreds of health care facilities and five of the top six major pharmacy retailers also use NarxCare, the company said.
The platform generates three Narx Scores based on a patient’s prescription activity involving narcotics, sedatives, and stimulants. A peer-reviewed study showed the “Narx Score metric could serve as a useful initial universal prescription opioid-risk screener.”
NarxCare’s algorithm-generated “Overdose Risk Score” draws on a patient’s medication information from PDMPs — such as the number of doctors writing prescriptions, the number of pharmacies used, and drug dosage — to help medical providers assess a patient’s risk of opioid overdose.
Bamboo Health did not share the specific formula behind the algorithm or address questions about the accuracy of its Overdose Risk Score but said it continues to review and validate the algorithm behind it, based on current overdose trends.
Guidance from the CDC advised clinicians to consult PDMP data before prescribing pain medications. But the agency warned that “special attention should be paid to ensure that PDMP information is not used in a way that is harmful to patients.”
This prescription-drug data has led patients to be dismissed from clinician practices, the CDC said, which could leave patients at risk of being untreated or undertreated for pain. The agency further warned that risk scores may be generated by “proprietary algorithms that are not publicly available” and could lead to biased results.
Bamboo Health said that NarxCare can show providers all of a patient’s scores on one screen, but that these tools should never replace decisions made by physicians.
Some patients say the tools have had an outsize impact on their treatment.
Bev Schechtman, 47, who lives in North Carolina, said she has occasionally used opioids to manage pain flare-ups from Crohn’s disease. As vice president of the Doctor Patient Forum, a chronic pain patient advocacy group, she said she has heard from others reporting medication access problems, many of which she worries are caused by red flags from databases.
“There’s a lot of patients cut off without medication,” according to Schechtman, who said some have turned to illicit sources when they can’t get their prescriptions. “Some patients say to us, ‘It’s either suicide or the streets.’”
The stakes are high for pain patients. Research shows rapid dose changes can increase the risk of withdrawal, depression, anxiety, and even suicide.
Some doctors who treat chronic pain patients say they, too, have been flagged by data systems and then lost their license to practice and were prosecuted.
Lesly Pompy, a pain medicine and addiction specialist in Monroe, Michigan, believes such systems were involved in a legal case against him.
His medical office was raided by a mix of local and federal law enforcement agencies in 2016 because of his patterns in prescribing pain medicine. A year after the raid, Pompy’s medical license was suspended. In 2018, he was indicted on charges of illegally distributing opioid pain medication and health care fraud.
“I knew I was taking care of patients in good faith,” he said. A federal jury in January acquitted him of all charges. He said he’s working to have his license restored.
One firm, Qlarant, a Maryland-based technology company, said it has developed algorithms “to identify questionable behavior patterns and interactions for controlled substances, and for opioids in particular,” involving medical providers.
The company, in an online brochure, said its “extensive government work” includes partnerships with state and federal enforcement entities such as the Department of Health and Human Services’ Office of Inspector General, the FBI, and the Drug Enforcement Administration.
In a promotional video, the company said its algorithms can “analyze a wide variety of data sources,” including court records, insurance claims, drug monitoring data, property records, and incarceration data to flag providers.
William Mapp, the company’s chief technology officer, stressed the final decision about what to do with that information is left up to people — not the algorithms.
Mapp said that “Qlarant’s algorithms are considered proprietary and our intellectual property” and that they have not been independently peer-reviewed.
“We do know that there’s going to be some percentage of error, and we try to let our customers know,” Mapp said. “It sucks when we get it wrong. But we’re constantly trying to get to that point where there are fewer things that are wrong.”
Prosecutions against doctors through the use of prescribing data have attracted the attention of the American Medical Association.
“These unknown and unreviewed algorithms have resulted in physicians having their prescribing privileges immediately suspended without due process or review by a state licensing board — often harming patients in pain because of delays and denials of care,” said Bobby Mukkamala, chair of the AMA’s Substance Use and Pain Care Task Force.
Even critics of drug-tracking systems and algorithms say there is a place for data and artificial intelligence systems in reducing the harms of the opioid crisis.
“It’s just a matter of making sure that the technology is working as intended,” said health economist Gibbons. | Epidemics & Outbreaks |
The birth of a baby can be a joyous time. A person is welcomed into the world with the promise of making a difference in the lives of others. But something unsettling is happening in America and most of the industrialized world. Babies are not being born as often as in the past. The fertility gap has important implications from climate change and public health to immigration and labor. Without enough people, who will farm, feed, work, care for and support a resource-constrained planet? Who will pay taxes? Who will care for the sick and the elderly? Who will make goods and who will buy them? Think about it: U.S. population growth has been in sharp decline for many years, made more dramatic by the COVID-19 pandemic. Last year was the first time since 2014 that America’s population crept up by 1 percent. Urbanization, new labor shifts, income inequality and concerns about climate change have made young Americans skeptical about bringing children into the world. With the pandemic came job loss, working from home, disease and death, and the prospect of an uncertain future. That turned out not to be a recipe for family expansion, although new federal data suggest couples may be getting used to the new normal and considering babies again. Still, the trend lines have been stark: The Brookings Institution estimates that 300,000 babies were not born in America because of pandemic-driven financial insecurity. According to Econofact, based at Tufts University, between 1980 and 2007 the U.S. birthrate hovered between 65 and 70 births per 1,000. As of 2020, the U.S. birthrate was 55.8 per 1,000 women — a decrease of almost 20 percent. Also of note is that teen fertility has declined by as much as 75 percent in recent years. America is not alone in its population sag. Close to half the world’s population currently lives in countries with low fertility. By some estimates, 91 countries have demonstrated fertility levels below 2.1, considered the fertility rate needed to sustain our society. Countries such as Spain, Portugal and Thailand could see their populations halved by 2011, according to the scientific journal “The Lancet.” Russia is a big country, but its population is declining, and the remaining population will face stiff sanctions and economic penalties from the war in Ukraine. Europe has also had declining populations, although the war has scrambled statistics in many countries with millions of refugees on the move. (Poland suddenly has over 2 million new people, including babies.) But the refugee crisis was unplanned and is straining resources, including child care, maternity wards and school systems. Asia is seeing enormous population shifts. Take China. For many years the Chinese government imposed a one-child policy., meaning most families were only allowed to have one child. But as its population declined, China faced the prospect of labor shortages, among other problems. In 2016 it implemented a two-child policy. Last August Chinese authorities announced a three-child policy. Estimates are that China is losing approximately 400,000 people a year by not replenishing its population. Japan has long struggled with low fertility rates, and its population decline is nearing historic records. South Korea is struggling with population decline. And even India, the world’s second most populous country, has seen its population decline. The reasons for population decline are as varied as the countries experiencing it. Certainly, the availability of contraception and abortion have driven down the numbers, along with the education of women about reproductive choices. More women joining the workforce has delayed childbearing in many Western countries. (There is also research suggesting declining global human sperm counts, but the numbers and impact are debatable.) Some countries are going in the opposite direction. According to the Economist, Africa’s population will double by 2050. By then, Nigeria could overtake the United States to become the third most populous country. Similarly, in Southeast Asia, Pakistan, a country of 220 million people, has a population growth rate of 2 percent Latin America has also tended to have positive population growth, but the situation fluctuates with immigration and conditions within the hemisphere. And in the Middle East, Israel, with a population surge in recent years, is thought to be, potentially, among the most crowded places on Earth. So, what is the answer? Does the planet have too many people with too few resources, or are we in danger of losing generations of talent and innovation? The truth is we don’t know. My worry is that populations are unevenly distributed, geographically, with much of the population declines in wealthy countries. That means poor countries are often saddled with more people than they can handle. Some of the possible solutions are worrisome. Coercion, like in the Chinese model, violates freedom and human rights. Using immigration policies to address worker shortages is fraught with unpredictability. Uncontrolled population growth, absent a national or international plan to address poverty and food insecurity, is reckless. Ultimately, we need to strike a delicate balance. We must respect individual choice when it comes to giving birth and, at the same time, create policies that help children grow and prosper, with nutrition, education and a sustainable planet to inhabit. That’s a big job. But it must be done. Tara D. Sonenshine is the Edward R. Murrow Professor of Practice in Public Diplomacy at The Fletcher School of Law and Diplomacy at Tufts University. | Global Health |
The World Health Organization warns dengue fever is spreading to more regions and countries around the world due to the increased movement of people, urbanization, and climate-related issues.
"About half of the world's population is at risk of dengue," Raman Velayudhan, a top official of the WHO's global program on the control of neglected tropical diseases, told journalists at a briefing Friday in Geneva. "Dengue affects about 129 countries. We estimate about 100 to 400 million cases are reported every year. This is basically an estimate."
The disease, which is spread by the Aedes species of mosquito, thrives mainly in tropical and subtropical climates. WHO reports it has grown dramatically worldwide in recent decades, with cases increasing from half a million in 2000 to more than 4.2 million in 2022.
Last year, the Latin American region reported 2.8 million cases and 1,280 deaths. Just seven months into 2023, the region has already matched those figures, with nearly three million cases and an almost equal number of deaths.
Velayudhan said dengue is a global disease, noting that the mosquito which causes dengue has been found in 24 European countries.
He said that in Africa there recently have been reports of more than 2,000 cases and 45 deaths in Sudan, as well as new reports within the past week of dengue being present in Egypt.
He said the presence of dengue in Africa is of special concern, noting that the figure of over 200,000 cases reported annually from the continent is likely an underestimate.
He added that the reporting of dengue cases in Africa must be improved.
"We know it is there," said Velayudhan. "But it has been masked by other diseases. But now that [the battle against] malaria, in particular, has made great strides and has reduced in Africa, we have seen an increasing percent of dengue, and this is something we really encourage the governments [to address]."
He said this is already happening as the WHO is currently tracking cases of the disease reported in Sudan, Ethiopia, Senegal, Kenya, Nigeria and Sao Tome.
The monsoon season has begun in Asia, a situation that health officials find very worrying as the region accounts for about 70 percent dengue cases. The WHO has issued an alert to governments to take preventive measures to control the spread of the disease.
Velayudhan said the monsoon already has hit many of the dengue endemic regions in the Indian sub-continent, where high precipitation, increased temperature and even water scarcity favor mosquitoes and pose a real threat.
"So, we really need to be better prepared and make sure that all our health facilities are alerted and as the water recedes, we need to prevent [mosquito] breeding. And this is the key message," he said.
He said people can protect themselves by eliminating stagnant water and other possible breeding areas around their homes.
Most people with dengue do not have symptoms and get better in one to two weeks. However, those who develop severe cases often require hospital care.
While there is no specific treatment for dengue, WHO says patients can be treated with medicines to lower the temperature and ease body pain.
The World Health Organization says new tools, such as diagnostics, antivirals, and vaccines for preventing and controlling dengue, are under development. Indeed, it notes one vaccine is in the market, and two are in the final phase three clinical trial and review.
Meanwhile, Velayudhan noted that the mosquito that transmits dengue tends to bite during the day. So, his advice to people is "to cover up during the day to lower their risk of being bitten and getting dengue." | Epidemics & Outbreaks |
The World Health Organization has declared the COVID-19 pandemic to be over as a global health emergency.
“However, that does not mean COVID-19 is over as a global health threat,” Tedros Adhanom Ghebreyesus, WHO director-general, said Friday. ‘This virus is here to stay. It is killing, and it is still changing. The risk remains of new variants emerging that cause new surges in cases and deaths.”
The first known outbreak of COVID-19 occurred in November 2019 in Wuhan, China. When the WHO declared COVID a public health emergency of international concern on January 30, 2020, there were fewer than 100 reported cases, and no reported deaths outside China.
In the three years since then, the number of global COVID deaths reported to WHO has risen to nearly 7 million, though the true death toll, according to Tedros, is several times higher, reaching at least 20 million.
“COVID-19 has turned our world upside down,” he said, severely disrupting health systems, causing severe economic and social upheaval, and plunging millions into poverty.
But for more than a year now, he said, “the pandemic has been on a downward trend, with population immunity increasing from vaccination and infection, mortality decreasing, and the pressure on health systems easing.”
He noted these were among the many reasons he decided to take the advice of the International Health Regulations Emergency Committee to lower the level of alarm and declare an end to COVID-19 as a public health emergency of international concern.
Didier Houssin, chair of the IHR committee, said only two or three people on the 18-member committee displayed any hesitation about declaring an end to the pandemic as a global threat.
He acknowledged that many uncertainties remained, “particularly regarding the evolution of the virus,” which he said continued to circulate in every country as the pandemic continued.
Houssin said the committee also expressed concern about the big gaps in surveillance, reporting and health care, “particularly in the most vulnerable countries.”
“However, the situation has markedly improved, with less mortality and an increased immunity against the virus, an immunity which is vaccine-induced or naturally induced, and a better access to diagnosis, vaccines and treatment,” he said.
Houssin emphasized that after more than three years, it was “time to confront the COVID-19 pandemic, which has caused so much suffering, with new tools and new ambitions,” underscoring the need to prepare for future pandemics.
‘The battle is not over’
Mike Ryan, executive director of WHO’s health emergencies program, said this virus would continue to persist and threaten, but at a much lower levels of impact, tragedy, hospitalization and death.
“We have got control over the virus by applying the science, and by applying the hard-won lessons we have learned from this pandemic,” Ryan said.
“We now need to move on to the next phase. The battle is not over. We still have weaknesses, and those weaknesses that we still have in our system will be exposed by this virus or another virus, and it needs to be fixed,” he said.
While the public health emergency might be over, he observed that in most cases, “pandemics truly end when the next pandemic begins,” which means that the world must prepare for what is to come.
His colleague, Maria Van Kerkhove, WHO technical lead on COVID-19, picked up on this theme, warning that the virus was evolving. “While we are not in a crisis mode, we cannot let our guard down. Epidemiologically, this virus will continue to cause waves,” she said.
“What we are hopeful of is that we have the tools in place to ensure that the future waves do not result in more severe disease, do not result in waves of death, and we can do that with the tools we have at hand,” she said. “We just have to make sure that we are tracking the virus, because it will continue to evolve.”
WHO chief Tedros said, “The virus is here to stay and … it is time for countries to transition from emergency mode to managing COVID-19 alongside other infectious diseases.”
He said the world must prepare for the next pandemic that surely will come and “move forward with a shared commitment to meet shared threats with a shared response.” | Epidemics & Outbreaks |
FIRST ON FOX: An independent watchdog agency found that U.S. taxpayer funds flowed to Chinese entities known for conducting coronavirus research, including the Wuhan Institute of Virology and an arm of the People’s Liberation Army, ahead of the COVID-19 global pandemic.
The findings are included in a Government Accountability Office report titled "NIH Could Take Additional Actions to Manage Risks Involving Foreign Subrecipients," first obtained by Fox News Digital.
The GAO, a nonpartisan agency which investigates federal spending, found that U.S. taxpayer dollars from two federal agencies--the National Institutes of Health (NIH) and the U.S. Agency for International Development (USAID)--directed funds to American universities and the non-profit EcoHealth Alliance.
The report found those funds were subsequently redirected to the Wuhan Institute of Virology as well as the Wuhan University and the Academy of Military Medical Sciences (AMMS), which is an arm of the People’s Liberation Army of the Chinese Communist Party.
The report comes after House Intelligence Committee Chairman Mike Turner, R-Ohio, and Rep. Brad Wenstrup, R-Ohio, lead Republicans in demanding that the GAO conduct a "comprehensive accounting of all public funds the United States Government disbursed" to the Chinese entities from January 2014 through December 2021. Turner and Wenstrup made that request to the GAO in April 2022.
"The selected entities are government institutions or laboratories in China that conduct work on infectious diseases, including pandemic viruses, and have had actions taken by federal agencies to address safety or security concerns," the report states. "All three selected Chinese entities received funds."
The report states that between 2014 and 2021, all three Chinese entities received more than $2 million combined from the U.S. government "through seven subawards" the GAO identified.
The National Institutes of Health provided $200,000 directly to Wuhan University for a period of March 2018 through February 2020. Neither the Wuhan Institute of Virology nor the Academy of Military Medical Sciences received money directly from NIH during that time period.
However, all three selected entities received "first-tier subawards."
The Wuhan Institute of Virology (WIV) received more than $1.4 million in U.S. taxpayer funds between June 2014 and May 2020, the report states.
NIH awarded EcoHealth Alliance funds, which then provided $598,611 in funds to the WIV for a period of June 2014 to May 2019. Those funds went towards research to assess the transmission of bat coronaviruses to humans. The research included conducting RNA extractions and DNA sequencing on bat samples, and conducting biological experiments on pathogen spillover form bats to humans.
The U.S. Agency for International Development (USAID) awarded the University of California, Davis funds, which then provided the WIV $815,109 for a research period between October 2014 to September 2019. Those funds went towards pathogen detection research, including conducting DNA barcoding of bat and rodent samples, and testing human and animal samples from study sites in Yunnan and Guangdong provinces. The research also included testing, cloning and sequencing bat samples that tested positive for coronaviruses and influenza viruses.
Next, the Academy of Military Medical Sciences, an arm of the People’s Liberation Army, received $514,129 in taxpayer funds between August 2014 and July 2019.
NIH awarded Duke University funds, which then awarded those funds—$514,129—to AMMS. Those funds went towards research on assessing transmission of swine influenza virus to humans. The research included collecting biological samples and performing molecular detention of influenza in biological samples from Chinese swine workers.
Next, Wuhan University received $240,496 in U.S. taxpayer funds between June 2015 and September 2016.
NIH awarded EcoHealth Alliance funds. EcoHealth Alliance awarded $201,221 to Wuhan University for the period of June 2015 to May 2017. The funds went towards disease surveillance research activities, including collection of biological samples from individuals in China with high levels of exposure to bats for Wuhan Institute of Virology to conduct further screening.
USAID awarded funds to the University of California, Davis, which went on to award Wuhan University $39,275 in September 2016. Those funds went towards collecting biological samples of individuals with exposure to bats, and to later collaborate with the Wuhan Institute of Virology on "viral detection."
"Today, the GAO confirmed that U.S. taxpayer dollars awarded from the National Institutes of Health and USAID were ultimately used for research by entities in China, including the Wuhan Institute of Virology, which was known to be doing coronavirus research," Turner and Wenstrup told Fox News Digital. "This revelation is very concerning due to the increased focus on the ‘lab leak’ theory, which suggests that the virus may have originated from the Wuhan laboratory rather than through natural means."
They added: "We have long argued that the American people deserve the truth about COVID-19’s origin and continue to take concrete actions to declassify intelligence related to the pandemic."
Three Biden administration agencies – the Energy Department, FBI and Office of the Director of National Intelligence – have determined that COVID-19 likely emerged from a lab leak in China. However, this hasn’t been connected directly to any U.S. funding.
NIH, in April, told Fox News Digital it never approved any research that would make a coronavirus more dangerous to humans, an agency spokesperson said.
"The research we supported in China, where coronaviruses are prevalent, sought to understand the behavior of coronaviruses circulating in bats that have the potential to cause widespread disease," an NIH told Fox News Digital in a statement in April. "Importantly, because of NIH-funded research to understand coronaviruses, the U.S. was able to move swiftly to develop vaccines against SARS-CoV-2 and save lives."
The NIH spokesperson continued, "The administration also continues to work with partners around the world to press China to fully share information and to cooperate with international investigations to get to the bottom of the origins of COVID-19, a priority for this administration."
Fox News' Fred Lucas contributed to this report. | Disease Research |
The one where Jennifer Aniston's fitness routine kicked my ass.
And I know this first-hand because I tried a variety of the exercises Jennifer does for Pvolve, an online fitness brand she recently partnered with that offers a wide range of low-impact, high-resistance workouts.
But before I dive into the sweaty details of the superstar's routine, it's important to offer insight into her training sessions.
"I leave every workout feeling energized and strong, but not beat up," Jennifer told CR Fashion Book in an interview published Sept. 27. "Whatever your fitness level, it's a workout where you can truly start where you are."
Now, The Morning Show actress isn't lying when she says there's an exercise for everyone, regardless if you're a beginner or longtime devotee. However, when it comes to her preferred exercises—a section titled Jen's Picks on the Pvolve site—they aren't for the faint of heart.
Most of the exercises listed in Jennifer's section are full body workouts that focus on sculpting and strengthening, which was exciting for me since I've been on a kick (no pun intended) to tone up and build muscle.
There are also a handful of sessions that target specific areas, like the core and upper body. Moreover, and quite possibly a potential downside for some, many of the trainings require equipment, including a mat, gliders, a small exercise ball and resistance bands.
The three sessions I really gravitated towards were the Lower Body and Core Strength (20 mins), the Full Body Sculpt and Burn (20 mins), and the Lower Body and Core Sculpt and Burn (30 mins).
Although I like to think I'm an intermediate fitness level since I exercise regularly, these routines really humbled me.
For one, the Lower Body and Core Strength training made my legs shake throughout, as it focused on building strength in the glutes and inner thighs. By the time the planks rolled around, I was so ready to quit but pushed through.
After all, what would Jennifer do? Probably finish the work out she picked. And while I didn't feel beat up, as the Murder Mystery actress had promised, I certainly felt sore afterward.
Next, I tried the Full Body Sculpt and Burn, a session that targeted the hips, upper body and core strength with weight-training exercises. Foolishly, I thought this would be easy since it required light weights, but it definitely made me break a sweat and got my heart pumping. In fact, the trainer herself huffs and puffs throughout the video, proving it was no easy feat.
But out of all the workouts I tried, my favorite was the Lower Body and Core Sculpt and Burn. I loved that it was a low-impact training, which doesn't make it any less challenging but a lot more doable. Additionally, I enjoyed that this training didn't really require equipment—just gliders—but you can easily do the exercises without them.
In short, Jennifer's workouts will make you work for the results.
Now, let's just say Jen's Picks aren't for you. Maybe they're too intense or maybe you want something less involved, Pvolve also offers a wide range of trainings to choose from.
Plus, they have sections that are specific to certain life milestones. They have a five-week menopause program, as well as a three-week post-natal series. Some workouts are even meant to help your body recover from pain or injuries, such as their physical therapy-inspired classes, which the brand says it co-creates with clinicians.
Like Jennifer noted, there's truly something for everyone.
"I've been motivated to work out in a way I haven't been in years," she shared with CR Fashion Book. "I look forward to the challenging classes and I feel stronger and more comfortable in my body when I'm doing it."
Considering I pushed my body in ways I wouldn't have before, I can attest that Jen's picks are hard but very much worth their weight. | Aerobics & Cardio |
Electrical stimulation of the brain can be used to improve mental processes in Alzheimer's patients, according to a new study. Researchers found that twice-daily current stimulation sessions of around 20 minutes improved the memory and overall cognitive performance of elderly people living with the condition.
The innovative technology, known as transcranial direct current stimulation (tDCS), could also be used as a treatment to improve brain plasticity in Alzheimer's sufferers - enabling ‘rewiring’ through the formation of new neural networks. The study, published in the journal General Psychiatry, sought to discover whether electrical stimulation might improve cognitive function in people living with Alzheimer's - a progressive condition that causes confusion and difficulties in memory.
The tDCS technology is delivered via a device with two electrodes placed over specific areas of a person’s head, which transmits a constant, low-intensity electrical current. It's already beginning to be used across many areas of medicine, including for the treatment of depression.
The researchers, from China, recruited 140 patients from four different hospitals with mild to moderate Alzheimer's and randomly allocated whether they would receive the two daily sessions of the active, constant low intensity 1-2 mA current, or a 'sham' version of the tDCS in a control or placebo group. Each participant received their respective treatment five days a week, over a maximum period of six weeks.
All participants were over the age of 65 and had had the disease for more than six months, with all also having scored below 26 on the Mini-Mental State Exam (MMSE), in which a score of less than 24 is seen as abnormal and indicative of cognitive impairment. Both the tDCS group and the control group were comparable in terms of age, sex, and educational attainment.
The currents were applied to the prefrontal cortex - the region of the brain involved in higher-order activities such as planning, decision-making, working memory, moderating social behaviours and controlling aspects of speech and language. The researchers then used the MMSE and the Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) Test, which focuses on language and memory, to evaluate cognitive performance at the start of the trial, after two weeks, and again after six weeks.
Readings of electrical signalling through the motor pathways of the nervous system - known as motor evoked potential or MEP - were also used to indicate changes in neural plasticity, which refers to the capacity of the nervous system to modify itself in response to experience and injury. A total of 133 patients completed the two-week intervention and 124 completed the six-week intervention, with no participants withdrawing due to discomfort.
The results of the study showed that after two weeks, tDCS significantly improved the cognitive function of those who received the treatment, particularly their word recall, recall of test instructions and word recognition. No such improvements were noticed in the group receiving the 'sham' treatment.
The results also showed that though cortical plasticity is impaired in those with Alzheimer's, this improved in patients after six weeks of tDCS. As well as a decrease in MEP, word recall and word recognition also improved in those in the tDCS group but not among those in the placebo group, suggesting that the improvement in cortical plasticity may reflect the degree of cognitive improvement.
First author Xingxing Liu, from the Zhejiang University in China, said the results were positive to suggest a treatment for those suffering from Alzheimer's. "Taken together, tDCS is a promising method for improving cognitive function with sufficient treatment," Liu said.
"It is supported by electrophysiological evidence (MEP) in patients with Alzheimer's disease, and these results support the potential role of cortical plasticity as a biomarker of treatment effect in patients with Alzheimer's. tDCS can significantly improve the working memory of older patients, and the stimulation changes the resting-state functional connectivity of the frontoparietal brain region.
"The results of this study strongly indicate that tDCS treatment is a significant and promising intervention for improving cognitive function in Alzheimer's. In addition, plasticity plays a vital role in cognitive change."
However, despite the positive results of their study, the researchers did admit to limitations such as the small study size, the lack of MRI or electroencephalography scans to chart changes in brain structure and the absence of cerebrospinal fluid and blood samples to monitor neurotransmitter changes. | Medical Innovations |
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People with diabetes who were prescribed fruits and vegetables, saw their blood sugar decline significantly. And adults with hypertension saw their blood pressure go down.
RyanJLane/Getty Images
People with diabetes who were prescribed fruits and vegetables, saw their blood sugar decline significantly. And adults with hypertension saw their blood pressure go down.
RyanJLane/Getty Images
The idea of food as medicine dates back to the ancient Greek doctor Hippocrates, and a new study adds to the evidence that a diet full of fruits and vegetables can help improve heart health. The research comes amid an epidemic of diet-related disease, which competes with smoking as a leading cause of death.
Researchers evaluated the impact of "produce prescriptions," which provide free fruits and vegetables to people with diet related diseases including diabetes, obesity and hypertension. The study included nearly 4,000 people in 12 states who struggle to afford healthy food. They received vouchers, averaging $63 a month, for up to 10 months, which could be redeemed for produce at retail stores or farmers markets, depending on the location.
Health care providers tracked changes in weight, blood pressure and blood sugar among the participants. "We were excited to see improvements," says study author Kurt Hager, an instructor at UMass Chan Medical School.
"Among adults with hypertension, we saw that systolic blood pressure decreased by 8 mm Hg and diastolic blood pressure decreased by about 5 mm Hg, which could have a meaningful impact on health outcomes," Hager says.
Among people with uncontrolled diabetes, their A1C levels, which is a 2-3 month average of their blood sugar, also declined significantly, by about .6 percent. "The reductions we saw in blood sugar were roughly half of that of commonly prescribed medications, which is really encouraging for just a simple change in diet," Hager says.
"I felt great," says Joann Erickson, 60, who participated in the Sacramento County Health Center's prescription produce pilot initiative in Sacramento, Calif. The program was organized by Wholesome Wave, a non-profit organization, at the forefront of initiatives aimed at making healthy food more affordable and accessible. Approximately 85% of the participants reported that taking part in the program improved their health.
"As a chef and father of two sons living with diabetes, I'm not surprised," says Wholesome Wave's co-founder Michel Nischan. "Our food strategy included increasing Chris and Ethan's consumption of fruits and vegetables significantly," he says, noting that his sons' A-1C went down and their insulin usage reduced as a result. "We knew we needed evidence to argue for policy change," he says.
"Being able to buy healthy food, I felt like a millionaire," Erickson says. She loaded her cart with strawberries, blueberries, cherries and salad greens, items she normally can't afford. "It was a big high for me," she says. After six months on the program her doctor was able to lower her blood pressure medication. Her blood sugar levels dropped, too. "I had more energy," Erickson says.
"Anything that lowers hemoglobin A1C and improves blood pressure control is beneficial," says Dr. Dariush Mozaffarian, a cardiologist and professor at the Friedman School of Nutrition at Tufts University, where the research was conducted. The challenge is to maintain these reductions. "Improvements in blood glucose can significantly reduce the risk of conditions like eye disease, kidney disease, and nerve disease," he says, which happen frequently among people with uncontrolled diabetes.
A year ago, following a White House conference on hunger, nutrition and health, the Biden administration announced a national strategy aimed at improving healthy eating and incorporating nutrition into health care. This created momentum to shore up the evidence as more healthcare providers connect the dots between diet and disease. "I think our study really provides a strong rationale for the next step of investment," says Hager. It's time to expand beyond pilot programs, "to further invest in larger trials with comparison groups," Hager says.
As the evidence continues to build, "it's important that we are simultaneously investing in the infrastructure needed to bring food is medicine prescriptions to scale," says Holly Freishtat, director of the Feeding Change initiative at the Milken Institute. Her team has outlined market solutions that could help support implementation, such as technology-enabled systems that would help patients to participate in food assistance programs, including SNAP (food stamps) and these newer approaches.
"With the increasing burden of chronic diet-related disease in the U.S., we can't afford [to] delay," Freishtat says. "We must find a way to make it easier for individuals to know their benefit eligibility, track their benefit amount status, and understand where and how to utilize those benefits," Freishtat says.
For now, the produce prescription programs offer only short-term assistance. Since Joann Erickson's produce vouchers ended, her monthly SNAP benefits were also cut significantly. Now, once again, she can't afford healthy food. "After I stopped the program, I saw my blood pressure going up," she says. "I would say there's a direct correlation," Erickson says.
For the food is medicine strategy to work, it's clear that the people will need long-term support.
"We need to get to a place where these are persistent benefits," says Mozaffarian. "If you get put on a blood pressure lowering medication, you're not going to go off the medication in six months," he says. The same is true if healthy food is prescribed. He says more research is needed to establish which patients benefit from which food assistance programs, whether it's medically-tailored meals or produce prescriptions, and what's the right amount they need to manage their conditions. But he says the ultimate goal is to get to a place where these are covered benefits for people who need them. | Nutrition Research |
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This could be why 02:42 Now playing - Source: CNN CNN — Jessica Rosario loved watching her 15-year-old, Eliana, play flute with the rest of the marching band during Open Door Christian School football games. But after the homecoming game in 2021, she got an alarming call from the Ohio school’s band director. Rosario’s daughter was on the floor of the band room, clutching her chest. “We ran up to the school, went into the band room, and I found her laying on the floor with her legs elevated on a chair, and I’m looking at her, and she’s not really moving,” Rosario said. The freshman couldn’t speak or stand. When paramedics transported her to the ambulance, she was dead weight, her mom says. Eliana’s condition turned out to be an extreme form of long Covid. She’s one of potentially millions of US children who have symptoms long after their initial infection. Children – even healthy teens and the very young – can have long Covid, several studies have found, and it can follow an infection that’s severe or mild. When Eliana collapsed, EMTs rushed her to University Hospitals Elyria Medical Center. “We had a room full of doctors. They were there ready to go, which I totally believe that God was in control of everything at this point,” Rosario said. Eliana’s blood tests, toxicology screens, chest X-ray and CT scan all looked OK, but she still had this strange paralysis. The hospital transferred her to UH Rainbow Babies & Children’s and hoped that the experts there could solve the mystery. “I was praying all this time for God to do a miracle and guide these doctors and nurses to shine some light on whatever it was that was causing this,” Rosario said. Eliana and the rest of the family had caught the coronavirus over Christmas 2020. Eliana’s case was mild, her mother says, but weeks after she recovered, she developed chest pain, heart palpitations and lightheadedness. Tests didn’t show any problems, and a pediatric cardiologist gave her the all-clear. The temporary paralysis came later. It went away and returned. The medical team eventually determined that Eliana’s chest pain and her elevated heart rate may have been related to inflammation due to Covid-19 – 10 months before the trip to the hospital. Doctors officially diagnosed her with Covid-related postural orthostatic tachycardia syndrome or POTS, a blood circulation disorder that causes an elevated heart rate when standing. Eliana had long Covid, also called post-Covid or long-haul Covid. “I had never heard of long haul until we were in the hospital,” Rosario said. More than a quarter of kids who get Covid-19 may develop long-term symptoms, according to a study from June. A 2021 study suggested that it may be even more; more than half of children between ages 6 and 16 in that study had at least one Covid-19 symptom that lasted more than four months. There’s no specific test or treatment for long Covid for kids or adults. Mount Sinai launches post-Covid care center for long-haulers 03:55 - Source: CNN Symptoms can include fatigue, rash, stomachache, headache, muscle ache, loss of smell and taste, circulation problems, trouble concentrating and pain, according to the American Academy of Pediatrics. The vast majority of children recover – sometimes even faster than adults do, according to UNICEF. But in some cases, kids can have symptoms for months or more. It’s still not clear why some kids develop long Covid and others don’t, but experts do know that children and adolescents don’t have to have been severely ill with Covid-19 to get long-term symptoms. Several institutions, including the National Institutes of Health, have studies underway to learn more. Dr. Amy Edwards, associate medical director of pediatric infection control at UH Rainbow Babies & Children’s, manages the hospital’s long Covid clinic and says she has been booked solid since she started seeing children with the condition in early 2021. “We just started seeing patients, and it slowly spread like wildfire,” Edwards said. “Looking at our first 60 patients that came to our clinic, we found that about 13% of our patients had these functional neurologic deficits.” These are conditions in which it appears the nervous system isn’t working the way it should, but doctors can’t figure out why. “In the case of our kids, it most always presents with loss of limb function, an inability to walk or move an arm, something like that,” Edwards said. “When you’re talking about 60 kids, 13% is a big number, especially when you’re talking about loss of limb function that has to be regained with physical therapy. It’s not a rare 1% complication.” It doesn’t help that not everyone believes these children are sick. The Rosarios and their pediatricians understood, but Edwards says that more than one adult has asked her how she knows that the children aren’t just making up their symptoms for attention or to get out of school. “One of the biggest things that I do with these kids is provide a diagnosis and reassure the families that they’re not crazy, because so many of these kids have been to see doctor after doctor after doctor who tell them they’re faking it or chalk it up to anxiety or whatever,” Edwards said. “I want to help them know they are not alone. I can’t cure them, but we can help.” Lynda Varno is grateful for that help and recognition. Her 12-year-old son, Ayden, had Covid-19 in November 2020. He recovered and seemed fine. Four months later, he used a push mower to mow the lawn of their rural Ohio home and, at bedtime, mentioned to his parents that his back hurt. When he woke up the next day, he couldn’t move. “He was in so much pain, from his head down to his toes,” Varno said. The local ER and, later, his pediatrician chalked it up to growing pains. But the boy who jumped on a trampoline every day, who loved to run and play football, could barely walk or move. “That pain level was still there. Nothing was helping,” Varno said. She spent months taking him to several hospitals, but none could find a way to ease his pain. It got so bad that it triggered nonepileptic seizures – up to 100 a day at one point, his mom said. It wasn’t until the next year, when Varno saw Edwards talk on the news about starting a pediatric long Covid unit, that she thought things could get better. “I just remember sitting there just sobbing because Ayden met every single thing she talked about,” Varno said. “It gave me goosebumps. I just sat there crying and saying, ‘God, thank you so much. This is what we needed.’ “ Varno got an appointment and said “it’s been a blessing ever since.” In addition to complex pediatric long Covid, Ayden had been diagnosed with orthostatic intolerance, an inability to remain upright without symptoms like lightheadedness, and dysautonomia, a dysfunction of the nerves that regulate involuntary body functions like heart rate and blood pressure. Edwards’ clinic uses an integrated approach to long Covid treatment. Ayden’s regimen included physical therapy, acupuncture, deep breathing and cognitive behavioral therapy, as well as diet changes. Children at the clinic are often urged to lower sugar in their diet and add more healthy whole foods. The eating plan limits animal products and emphasizes minimally processed foods, vegetables, fruits, whole grains, beans, seeds and nuts. Although more research is needed in children and adults, some early studies suggest that a plant-based diet may generally benefit adults with long Covid. In January 2022, Ayden started with Sara Pesut, a physical therapist at University Hospitals. She normally works with adults with functional neurological disorders, but Ayden and some of the others at the pediatric long Covid clinic were around the same age as her own children. “It was kind of like, ‘how do I not lean into this problem and try to help if I know something that could possibly help these families?’ ” Pesut said. He came to her first appointment in a wheelchair, she said, but after about three weeks working on balance, body position exercises and other activities, he no longer needed it. “It just kind of evolved from there,” Pesut said. “He’s really done a wonderful job.” Ayden went for PT for 9 months and also had some virtual visits for check-ins, as well as doing home exercises and following his therapy guidelines at home, Pesut said. Ayden went from a point where he couldn’t feed, bathe himself or walk to running and playing sports. “It has been like night and day from where Ayden was this time last year to now. It is a complete 180,” his mother said. Edwards’ clinic isn’t the only one to see kids with these extreme symptoms. At Johns Hopkins Children’s Center, pediatric rehabilitation physician Dr. Amanda Morrow said the main symptom is severe fatigue, but she has also seen patients like Edwards’ who have more complicated conditions. With treatment, she believes, long Covid won’t mean a lifetime of problems for any child. “We’re hopeful that the more we can support these kids earlier on and provide recommendations and things, we’re hopeful that that helps out their recovery or maybe doesn’t trigger them to go down this road where things are really difficult long-term,” said Morrow, who is also an assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. Murrow and Edwards remind parents that the best way to protect kids from long Covid is to keep them from catching the virus in the first place. Vaccinations are important, as well as precautions like wearing a mask when cases are high and washing hands thoroughly. Eliana spent eight days in the hospital and then was treated as an outpatient at Edwards’ pediatric long Covid clinic. “We work with them as if they’ve had a stroke, and they recover very, very well, actually,” Edwards said. When Eliana came into the clinic, physical therapist Art Lukovich said, he had to go back to basics and figure out what would help her best. “You don’t see stuff like this,” he said. He had her go back to the foundations of movement and motor control, and he figured out how much he could push. “Which has definitely given me some sleepless nights and gray hairs, but definitely worth it in the end.” “I had a sense of humility since this is a young lady that basically had her life put on pause because of this,” he added. In eight months of physical therapy, Eliana went from a wheelchair to a walker to a cane, her mom says. “When I saw her run for the first time in the clinic, I definitely had that moment where I was like ‘Oh, my God.’ I think her mother and I both looked at each other and thought, ‘wow!’ We didn’t completely think we could get there,” Lukovich said. Today, Eliana is back to school and back to feeling good. She finished her freshman year with straight As. Her mother is proud of the way she handled long Covid. “Not once did she cry. Not once did she panic. She gave me strength every day,” Rosario said. “She’s come a long way, and with the right people in place, she’s now running and jumping and riding roller coasters.” | Epidemics & Outbreaks |
US researchers say they may have discovered why some people get a headache after just one small glass of red wine, even though they are fine drinking other types of alcohol.
The University of California team say it is due to a compound in red grapes that can mess with how the body metabolises alcohol.
The compound is an antioxidant or flavanol called quercetin.
Cabernets from the sunny Napa Valley contain high levels of it, they say.
High-quality grapes
Red grapes make more quercetin when they are exposed to sunshine.
And that meant more expensive red wines, rather than cheap reds, would be worse for headache-prone people, one of the researchers, Prof Andrew Waterhouse, told BBC News.
"The cheap grape varieties are grown on vines with very large canopies and lots of leaves, so they don't get as much sun," he said. "Whereas the high-quality grapes are from smaller crops with fewer leaves.
"The amount of sunshine is carefully managed to improve the quality of the wine."
Others are sceptical though.
Prof Roger Corder, an expert in experimental therapeutics, at Queen Mary University of London, told BBC News anecdotal evidence suggested cheaper wines were worse for headache, so understanding some of the additives used in making lower-end mass-market red wines might be more informative.
Possible culprit
Several theories have been put forward to explain red-wine headaches, which can strike within 30 minutes of drinking even small amounts.
Some have suggested the cause might be sulphites - preservatives to prolong shelf-life and keep wine fresh.
Generally though, the sulphite content is higher in sweet white wines rather than reds.
And while some people can be allergic to sulphites and should avoid them, there is little evidence they are to blame for headaches.
Another possible culprit is histamine - an ingredient more common in red wine than white or rose.
Histamine can dilate blood vessels in the body, which might trigger headache. But again, absolute proof is lacking.
Toxic compound
Experts do know more than one in three people with East Asian heritage are intolerant of any type of alcohol - beer, wine and spirits - and will experience facial flushing, headaches and nausea when they drink.
This is because of a gene affecting how well an alcohol-metabolising enzyme called ALDH2 or aldehyde dehydrogenase works.
Alcohol is broken down in the body in two steps - it is converted into a toxic compound called acetaldehyde, which ALDH2 then changes into harmless acetate, basically vinegar.
If this cannot happen, harmful acetaldehyde builds up, causing the symptoms.
And the researchers say a similar pathway is involved in red-wine headache.
They showed in the lab quercetin could indirectly block the action of ALDH2, through one of its own metabolites.
'Stay tuned'
Quercetin only becomes problematic when mixed with alcohol, according to the researchers, who crowd-funded for their work and have now published the findings in Scientific Reports journal.
Quercetin is also found in many other fruits and vegetables - and is even available as a health supplement because of its beneficial anti-inflammatory properties - and does not appear to cause headaches on its own.
The researchers still need to prove their theory in people and say a simple experiment could be to give volunteers prone to red-wine headaches a quercetin supplement or a dummy pill, along with a standard drink of vodka.
Co-author Prof Morris Levin, an expert in neurology and director of the Headache Center at the University of California, San Francisco, said: "We are finally on the right track toward explaining this millennia-old mystery. The next step is to test it scientifically on people who develop these headaches, so stay tuned."
They hope to start those studies in a few months.
But Prof Corder, who has studied the possible health benefits of wine, suspects other ingredients are worth exploring as headache triggers:
- Pectinases accelerate the release of anthocyanins, which speeds up winemaking by releasing the colour, without the slow maceration processes of traditional winemaking, but are methylhydrolases and a side product of their activity is methanol production
- Dimethyl dicarbonate is used as a preservative for cheaper wines, particularly those being shipped in large containers for bottling in the UK but also breaks down to create methanol
Drinking a lot, quickly, or drinking to get drunk can have serious consequences for short- and long-term health.
- Regularly drinking more than 14 units a week - about six pints of average-strength beer or 10 small glasses of lower-strength wine, the type of alcohol does not matter - can damage the liver and cause other health issues, including strokes and heart disease
- Alcohol causes seven different types of cancer - the risk rises with every drink
- About one in 10 breast-cancer cases is caused by drinking alcohol - about 4,400 a year in the UK | Disease Research |
FILE – A vial of the Moderna COVID-19 vaccine is displayed on a counter at a pharmacy in Portland, Ore. on Dec. 27, 2021. A government advisory panel met Tuesday, June 14, 2022, to decide whether to recommend a second brand of COVID-19 vaccine for school-age children and teens. The Food and Drug Administration’s outside experts will vote on whether Moderna’s vaccine is safe and effective enough to give kids ages 6 to 17. If the panel endorses the shot and the FDA agrees, it would become the second option for those children, joining Pfizer’s vaccine.(AP Photo/Jenny Kane, File) A Food and Drug Administration (FDA) advisory panel on Tuesday recommended the agency expand the authorization of Moderna’s COVID-19 vaccine to children and teenagers ages 6 to 17. The vaccine is currently approved for adults only. The panel voted 22-0 to recommend authorizing Moderna’s two-dose vaccine for adolescents and teenagers ages 12 to 17. The panel similarly voted 22-0 to recommend authorizing the shot for 6-year-olds to 11-year-olds. Children ages 6 to 11 would receive a smaller 50 microgram shot, while teens ages 12 to 17 would receive the same dose as adults at 100 micrograms. The FDA is likely to follow the panel’s advice in the coming days, but there ultimately won’t likely be much of an impact on vaccination rates, since children and teenagers have had access to Pfizer-BioNTech”s vaccine since last year. After the FDA, the Centers for Disease Control and Prevention will consider the matter as early as Friday. Moderna initially asked the FDA to clear its vaccine for adolescents ages 12 to 17 last June, but concerns over a rare heart condition led officials to delay authorization. On Tuesday, health officials said the risks for myocarditis and pericarditis may be higher in male adolescents, but the overall incidence is relatively rare and not statistically significant enough to draw definitive conclusions. In addition, the vast majority who suffer the side effect fully recover. Several panel members expressed concern that the emergency authorization would only be for a two-dose primary series, even though there’s evidence that a third dose will be needed. Moderna’s clinical trials were conducted before the omicron variant became dominant throughout the country. The data was based on variants that are no longer a threat. The FDA’s Doran Fink said Moderna will present data on a third dose soon. “I think the benefits clearly outweigh the risks, but I say that with the comfort being provided that there will be a third dose,” said panel member Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “If that was not true, I wouldn’t feel the same way. We’re not in the same part of this pandemic anymore. It’s a different time.” Updated at 4:53 p.m. Tags Coronavirus coronavirus pandemic coronavirus vaccine COVID-19 COVID-19 vaccine COVID-19 vaccines FDA Food and Drug Administration Moderna Moderna vaccine | Vaccine Development |
In this photo taken on April 3, 2022, South Korean boy band BTS arrives for the 64th Annual Grammy Awards at the MGM Grand Garden Arena in Las Vegas. BTS announced on June 14, 2022 that they were taking a break from one of the world’s most popular acts to focus on solo pursuits. Photo: ANGELA WEISS / AFP It was meant to be a celebratory occasion, but fans around the world were left heartbroken after K-pop group BTS released a highly anticipated video event marking the ninth anniversary of their debut. Seated at a long table and surrounded by purple balloons, the boy band dropped a bombshell announcement on their future plans.“We’re going into an ‘off’ now,” said BTS member Suga, which was originally translated as “hiatus” in the video’s English subtitles. But just hours after the news broke, Hybe, the entertainment company that manages BTS, scrambled to clear the air, denying that the band is going on a “hiatus.”As of writing, the subtitles have been revised to say that BTS is taking a “temporary break.”“To be clear, they are not on hiatus but will take time to explore some solo projects at this time and remain active in various different formats,” Hybe said in a statement sent to VICE World News. But fans got the gist of their message: BTS is going on a break. The announcement came as a shock to most, with the band giving no definite indication that they were considering the move. “I immediately started bawling,” Trish Sotto, an ardent BTS fan from the Philippines who had flown to Los Angeles last year to catch the group perform live, told VICE World News. “Not in my wildest imagination would I have expected an announcement about a break. In fact, our entire fandom was gearing up for a tour announcement.”As fans wonder what the break means for the future of BTS, many have also expressed overwhelming support for the band’s decision to put their mental health first. Some say that the break is a long time coming for the boy band, as members faced burnout, an identity crisis, and looming enlistment into South Korea’s military.Since debuting in 2013, the group has grown to become one of the world’s biggest music sensations. They have unlocked milestones for K-pop on the world stage—becoming the first K-pop group to be nominated for a Grammy Award, bagging Artist of the Year at last year’s American Music Awards, and having been invited to speak at the United Nations.But between relentless concert tours, album preparation, and dance choreography, it is clear now that burnout had begun to set in. In the video released on Tuesday, the members opened up about their struggles with exhaustion and creative block.“The problem with K-pop and the whole idol system is that they don’t give you time to mature. You have to keep producing music and keep doing something,” said RM, the group’s leader. “It feels so wrong to even say that we’re exhausted.”“[Making music] now compared to seven, eight years ago feels completely different. Back then, I had something to say but just lacked the skills. Now I don’t have anything to say,” added Suga. “Right now, I’m just squeezing it out because we have to satisfy people’s wants and the listeners.”For fans, these revelations came as a surprise. While the group has not shied away from sharing their struggles, they usually avoided speaking about those issues until they’ve been resolved.“In the past, whenever they said they were in a funk, it was always after they had gotten over that hump. But I think this is the first time they’re sharing that they don’t know what to do except to take a step back,” said Sotto, who described Tuesday’s announcement as a “glass shattering moment.”“It’s a lot of bravery to take a step back when you’re at the peak of your career.”Since the announcement, fans have rallied to show their support for BTS amid the changes. Popping off on Twitter are hashtags like #BTSBestFriendsOfMyLife and #ThankYouBTS, as fans flooded the platform with tributes to the band.“I believe they are doing this simply because they do need a break. They worked nonstop for a whole decade,” Betty Silva, a 20-year-old fan from the U.S., told VICE World News. “We all go through changes and we just need to accept it with open arms and embrace it.”According to BTS, their creative struggle stems from an identity crisis, as members figure out the goals of the group. “We’ve come to think about what kind of artists we each want to be remembered as to our fans. I think that’s why we’re going through a rough patch right now. We’re trying to find our identity and that’s an exhausting and long process,” said Jimin.Jung Min-jae, a music critic in South Korea, told VICE World News that he thinks that the group is setting a good example for other pop idols to take care of their well-being while balancing their careers.“Fans may be disappointed, but I’m looking at it positively,” he said. “If BTS spends their rest period well and returns fully, I think it will set a good precedent for other K-pop groups, too.”Upcoming military conscription is also a major reason why a change of plans appears inevitable for the wildly popular boy band. The conscription of 29-year-old Jin, BTS’ oldest member, has been the subject of much debate for years. Under a new law introduced in 2020, Jin, who was originally scheduled to join the military last year, has managed to put off his conscription until the end of this year. Despite his stardom, he remains obligated to serve almost two years in the military—a requirement for all young, healthy men in South Korea.Kim Do-heon, another music critic in South Korea, told VICE World News, that the announcement “shows that the first chapter of BTS [has] ended.” “Each member will try to get back to normal and work on solo projects to show their own musical styles that they couldn’t as a group,” said Kim. “They were honest about this on their own content, which carries considerable weight in the group, even in the K-pop and music industry.”Follow Junhyup Kwon on Twitter.Follow Koh Ewe on Twitter and Instagram.ORIGINAL REPORTING ON EVERYTHING THAT MATTERS IN YOUR INBOX.By signing up, you agree to the Terms of Use and Privacy Policy & to receive electronic communications from Vice Media Group, which may include marketing promotions, advertisements and sponsored content. | Mental Health Treatments |
Less than six months ago, mpox was an exploding health crisis. What had been an obscure disease from Africa was ripping through European and U.S. gay communities. Precious doses of an unproven vaccine were in short supply. International officials declared health emergencies.Today, reports of new cases are down to a trickle in the U.S. Health officials are shutting down emergency mobilizations. The threat seems to have virtually disappeared from the public consciousness.“We’re in a remarkably different place,” said Dr. William Schaffner, a Vanderbilt University infectious diseases expert. “It’s really impressive how that peak has come down to very, very low levels.”So who deserves the credit? It’s an unsettled question, but experts cite a combination of factors.Some commend public health officials. Others say more of the credit should go to members of the gay and bisexual community who took their own steps to reduce disease spread when the threat became clear. Some wonder if characteristics of the virus itself played a role.“It’s a mixed story” in which some things could have gone better but others went well, said Dr. Tom Frieden, a former director of the U.S. Centers for Disease Control and Prevention.Cases soar, then fallMpox, formerly known as monkeypox, is a rare disease caused by infection with a virus that’s in the same family as the one that causes smallpox. It is endemic in parts of Africa, where people have been infected through bites from rodents or small animals, but it was not known to spread easily among people.Mpox cases began emerging in Europe and the U.S. in May, mostly among men who have sex with men. Cases escalated rapidly in dozens of countries in June and July, around the time of gay pride events. The infections were rarely fatal, but many people suffered painful skin lesions for weeks.In late July, the World Health Organization declared an international health crisis. In early August, the U.S. declared a public health emergency.Soon after, the outbreak began diminishing. The daily average of newly reported U.S. cases went from nearly 500 in August to about 100 in October. Now, there are fewer than five new U.S. cases per day. (Europe has seen a similar drop.)Experts said a combination of factors likely turned the tide.VaccinationsHealth officials caught an early break: An existing two-dose vaccine named Jynneos, developed to fight smallpox, was also approved for use against the monkeypox.Initially, only a few thousand doses were available in the U.S., and most countries had none at all. Shipping and regulatory delays left local health departments unable to meet demand for shots.In early August, U.S. health officials decided to stretch the limited supply by giving people just one-fifth the usual dose. The plan called for administering the vaccine with an injection just under the skin, rather than into deeper tissue.Some in the public health community worried that it was a big decision based on a small amount of research — a single 2015 study. But the Centers for Disease Control and Prevention since then has confirmed there was no difference in vaccine performance between the two methods.“They got criticized for the revised dosing strategy, but it was the right call,” said Frieden, who is currently president of Resolve to Save Lives, a non-profit organization focused on preventing epidemics.Cases, however, had already begun falling by the time the government made the switch.Community outreachThe current CDC director, Dr. Rochelle Walensky, cited efforts to educate doctors on how to better diagnose and treat mpox. Other experts said that even more important was outreach to the sexually active gay and bisexual men most at risk.In the first months of the outbreak, the government was cautious about focusing warnings too intently on gay and bisexual men for fear of stigmatizing the men and — in so doing — undermining efforts to identify infections. (Indeed, in November the WHO changed the name of the disease from monkeypox to mpox in an effort to reduce stigma.)“They were a little coy about the population principally affected,” Schaffner said.Many say queer activists and community organizations stepped up to fill the void, quickly offering frank education and assistance. In an online survey conducted in early August, many men who have sex with men reported having fewer sexual encounters and partners because of the outbreak.“The success was really due to grassroots activities,” said Amira Roess, a George Mason University professor of epidemiology and global health. Leaders in the gay community “took it upon themselves to step in when the government response was really lacking” in a way that recalled what happened during the plodding government response to the HIV/AIDS epidemic in the 1980s, she said.Among those efforts was called RESPND-MI — Rapid Epidemiologic Study of Prevalence, Networks, and Demographics of Monkeypox Infection. The grant-funded organization put out transmission-prevention messaging, conducted a community-led survey of mpox symptoms, and mapped the social and sexual networks of queer and transgender people in New York City.Nick Diamond, a leader of the effort, said government response improved only after gay activists pressured officials and did a lot of the outreach and education themselves.“A lot of HIV activists knew that it would be up to us to start a response to monkeypox,” he said.But Diamond also noted another possible reason for the declines: Spread of mpox at LGBTQ celebrations in June — coupled with a lack of testing and vaccinations — likely contributed to the July surge. “A lot of people came out of Pride, after being in close contact, symptomatic,” he said. They suffered blisters and scabs, bringing home the message to other at-risk men that the virus was a very real danger.Biology vs. BehaviorThere are also possible explanations that have more to do with biology than behavior.The number of new infections may have been limited by increases in infection-acquired immunity in the men active in the social networks that fueled the outbreak, CDC scientists said in a recent report.Past research has suggested there may be limits in how many times monkeypox virus will spread from person to person, noted Stephen Morse, a Columbia University virologist.“The monkeypox virus essentially loses steam after a couple of rounds in humans,” Morse said. “Everyone credits the interventions, but I don’t know what the reason really is.” | Epidemics & Outbreaks |
Obesity and prediabetes are major health concerns in Africa and the Middle East, affecting over 40% of the population. In Egypt, 20% of adults have diabetes; the figure in Saudi Arabia is 30%. In Nigeria, 1 in 17 adults has diabetes. The issue of prediabetes and obesity is even more widespread. Yet, it’s essential to recognize that these health challenges are largely preventable through lifestyle management and monitoring.
The significance of Almouneer, an Egyptian healthtech company, in this context, cannot be overstated. The platform, on a mission to revolutionize healthcare for individuals grappling with diabetes and obesity, has secured $3.6 million in funding.
Dubai-based Global Ventures led the seed round. Other international investors, including Proparco and Digital Africa via the Bridge Fund, Wrightwood Investments — the family office of Diane & Henry Engelhardt from the U.K., and other prominent international funds participated. Almouneer has disclosed that the funds raised will be primarily allocated to support the development and expansion of DRU, which it characterizes as the “first patient-centric, digitally-enabled lifestyle and diabetes management platform in the Middle East and Africa.” The platform plays a critical role in diabetes, prediabetes, and obesity prevention and management by connecting patients with doctors and an extensive network of healthcare providers through its app.
Co-founder and CEO Noha Khater shared with TechCrunch that the seed investment will assist in attracting top talent to join Almouneer. Also, it is exploring potential product expansion into neighboring markets across Africa and the Middle East. Saudi Arabia, the UAE, Nigeria, and Kenya are top of mind for the healthcare company next year.
The capital raise comes on the heels of significant growth for Almouneer. The Giza-based startup serves over 120,000 patients through a network of nine hospitals and clinics in Egypt. The healthtech also reported a doubling of its business volumes and revenue numbers within the past year, according to Khater.
From ophthalmology to diabetic care
In 2017, Khater launched Almouneer as a cluster of tech-enabled clinics with a strong emphasis on ophthalmology. The chief executive told TechCrunch that she started the company based on first-hand experience as an ophthalmologist and practicing physician. In the early 2000s, Khater pursued training in the U.S. and was deeply impressed by the quality of healthcare services. Patients had easy access to all their medical data, and the communication with their healthcare providers was outstanding. The meticulous documentation of even the most straightforward medical procedures left a profound impact on her.
Witnessing this level of healthcare excellence in the U.S. motivated her to strive for similar benefits for the Egyptian population. This drive led her to establish Almouneer with Rania Kadry. Kadry serves as the CTO and brings her background in economics and social science computing to the startup.
“Most of my patients were diabetics, even as a retina specialist. And as you know, the journey of a chronic patient can be harrowing. Diabetes is a disease a large number of people have for life. And with many having ups and downs, there’s always a need for reassurance,” said Khater. “Whether in terms of connecting with the doctor, asking a question, or making sure that your data or medical records are fine. So, it was obvious that this kind of service did not exist and was very fragmented in Egypt. A typical diabetic or chronic patient would have several doctors dealing with them in different places and lose their data. So, having all this in one place in your pocket was something that was missing. In Egypt, we have gone almost 110 million; you can imagine how many people this problem affects.”
The DRU app
After operating tech-enabled ophthalmology clinics, Almouneer expanded to serve diabetes and chronic disease patients. Subsequently, it shifted from managing digital clinics to providing operational support for external doctors and healthcare providers. In this capacity, Almouneer deploys comprehensive practice management software, encompassing financial, electronic medical records, and booking systems that are all interconnected.
This change also coincided with the launch of its patient-centric app, DRU. With DRU, patients can upload their medical records, including vital metrics such as blood sugar and blood pressure. The app provides access to their most recent medical data and current medications and allows doctors to view these records. Additionally, the subscription-based app offers teleconsultation options, enabling patients to connect with healthcare personnel via chat or phone.
“We have many patients from Africa and the Middle East that come to Egypt for treatment because of two things. One is the good medical expertise here in the region—two, because of its affordability. So one of the biggest challenges when those patients go back home after getting treatment is that it’s hard to maintain contact with the doctors or healthcare provider,” the CEO said. “Even if they do, they don’t have the same care or attention they would have when they fly in. So, the app allows them to upload medical records or the latest tests. It also helps with conversations with the doctors so they don’t have to fly back to Egypt now and then for a follow-up.”
Expanding product offerings
Yet, Almouneer aims to expand and enhance its service offerings, Khater says. In the next few months, the six-year-old healthtech plans to launch patient-customized treatment and nutrition plans. Patients can subscribe to personalized plans for uncontrolled diabetes and obesity, focusing on blood pressure and blood sugar improvement. Almouneer’s revenues come from subscriptions and these customized plans. The healthtech also takes a percentage from the fees it charges doctors for referrals and is set to add marketplace revenue to the mix. The marketplace will connect patients with essential consumables such as glucose monitors, blood sugar strips, care products for their extremities, and nutrition plans.
Meanwhile, the seed investment will be instrumental in driving the adoption of the recently launched DRU app. It’ll also focus on expanding the provider ecosystem to include doctors, health coaches, labs, and nutritionists (among which it is launching the DRU app for doctors in Q1 2024.)
“Over the years, we have had the privilege of working with a stellar group of healthcare entrepreneurs who are materially improving the lives of patients worldwide, enhancing access, quality and cost of care,” Noor Sweid, Founder and Managing Partner of Global Ventures, commented “Noha and Rania are now part of this group. We are excited to work alongside them as they leverage their specialized expertise across business-building and chronic care to tackle a prevalent health issue across the Middle East and Africa. On its mission to become the lifelong companion of diabetic patients in the region, Almouneer is a unique and necessary innovation.” | Medical Innovations |
By Alison Massey, as told to Susan Bernstein
There is a perception that chemotherapy is like treatments from 20 or 30 years ago. They think it will have side effects that are not tolerable, but we have made significant advances in managing the toxicities that come with these cancer medications. People think chemo will make them sick, but thatâs not the case. Each individual treatment regimen has its own side effect profile. If you look at the list of possible side effects, people can be overwhelmed. Most people will experience a side effect, but no one gets every possible side effect.
Generally, people will be a little tired or have a dip in energy level for a few days. But between your treatments, we hope that youâll be able to live your normal life. We have many people who continue to work between their treatments.
Nausea is another common side effect, but weâve made advances in how to manage nausea you may experience around your treatments as well. We can offer patients a range of anti-nausea medications. Some treatments do cause hair loss, and if thatâs the case, we let you know that up front. Itâs important to note that the vast majority do not cause hair loss, although some may cause hair thinning. We definitely have ways to help you manage these issues, including offering a prescription for wigs or other resources. With hair thinning, we can also check certain labs or get our dermatology colleagues involved to help you.
Fatigue is the main thing you may experience with radiation. Radiation can cause inflammation in your body as it kills the cancer. Itâs the inflammation that causes the side effects. Depending on what is being radiated, you may have pain. For example, if you are receiving lung radiation, your esophagus can be involved because the radiation may be close to that area of your body. If so, you may have pain with swallowing or difficulty swallowing. You may even feel like food gets stuck after you swallow it. People who are having radiation may not realize that it could affect swallowing food.
Sometimes people will need radiation to a painful lesion. While receiving radiation at a particular spot for people with advanced lung cancer, you may have a flare-up of that pain. Ultimately, the hope is that pain will disappear. During this time, we can also treat you with pain medications or steroids like dexamethasone to minimize the inflammation that causes pain.
Checkpoint inhibitors [immunotherapy medications for lung cancer] can have side effects, but they are different than chemo because they act on your immune system. These medications can overactivate your immune system, which leads to the side effects. Sometimes, we see patients develop dermatitis, which appears as a rash, or experience colitis that causes diarrhea, or pneumonitis of your lungs, which may cause shortness of breath or a cough. Checkpoint inhibitors may also cause arthritis or myositis, which is inflammation of your muscles. Sometimes, we can even see swelling of your joints. Itâs important that if patients notice any new symptoms while taking a checkpoint inhibitor, they let us know about it so we can initiate treatment. The quicker you tell us about these side effects, the sooner we can treat and reverse them.
Anxiety and depression are two things we deal with very often during cancer treatment. In my experience, people may feel lost when they are first diagnosed. But once you have found your oncologist and your whole cancer support team, and you know you have a plan of attack to treat your cancer, most people feel better. Many have a fear of cancer treatments and the potential impact of treatment on your quality of life. We let people know that they can still live their life and they should continue to do the things that they enjoy.
Your mood and outlook may depend on where you are in your cancer treatment course or disease progression. Early on, most people are more functional and have less fatigue. Some people may still be able to work. Others may need to hang out at home for a few days after each treatment. Our goal is that you donât stay in bed the whole time youâre being treated for cancer. Keep an active schedule as much as you can. Realize that you will be tired after your treatment and plan for those days. And donât forget to ask for help if you need it!
Sleeping well can also affect your mood and quality of life. A lot of our patients have insomnia. Often anxiety may be causing that insomnia. Your mind is racing, so you canât sleep. Also, some of the meds you take for nausea or steroids for inflammation can rev you up and cause insomnia. And sometimes an annoying cough can disrupt your sleep.
Some people with lung cancer may need to use supplemental oxygen. In my experience, people struggle with the idea of wearing oxygen because, like the association with hair loss, now people on the outside are able to see that they are sick. But from a medical perspective, itâs important to wear it if you need it.
Loss of sexual function is something we can see in both men and women. In my experience, men are more vocal about this, so speak up, ladies, if you have any concerns! Erectile dysfunction can affect men during cancer treatment. Women may experience vaginal dryness or pain during intercourse. If that happens and you let us know, we can refer you to a sexual health doctor. Treatments can also affect womenâs menstrual cycles. If youâre someone who could get pregnant, you should be careful to use contraception while youâre being treated for cancer.
Show Sources
Photo Credit:Â Pornpak Khunatorn / Getty Images
SOURCE:
Alison Massey, ANP-BC, Memorial Sloan Kettering Cancer Center, New York. | Disease Research |
Judge Chad Floyd didn’t waste any time Tuesday morning as he addressed defendants and family members gathered in a small third-floor courtroom atop the Cullman County Courthouse.
“If we hurry, I think you should be able to make it back by second period,” Floyd said.
All seven defendants had already missed first period middle and high school classes in Cullman County. All seven had been caught with vape devices on campus.
They are part of a new program that’s spreading across Alabama, as a small number of counties take on the prosecution of students who are busted vaping at school. The schools have invested hundreds of thousands of dollars in high-tech vape sensors to catch children puffing in bathrooms and locker rooms.
In addition to receiving school-based punishments that can include alternative school or in-school suspension, those students now get a ticket and a date in the county’s vape court.
If the defendants – all first-time offenders – complete a two-hour education class and 16 hours of community service within the next two months, their charges will be dropped, and they won’t be required to pay any court costs. If they miss the deadline, they must perform additional community service, said Kay Bell, director of Cullman Juvenile Probation.
The program, which started in 2021, seems to be curbing the vaping problem in Cullman schools, Bell said.
“We had 126 our first year and that decreased by 27 percent the following year,” Bell said. “We actually have pretty good success rate. If they have issues, they can call in and we’ll help.”
Fast-growing Marshall County next door and rural Coosa County in central Alabama have already launched vape courts based on the Cullman County model. The goal is to help schools struggling to prohibit vaping on campus. Administrators and school resource officers had become overwhelmed with cases, Bell said.
“It was disrupting the whole school day,” she said.
Although Bell and Floyd say the process is supposed to help students, some experts worry that using courts to crackdown on vaping in school could criminalize young students, leaving them with fines and criminal convictions in some cases.
“This vape court doesn’t help kids avoid anything,” said Leah Nelson, research director for progressive policy group Alabama Appleseed. “If anything, Cullman is constructing a new feeder into the school-to-prison pipeline for no good reason and without legal authority.”
Fines and fees
Vape court is is based on Alabama law, which states that people under the age of 21 who possess vape products can receive tickets and fines that range from $10 to $50.
But students in Cullman County are not required to pay fines or return to court if they complete the program requirements in two months. They can can face hefty court costs that range from $350 to $500 if they don’t complete the requirements on time, according to the student handbook. And fines and fees may kick in on the third and fourth offense, according to the policy posted by the Cullman County Board of Education.
In Marshall County, if students miss an appearance in court, warrants can be issued for failure to appear or contempt of court, and violators can be taken to jail, the handbook said.
But the programs carry other hidden costs, said Jenny Carroll, a law professor at the University of Alabama.
“It costs money to get to a community service location,” Carroll said. “It costs money to participate in educational programming. You may have to pay to go there, or parents have to pay to get them there. For some kids, there are uniform requirements for community service. There’s costs in terms of lost income for the child.”
For Robert Smith of Cullman, attending his son’s vape court appearance on Oct. 3 meant missing a day of work. His job takes him to pipelines across the state, and that morning, he was set to drive to Boaz. Instead, he had to take off because he’s the only one in the family with a driver’s license.
“I’m losing $160 a day to come here,” he said.
Cullman County court officials said they are sensitive to concerns about costs. They recently switched from an online vaping education course that cost $50 to a free in-person class.
Floyd said the program works because it sends a message that underage vaping is a serious offense with real health consequences.
“Our most successful cases are the cases where we have buy in from the parents and everyone is pulling in the same direction,” Floyd said. “And I would say about 99 percent of the time, we have the parents on board with us.”
But when he was in high school, said Smith, smoking on campus was punished in the principal’s office. Students might get detention or paddling. He worries the penalties meted out in court might fall more heavily on parents than students.
“Let the kids suffer for it, not the parents,” he said.
Addiction
School officials have become increasingly concerned about the dangers of vaping.
Vaping can harm brain development among teens, affect mood, learning and impulse control and increase the risk of addiction to other drugs, according to the U.S. Centers for Disease Control and Prevention.
Most vape cartridges sold commercially contain nicotine, but some are filled with THC. Some school officials have raised concerns about fentanyl in vape devices, but it’s unclear whether any cases of opioid contamination have been documented in Alabama.
But some of the organizations concerned about the health risks of vaping have said criminalizing underage use is not the best approach. Jada Shaffer, state government relations lead for the American Heart Association in Alabama, said tobacco companies have spent billions of dollars targeting young people with addictive products. Instead of punishing users, state officials should increase regulations and taxes on vape products, she said.
“It is disappointing and frustrating that Alabama continues to further victimize Alabama’s youth by putting them through the courts, while there is no accountability or repercussions on the industry making billions of dollars off kids’ addictions,” Shaffer said. “There is no evidence that fining children helps them with their addiction. They instead need education, counseling and cessation resources to help with their addiction.”
Gracie, an 11th-grader who had her first court appearance Oct. 3, said bringing her vape to school was a dumb mistake. Going to court and spending several days in alternative school has been embarrassing, but she said it has also been helpful.
“I feel like it was a good thing because I might not have ever quit otherwise,” she said.
Officials in Cullman County said they are aware that many students may be addicted to vaping. The vape court judge can refer a student for treatment, which might not be an option for schools.
Judge Rusty Turner started the vape court in Cullman County in his juvenile court before it moved to the misdemeanor docket. He said vaping poses special problems for schools. Unlike smoking, it can be hard to detect.
“The ease of use and the ease of access, that’s an issue that everyone has to deal with,” Turner said. “It’s not something you can pick up that easily, like smoking. Everyone can smell cigarette smoke, but it’s harder to do with the vaping.”
Vape detectors
Schools in Alabama have invested hundreds of thousands of dollars in vape detection equipment. Cullman City Schools spent $230,826 on 152 HALO Smart Sensors for middle and high schools, according to records from Alabama Appleseed. Walker County schools spent $130,000 for 66 of the devices, according to ABC 33/40. Limestone and Lauderdale counties are also investing in sensors, AL.com reported.
Many schools place them in bathrooms and locker rooms. The devices are designed to detect vaping, THC, heat, particulate matter and other measures. They do not have cameras or recording devices. They alert administrators to check the bathroom or locker room.
There are concerns about whether those sensors can pinpoint which person was using the vape and whether it is an invasion of student privacy. In a presentation last year for the Children’s Policy Council, an organization that represents juvenile justice and children’s service organizations across the state, Floyd said the sensors led to about 90 percent of the vape cases.
State lawmakers have also looked at cracking down on vaping in schools. In the last state legislative session, Rep. Barbara Drummond, D-Mobile, proposed a bill that would increase criminal penalties for vape possession by underage users. It would have increased fines and community service on people between the ages of 18 and 20 and sent those younger than 18 to juvenile court. The bill failed.
Right now, court officials place those cases on the regular misdemeanor docket, then take all the vape cases up to a different courtroom to give the young defendants more privacy. Turner, the judge in Cullman, supports efforts to revive Drummond’s bill next year and to put vape court back under the jurisdiction of juvenile court. He said that moving the cases to juvenile court would unlock more services for young people who might need them.
Vape court will accept kids as young as 12, but Turner said the average age is 14 to 15. During a court day this month in Cullman, one of the defendants was just 13 years old.
Growing the program
Floyd and Bell have made presentations about vape court to prosecutors and to children’s advocacy groups. Officials in other counties have expressed interest in starting similar programs.
Judge Jay Mastin of Marshall County is one of them. His vape court in Guntersville launched at the beginning of the school year and is modeled on Cullman County. Students will have 16 hours of community service and education on the first offense, with punishments that escalate with each additional offense.
Mastin said he is concerned that kids are vaping without understanding the long-term health consequences. The problem has also become too widespread for schools to handle with regular forms of discipline, he said.
“Traditionally if you were smoking at school, you had to light up a cigarette somewhere in the building,” Mastin said. “But with vaping, they can carry it around in their pocket and basically use it all day long as long as they aren’t that obvious with it.”
By coming down hard on vaping, he hopes to send a message to kids in the area to avoid substances that could cause addiction and lung damage.
“The worry is how it’s marketed,” Mastin said. “The fact that so much of it is scented and flavored with kind of trendy labels and colors. It just seems that it’s geared to be more attractive to kids.” | Epidemics & Outbreaks |
Labour leader Keir Starmer unveiled the plan to prevent more "horror stories of DIY dentistry" alongside introducing supervised toothbrushing in schools. The NHS dental contract will be reformed and dentists will be incentivised to work in poorer areas where there is greatest need.
In his first policy announcement ahead of the party's annual conference in Liverpool, Mr Starmer said: "People are finding it impossible to get an NHS dentist when they need one, with appalling consequences. Horror stories of DIY dentistry are too frequent. My Labour government will not stand for millions of people being denied basic healthcare.
“To rescue dentistry from the immediate crisis, we will provide 700,000 more appointments a year to those in the most urgent need, recruit more dentists to areas with the most severe shortages, and protect children’s teeth."
The plan centres on 700,000 more urgent appointments such as fillings and root canal being funded by Government. New analysis of patient survey data suggests that 4.75 million people were denied an appointment with an NHS dentist in the past two years.
Figures show millions were either told no appointments were available or that the practice they contacted was not taking on new patients. It comes amid a series of stories about patients in pain who yank out their own teeth with pliers or string.
Labour also plans to reform the hated NHS dental contract which dentists say provides perverse incentives, so that the most high-needs patients are least welcome. Dentists can be paid the same for doing one filling as they are for five, meaning they can make a loss on those needing lots of treatment.
Mr Starmer added: "My mission-led government will always do more than fix the basics. We will reform the dental contract to rebuild the service in the long-run, so NHS dentistry is there for all who need it.”
Labour's plan will cost £111million a year, which Labour said would come from abolishing the non-dom tax status. Scrapping the tax exemption is how the party proposes to fund the largest-ever workforce expansion of the NHS if it wins the general election expected next year.
Shawn Charlwood, general dental chair of the British Dental Association, said: “We’re seeing patients in pain reach for pliers because of choices made in Westminster. These access problems are not inevitable, and giving dentists the time and the resources will make a real difference. Labour has recognised the scale of this crisis. NHS dentistry is hanging by a thread and every party has a moral responsibility to set out a plan.”
It comes after a damning report by the Commons Health and Social Care Select Committee, published in July, which indicated more people were pulling out their own teeth at home as they could not access NHS services. The review included a YouGov poll of 2,104 people across the UK conducted in March 2023, in which 10% admitted to attempting "DIY dentistry".
Experts have called for urgent change to NHS dentistry after figures revealed the number of patients being seen remained well below pre-pandemic levels. | Health Policy |
For centuries, eternal life has been a common quest for women and men around the world.
Even today, tech tycoons like Jeff Bezos and Sam Altman are investing in startups that aim to reverse ageing by making tweaks to animal cells.
While this sounds like a wonderful new era of carefree living, one expert has cast doubt over whether it would even be a good idea.
Dr Stephen Cave, a philosopher at the University of Cambridge, said an extended human lifespan would be 'absolutely catastrophic'.
Attempts to radically lengthen lifespans will put too much pressure on Earth's resources, he claims – and could mean humanity will go extinct sooner.
Dr Cave and US philosopher John Martin Fischer are authors of a new book entitled 'Should You Choose to Live Forever?', which debates whether 'we are wise to wish for immortality'.
'Never before in human history has so much money and so much talent been poured into trying to solve the problem of ageing,' Dr Cave told the Times.
'If you think the planet is already at its carrying capacity for humans, or has maybe exceeded it – if you look at the destruction of biodiversity and habitat loss and climate change and so on – then obviously this could be absolutely catastrophic.'
Advances in technology have already doubled in the last 300 years or so, from 40 years to 80 years, so maybe it could double again, the academic said.
Dr Cave also thinks it's possible the technology to prolong human lifespans will be available, but it'll be so expensive that only the very wealthy would afford it.
'We have this terrible scenario, then, of this incredibly rich and powerful gerontocracy who watch generations of us ordinary folk go by and like so many flies,' he said.
Dr Cave is leading Cambridge's new Institute for Technology and Humanity, which is to explore how technological progress – including attempts to lengthen lifespans – will affect society.
This ancient question is as topical as ever, as billions of dollars are currently being poured into anti-ageing research.
For example, Amazon founder Jeff Bezos has invested in a firm called Altos Labs, which wants to develop tech that can reverse the human aging process.
Atlos Labs has raised at least $270 million (£215 million) to look into the potential of cell reprogramming to turn back the clock in animals, including humans.
The firm has its HQ in California but it also has offices at Cambridge Institute of Science in the UK, which opened in July last year.
Bezos has also invested in Unity Biotechnology in California which is developing drugs said to purge the body of ageing, dying cells.
Meanwhile, OpenAI founder Sam Altman this year invested $180 million in Retro Biosciences which states its objective as adding 10 years to healthy human lifespan.
Some experts think that humans could become immortal around the turn of the next decade, although this could be taken as wishful thinking.
Former Google engineer Ray Kurzweil said humans will achieve immortality in just eight years because of technology that can cure diseases.
According to Kurzweil, tiny nanobots – small robots that can enter the human body – will be able to repair damaged cells and tissues that deteriorate as the body ages and make us immune to cancer and other illnesses.
Earlier this year, scientists at Harvard said human lifespans could be lengthened by an anti-ageing jab within five years.
Their experimental therapy managed to rejuvenate cells in mice, helping them live longer, while reducing frailty and boosting heart and lung health.
It's hoped the findings will lead to treating humans in the same way, boosting their resilience against disease by making them biologically younger. | Longevity |
SACRAMENTO, Calif. -- California Gov. Gavin Newsom has vetoed a bill aimed at decriminalizing the possession and personal use of several hallucinogens, including psychedelic mushrooms.
The legislation vetoed Saturday would have allowed those 21 and older to possess psilocybin, the hallucinogenic component in what's known as psychedelic mushrooms. It also would have covered dimethyltryptamine (DMT) and mescaline.
The bill would not have legalized the sale of the substances and would have barred any possession of the substances on school grounds. Instead, it would have ensured people are neither arrested nor prosecuted for possessing limited amounts of plant-based hallucinogens.
Newsom, a Democrat who championed legalizing cannabis in 2016, said in a statement Saturday that more needs to be done before California decriminalizes the hallucinogens.
“California should immediately begin work to set up regulated treatment guidelines - replete with dosing information, therapeutic guidelines, rules to prevent against exploitation during guided treatments, and medical clearance of no underlying psychoses," Newsom's statement said. “Unfortunately, this bill would decriminalize possession prior to these guidelines going into place, and I cannot sign it.”
The legislation, which would have taken effect in 2025, would have required the California Health and Human Services Agency to study and to make recommendations to lawmakers on the therapeutic use of psychedelic substances.
Even if California made the bill a law, the drugs would still be illegal under federal law.
In recent years, psychedelics have emerged as an alternative approach to treating a variety of mental illnesses, including post-traumatic stress disorder. The Federal Drug Administration designated psilocybin as a “breakthrough therapy” for treatment-resistant depression in 2019 and recently published a draft guideline on using psychedelics in clinical trials.
Public opinion on psychedelics, which have been mostly associated with 1960s drug culture, has also shifted to support therapeutic use.
Supporters of the legislation include veterans, who have talked about the benefits of using psychedelics to treat trauma and other illnesses.
“Psilocybin gave me my life back,” Joe McKay, a retired New York City firefighter who responded to the 9/11 attacks, said at an Assembly hearing in July. “No one should go to jail for using this medicine to try to heal.”
But opponents said the drugs’ benefits are still largely unknown, and the bill could lead to more crimes — though studies in recent years have shown decriminalization does not increase crime rates. Organizations representing parents also worry the legislation would make it easier for children and young people to access the drugs.
State Sen. Scott Wiener, who authored the bill, called the veto a missed opportunity for California to follow the science and lead the nation.
“This is a setback for the huge number of Californians — including combat veterans and first responders — who are safely using and benefiting from these non-addictive substances and who will now continue to be classified as criminals under California law,” Wiener said in a statement Saturday. “The evidence is beyond dispute that criminalizing access to these substances only serves to make people less safe and reduce access to help.”
He said he would introduce new legislation in the future. Wiener unsuccessfully attempted to pass a broader piece of legislation last year that would have also decriminalized the use and possession of LSD and MDMA, commonly known as ecstasy.
Lawmakers can override a governor’s veto with a two-thirds vote, but they have not tried in decades.
In 2020, Oregon voters approved decriminalizing small amounts of psychedelics, and separately were the first to approve the supervised use of psilocybin in a therapeutic setting. Two years later, Colorado voters also passed a ballot measure to decriminalize psychedelic mushrooms and to create state-regulated centers where participants can experience the drug under supervision.
In California, cities including Oakland, San Francisco, Santa Cruz and Berkeley have decriminalized natural psychedelics that come from plants and fungi.
Despite Newsom’s veto, California voters might have a chance to weigh in on the issue next year. Advocates are attempting to place two initiatives to expand psychedelic use on the November 2024 ballot. One would legalize the use and sale of mushrooms for people 21 and older, and the other would ask voters to approve borrowing $5 billion to establish a state agency tasked with researching psychedelic therapies. | Mental Health Treatments |
Looking back at the start of the coronavirus pandemic, Prof Paul Elkington says it was soon apparent that he and his colleagues would run out of PPE (personal protective equipment).
"I'm a lung doctor, and by mid-March 2020 we realised the process we had to protect our staff was not going to be sustainable," says Prof Elkington, a respiratory consultant at University Hospital Southampton.
"We were initially wearing disposable FFP3 masks, gowns and visors, but within a few weeks it was obvious we weren't going to be able to maintain those supplies."
As the airborne coronavirus spread around the world, urgent demand for PPE led to severely stretched supply chains, and rationing of supplies in many countries.
In the UK, doctors like Prof Elkington were forced to improvise. His team came up with the PeRSo, a personal, battery-powered respirator device worn over the head like a hood with a clear window, that travels around with you.
Priced at around £225 each, and lightweight and reusable, it works using a replaceable hepa (high-efficiency particulate absorbing) filter, which sterilises incoming air.
Over time it became clear that not only was PeRSo more comfortable and efficient, but it was more cost effective versus disposable PPE.
The PeRSo respirator was not only used in Southampton, but across 16 other NHS trusts. Crucially, staff absences were lower at Prof Elkington's hospital than the rest of the country.
He and a colleague, Prof Hywel Morgan, both later won an MBE for their work producing the respirator, but despite talks with Dyson, they decided not to patent their design. Instead they made it open source - publishing the design on the internet so that others could reproduce it in South Africa among other countries.
Fast-forward to 2023 and supplying PPE remains a "deeply emotive issue" for everyone "because so many people got burnt," says one senior NHS manager who asked not to be named.
He specifically references how procurement managers at the height of the crisis found themselves desperately paying high prices for products largely from China, some of which turned out to be unsuitable or even fake.
However, the Department for Health and Social Care accounts for 2020/21 reveal that £673m worth of PPE bought during the pandemic was unusable, while £750m of equipment was not used before its expiry date.
Relying on just one supply country was always a horrible risk, says Willy Shih, the Robert and Jane Cizik professor of management practice at Harvard Business School who studies global supply chains.
He says that the primary challenge with PPE is: "Governments not buying until they really urgently need it... demand is very spiky."
Prof Shih wants to see strategic reserves or national stockpiles created.
He also makes the point that if you want to retain domestic manufacturing capacity on-tap, "it costs you money to keep that manufacturing facility warm and functioning".
Aside from the environmental cost, spending money to ship disposable PPE from China, storing it in warehouses, and getting rid of the waste after it has been used is all painfully expensive.
Analysis from sustainability experts like Chantelle Rizan, clinical lecturer in sustainable healthcare at Brighton and Sussex Medical School, suggests that the best way of tackling this problem is threefold.
Firstly, by drastically reducing the use of gloves, and replacing them with more hand washing. And combining this with manufacturing PPE closer to home and, crucially, extending the use or reuse of things like masks and gowns.
Global Trade
Dr Tom Dawson says that until around 2004 the drapes and gowns used in hospital operating theatres were largely made of cotton, but then there was a rapid shift to disposable plastics.
He is a former emergency medicine doctor who founded Revolution-ZERO, a reusable medical textile company in May 2020.
Dr Dawson describes the "PPE chaos of the pandemic and the inevitable deaths that followed" as painful to watch. In response he designed a robust suite of reusable gowns, aprons, surgeons' drapes and caps.
His textile products, typically made from polyester or cotton, range from £4 for masks and wraps, up to £50 for specialist draping systems. Using a specialised laundry process and 134C sterilisation they can be used multiple times before being repurposed into other healthcare items like screens.
But swapping from disposable to reusables is not a simple fix for most hospitals because they no longer have laundry facilities on-site - it's all been outsourced.
So, although Dr Dawson has had enthusiastic interest from 150 trusts, he's having to work at building the firm's own decontamination units and laundries that are on, or close to, healthcare sites. One such facility is due to open in Cornwall in April.
Meanwhile, the firm has sold more than £300,000 worth of products to date. And overseas, medical charity Médecins Sans Frontières will soon be using Revolution-ZERO's products for their operations in Mozambique and Kyrgyzstan.
But what can hospitals do with used plastic PPE waste? That is where Welsh firm Thermal Compaction Group comes in.
Its machines, which are about the size of a US fridge-freezer, melt down used plastic PPE at more than 300C. The plastic is then compressed and cooled to create solid blocks.
Hospitals can then sell these blocks to manufacturers who will use them to make new plastic products, such as buckets.
The firm has sold more than 100 units, mainly in the UK, but also in Australia and the Netherlands. It is also just about to enter into a deal with the US Navy who want to adapt its units for use on warships.
Some customers buy the processing units while others rent them. An average hospital might pay anywhere from £1,000 per month, up to £2,500, depending on volumes and equipment needed.
The other strategy to reduce the volume of PPE waste is to avoid its use in the first place.
This happens because people forget to change them at key moments during a shift, for example moving from a computer back to examining a patient.
"We could drastically reduce inappropriate use of gloves with more education around when you don't need them," says Paul Chivers, head of PPE innovation and sustainability at NHS Supply Chain.
He says workers only need to wear them if in contact with bodily fluids, or highly infectious patients. Mr Chivers estimates that reducing the number of times workers wear gloves has the potential to save £48m in procurement costs or 9.5 tonnes of waste in NHS England.
Back in Southampton, Prof Elkington is sceptical that the UK is better prepared for the next pandemic in any meaningful way.
"My worry is that the painful lessons of the early pandemic have been completely forgotten," he says, pointing to the current funding crisis overwhelming the NHS.
"Someone somewhere should be saying, 'we have to learn those lessons [from the pandemic], we need a plan, a government driven strategy.'"
He adds that in the meantime, most of his hospital staff are keeping their personal respirators on standby in their offices. "At least we're ready within this hospital for the next one - we have 5,000 ready." | Medical Innovations |
As dozens of states have legalized recreational and medicinal use of marijuana in recent years, the federal government has maintained its classification as a Schedule 1 controlled substance—keeping marijuana in a group defined as having "no currently accepted medical use and a high potential for abuse," which includes heroin and LSD.
The incongruity has muddled marijuana regulation and enforcement, stifled cannabis businesses, and hampered medical research. But the situation could soon ease.
The Department of Health and Human Services has recommended to the Drug Enforcement Administration that it should downgrade marijuana from a Schedule 1 to a Schedule 3 controlled substance, which is defined as having "a moderate to low potential for physical and psychological dependence." The move would put marijuana in the ranks of ketamine, testosterone, and products containing less than 90 milligrams of codeine.
HHS's recommendation is based on an evaluation done by the Food and Drug Administration, which was part of an official review process. Whether the rescheduling will occur is ultimately up to the DEA, however.
The DEA confirmed to the media that it had received HHS's recommendation and will now conduct its own review, which could take months.
Some experts expect the DEA will follow the HHS's recommendation. Howard Sklamberg, a former FDA official, said the HHS position is "a big deal," and predicted the DEA would follow suit, according to The Washington Post. He reasons that the DEA has to rely on the HHS for scientific and medical information, which strongly influences scheduling.
Sklamberg added that the downgrade would send the message that marijuana is less of a public health risk than the government has previously indicated. "That could make it easier in some states to legalize and decriminalize" marijuana, he said.
For states that have already legalized marijuana, some state administrators say the rescheduling would have limited impact.
"This adjusts the type of security and type of bureaucracy that exists around federal research into the substance [and] it would make it easier for companies to bring cannabis based pharmaceuticals into market," John Hudak, director of Maine’s Office of Cannabis Policy, told Politico in an interview. "But in terms of administration of a state program, it has very little impact."
Currently, 23 states and Washington, DC, have legalized recreational marijuana, and 38 states have legalized medicinal use.
While groups that oppose marijuana legalization criticized the HHS's recommendation, some advocates say the rescheduling doesn’t go far enough and that marijuana should be removed from the controlled substances list entirely. | Drug Discoveries |
Episode notes Parents, teachers, students and experts alike say that the UK’s education system desperately needs reform. The Times Education Commission has spent the past year trying to figure out how to fix it. Today, we take a look at the recommendations in its report from a more robust focus on children’s wellbeing and mental health to a broadening of the curriculum.This podcast was brought to you thanks to the support of readers of The Times and The Sunday Times. Subscribe today and get one month free at: thetimes.co.uk/storiesofourtimes. Guests:Rachel Sylvester, Times columnist and chair of the Times Education Committee. Lucy Kellaway, teacher and commissioner. Nicola Noble, co-head teacher at Surrey Square Primary School. The pupils at Surrey Square Primary School. Host: Manveen Rana.Clips: Times Education Commission, Evening Standard, Children's Commissioner for England. See acast.com/privacy for privacy and opt-out information. | Mental Health Treatments |
Kate Bingham
‘It was a great privilege’
When I was asked in May 2020 to chair the UK Vaccine Taskforce to hunt for a vaccine, we faced a daunting task: no vaccine had ever been successfully developed against any human coronavirus, so we had no play book to follow.
The pace was relentless. And there were many surreal moments, from using pizza boxes as a substitute for the Pfizer vaccine containers to stress test the delivery system, to pacing in the garden to get phone signal for important calls.
There were frustrations and some lows but these were more than offset by the massive highs. When the Pfizer vaccine data came through at 94 per cent efficacy – we were hoping for around 50 per cent – I danced around my kitchen table and went for a celebratory run on the Welsh hills with our neighbour’s wonderful dog Gruff.
Ours was a busy house during lockdown. My husband was running the furlough scheme at the Treasury and two of my children were completing their university work remotely so we rarely saw each other. But if I ever had a spare moment, I went running out in the hills or round the lanes at night with a super-bright head torch.
It was a great privilege in all – and one moment will always stand out. We have a lovely man who comes and cleans our windows. He’s done this for years and is very good at it… but he’s never really said anything to me before. Then, one day in early 2021, when he came to do the windows, he asked ‘Can I say something?’ I said ‘Yes, of course’. And he just replied ‘fucking good job’. That made my day.
Go-to meal after a long day of work? Any Ottolenghi dish with my home grown vegetables.
Jonathan Van-Tam
‘I’ve struggled getting used to ordinary life again’
It was like being on a warfront for two years and I’ve struggled transitioning away from that and getting used to ordinary university life again.
When you’ve been doing something that intense and serious, with that much responsibility hanging over you, I think whatever comes afterwards is going to be difficult to adjust to. It’s as simple as that.
Given the days were so long – typically 16 hours at the start – you just have to chop the job into bits, into daily chunks.
I would say to myself: ‘I do the best I can today and when it goes quiet, when the calls stop, when the emails slow down towards the end of the evening, then that's it. You’ve done the very best you can, you've done a good day's work. You're entitled to go to sleep, go for a run, have a gin and tonic, watch a bit of football on the TV. You're entitled to relax.’
I've got a brilliant family. They were absolutely supportive all the way through. They understood, even the little ones, the pressure and the responsibility and what this was about. They set me free to get on and do it.
Shore fishing was my means of escape during the pandemic. For me, it blends moments of tranquillity and isolation with contrasting moments of intense concentration; but on something very basic (hunting for food) rather than the complex world of public health policy and infectious diseases. When it was safe and legal to do so, 24 hours out of the firing line on a north Norfolk beach was pure solace and recuperation, leaving me ready to go again.
Aspect of pre-Covid life that you missed the most during lockdown? Watching Boston United on a Saturday afternoon.
Devi Sridhar
‘I miss my anonymity’
The Meadows feels like the lungs of Edinburgh, and with its location right next to the university, it was where my life was largely centred around during the pandemic.
It’s where I escaped to run and reflect on the latest Covid data and what the best scientific advice would be on schools or testing to governments. All while listening to Taylor Swift and Ariana Grande.
When it was permitted in Autumn 2020, I joined an outdoor bootcamp and met a group of fantastic women who kept me going through the difficult days with burpees, singing and laughter.
I stayed out in all weather, except for one day – while doing a plank in the snow, I felt like I was losing my fingers to frostbite. It’s the only time I gave up.
People coped during the pandemic in different ways: the winter lockdown in Christmas 2020/21 was especially hard. We knew vaccines would be arriving soon, but not soon enough to avoid a huge wave in infections, hospitalisations, deaths, and accompanying restrictions.
We knew children needed to get back to in-person learning, but that unions wanted their teachers and school staff to be safe from severe illness and death. The scientific advice was sober, and the political decisions excruciating.
There were no easy decisions or ways for life to look like it did before Covid-19 then: only various paths and choices, all with major costs. The Meadows was where I escaped to think. I needed to orient my day around something other than work – and exercise became the focal point, whether indoors or outdoors.
Aspect of pre-Covid life that you missed the most during lockdown? Anonymity.
Peter Horby
‘The opening months were the worst for abuse’
It was full on – eyeballs out for months at a time, with very little decompression. For the first eight months, it was every day to 10pm and even midnight, working every weekend, too, at least four to eight hours. It was pretty hard.
You get to a point where you start to burn out. I’m now much better at recognising when I’m starting to get fatigued and jaded. When that happens, you need to take time out for yourself.
For me, it was the mundane stuff: just relaxing at home, a glass of wine with my wife, or watching telly. I’m a runner and particularly in Covid, I took up windsurfing. There’s a reservoir near my house that’s got one of the biggest windsurfing clubs in the country; learning a new sport out on the water was a real release.
The opening months of the pandemic were the worst for abuse. I was quite high profile because I was chairman of Nervtag [a sub-group of Sage dedicated to new and emerging virus threats] and chief investigator of Recovery [a UK trial which showed that dexamethasone was effective at treating hospitalised Covid patients].
It was my first time experiencing social media abuse, which was quite unpleasant. The stuff that hurt the most, I think, was the professional stuff where you’re getting undermined by colleagues.
I did think quite frequently about stepping back from media work, as you just think is the inevitable pushback worth it, but you’re kind of torn because you feel you've got a duty to communicate with the public.
Proudest moment of the pandemic? That's easy – finding out dexamethasone saved lives. Seeing that first graph on the computer, and thinking ‘shit, it works!’
Dido Harding
‘We had TV crews outside our house’
I grew up on the Somerset-Dorset border and home for the last 23 years has been the village of Winscombe on the edge of the Mendip hills. If you go out of our back door and walk straight up the hill you get to the top of Wavering Down, where you can see for miles in all directions.
The Somerset levels stretch out beneath you with Glastonbury Tor to the far left, Exmoor to the right and the Welsh Hills behind you. It’s an ancient English landscape full of raw beauty and history.
In the very rare moments when I had time during Covid, I would go up on the hill for a walk, sometimes with my family and sometimes, early in the morning, just with my dog. Fresh air and exercise are how I decompress, and Wavering Down always helped to put any stress in perspective and remind me how incredibly lucky I was, especially during Covid, to be able to walk in such a beautiful place.
Sometimes we had TV crews outside our house, shouting every time we came out, which worried my daughters, but we could sneak up through the woods and onto the hill unnoticed and pretend for half an hour that all was normal again.
Your go-to meal after a long day of work? Cheese and tomato toastie.
Lim Wei Shen
‘We hope no future pandemic will strike as deeply’
Throughout the toughest periods of the pandemic, my wife was my constant, unwavering support. Each weekend, she would insist that we invest a few hours in going for a short walk to “have some fresh air”.
One of our favourite walking areas was amongst the many paths close to Dale Abbey, in Derbyshire, and The Cowshed tearoom. These walks provided us with important space to spend time together and to reflect on the many changing events around us.
The pandemic created turmoil and suffering for everyone. Our walks proved to be opportunities for organising thoughts and for reflecting on the many people displaying enormous kindness, courage and kinship throughout the week. In the midst of hard times, it was good to seek out reasons to be thankful.
From one of the paths, there is a view of a solitary tree standing tall at the crest of a rise, remarkable in its contrast to the surrounding fields. The apparent calm constancy of that tree resolute against the shifting skies is one of the joys of that walk.
During many periods of the pandemic, we were keenly aware of friends living in other countries who had to face tougher restrictions to their freedoms – what they would have given to replace pale grey concrete for a field of waving grass. This pandemic has afflicted so many lives. We hope no future pandemic will strike as deeply.
Your go-to meal after a long day of work? A mug of strong Yorkshire tea.
Jenny Harries
‘I had to advise my children on personal safety’
The pebble beach at Aldeburgh and the coast further along at Thorpeness – whether in cold, grey, North Sea storms, or expansive sunny summer skies – is my lifetime natural haunt to unwind, destress, and reconsider the universe and my place in it.
As a small child I spent every summer holiday here with my family. In my formative teens I worked in the craft shops owned by my wonderful great Auntie Muriel – a potter and artist. Almost every year of my adult life, including this recent pandemic, I have gone back to recharge my batteries.
I have many happy memories from our holidays at Aldeburgh: our dogs on the beach, sailing yachts on the boat pond, the regatta on the Mere nearby, the same small fishing boats being repainted and netted. My mother’s last ever holiday photo was taken on the beach, too.
Being able to visit the beach, once allowed to do so, restored my physical and mental health during the tough times of the pandemic. Helping deliver a critically important mission of protection for the population, the very essence of my professional job, also gave me energy.
When it comes to criticism from the public, for me the most important thing is to put yourself in the position of the people you are trying to support and always to lead and work by your values.
My family also had a hard time getting used to me being continuously under public scrutiny and criticism – at one point I had to specifically advise all of my children on personal safety.
That said, I’m regularly stopped by people in the street, whether in London or back home in Wales, who want to thank me and my colleagues for our work. It’s the criticism that makes good headlines, but the thanks seem to last much longer in my experience.
Favourite TV programme of the pandemic? Escape to the Country!
John Bell
‘My daughters caught Covid – one was very sick’
I spent most of the pandemic at home mostly with my family. We live on the Thames and have the river at the bottom of our garden.
My wife and I are both avid scullers and taking the boat out early in the morning proved to be a remarkable break for both of us. The rest of the day was spent on calls and in virtual meetings.
It was seven days a week for most of the first year, starting early and ending late at night. It was exhausting but also very interesting and challenging as we discovered new features of this new disease on a weekly basis. It was hard to stop as our work was having a major impact.
I had a little social media noise but for me the swell of positive comments was significant. People appreciated being told honestly and clearly what was happening and that it would be alright in the end.
We have two daughters at university, both of whom caught Covid early on. One was very sick and locked up in her dorm. That was a concerning time for us.
The kids were mostly worried about whether I was going to get infected through my work. When we were all at home, the evening meal was a great time to meet up together. In the spring and summer we would eat outside, which helped us all to decompress. We had very little tension in the family – our biggest gripe was when the internet underperformed.
Proudest moment? Our work with Astra Zeneca on the vaccine, which saved an estimated six million lives globally.
Meaghan Kall
‘It put a lot of pressure on my relationship’
I don’t think that there's been a lot of recognition of the impact that working in the pandemic response had on personal life. Because it wasn’t just decision-makers having to work silly hours, it was the people who had to provide the data to them so they could make their decisions.
We worked in shifts at the beginning and it was 12-hour days, if not more. For three nights, I’d stay in a hotel right next to our office, as by the time I’d finished, it was so late and wouldn’t be worth making the journey out of London to head home. Thursdays and Fridays I’d deal with “non-Covid” work, and I’d often do weekend shifts too.
My life is always a juggle, trying to manage everything. So when the pandemic came, it really threw the whole balance out. And I think that with that came the strain on family life.
The number of hours I was working, the unsociable hours, working in the hotel away from my family – it put a lot of pressure on my relationship with my wife. But we got through it all. Watching TV and going for walks with our son Luther in his wheelchair was always therapeutic and helped everyone de-stress.
Now every weekend we try to keep one full day free where we don’t plan anything, like during lockdown, and dedicate that time to each other.
Proudest achievement? I helped develop the surveillance system to monitor deaths, which was used throughout the pandemic and helped inform the response. On a personal level, David Spiegelhalter, who is a god among us data geeks, put me in the acknowledgements of one of his books. That was a fantastic feeling.
David Spiegelhalter
‘I constructed a ‘den’ ... everyone should have one’
I had it much easier than most, with no children to educate or ageing parents to worry about; just me, my partner and the dog, and with good commons for walking nearby. And to be honest the simplified life suited me – fewer arrangements to make and people to see, and more time to read, cook nice food and catch up on TV.
I was dealing with continuous requests for media appearances, and had to be ready to explain all the current statistics, while also politely fending off questions about what should be done, who was to blame and so on. I wonder how many other people on ‘Any Questions’ have simply refused to answer a question because this was not their job?
The front room was set up as a studio, with lights and the computer positioned at eye-height – fortunately I realised I could set up my own autocue, by scrolling through my notes just below the green camera dot. So it would look like I was chatting spontaneously and had all the numbers in my mind, whereas I was actually keeping to a very tightly prepared set of points.
Being old, white, and not very controversial, I largely escaped online abuse. After a newspaper article on vaccines, we were told on Twitter that we “were genocidal and should be destroyed”, but my co-author made light of it: “A bit harsh, I thought it was a good article.”
The pressure did become stressful at times. Then I remembered that as a boy I used to retreat to a large cardboard box when I wanted some peace, and so I constructed a substitute from clothes-lines and duvet-covers in the corner of the room, a tiny ‘den’ in which no electronics were allowed, and from which even the dog was banned. Everyone should have one.
Your proudest achievement of the pandemic? Getting on Desert Island Discs.
Sunetra Gupta
‘I found out who my real friends were’
My experience during this pandemic has been one of widespread dismissal by the academic community as well as that of downright slander from many quarters, including some of the most powerful players and former friends.
Being able to go on long walks with my dog, Maisie, was the perfect antidote to these events.
In fact, my personal experience of lockdown was generally extremely pleasant as both my daughters came home – one was in the final year of her degree and the other had just started a training contract in a law firm and both were able to continue online in these endeavours.
Others were not so fortunate and my thoughts were constantly occupied by the plight of the poor, and particularly of vulnerable children, who suffered during lockdowns.
I, and the handful of academics who joined me, were unsuccessful in opening up the debate on our pandemic response – speaking out was the only option as I sat in the comfort of my home, enjoying the company of my family, cooking delicious meals together and spoiling Maisie with endless walks and cuddles.
Aspect of lockdown that you actually came to tolerate: Finding out who my real friends are…
Adam Kucharski
‘I had bizarre threats about Nuremberg 2.0’
During the pandemic, my days involved tackling big questions on a small screen. The vast emptiness of our local woods therefore gave me space to pause and reflect. Darkness and mist faded into spring as the Alpha wave subsided. Bluebells suddenly appeared when Delta took off. Long rays of summer sunshine accompanied our second vaccines.
It was clear from our early 2020 analysis that Covid was going to be a problem for a long time, so to some extent I’d mentally prepared. But unlike previous outbreaks, where we’d work intensively for a few weeks, this would be months, then years, coupled with daily media queries and growing online abuse.
In a way, the increasing absurdity of the social media attacks made them easier to ignore – whether the accusations of treason in all caps, or bizarre threats about 'Nuremberg 2.0'.
Everyone had a rough time during the pandemic – whether personally or professionally – and it was hard to see friends and family suffering, knowing the end was still so far away.
There were times where I ran close to the wire on burnout, feeling a sudden deterioration in my ability to focus and function. Each time I dialled things back as much as I could, trying to protect my energy for our most important work.
As well as woodland walks, I had a weekly poker game with friends on Zoom, and lots of cocktails and cooking with my wife. Then, when my son was born in late 2021, I finally took some proper leave.
Go-to meal after a long day of work? Thai green curry.
Kevin Fenton
‘My work-life balance was a constant concern’
I have always found being close to bodies of water comforting and healing. Throughout the most intense phases of the pandemic, it was no surprise that being close to the Thames was so therapeutic – whether when taking my morning walks, commuting into office, or sitting along the river bank to observe the ships, sunsets and silence of lockdowns.
The pandemic response was intense and relentless. At its peak we were easily working 18-hour days, with an incessant stream of emails, briefings, Teams and Zoom calls, and detailed outbreak management activities.
I committed to doing as much media, community and stakeholder briefings as I could – ensuring Londoners and those who served them had the best and most up to date information they needed.
Despite occasionally being at the receiving end of people’s frustrations, fears and critiques, I feel that the public and our partners saw we were doing our best under very difficult, uncertain and complex circumstances.
The long hours definitely had their impacts – it often meant time away from family and friends, more disrupted sleep, more unhealthy behaviours, and prolonged fatigue. Finding time to keep and restore work-life balance was a constant concern for me.
While I never thought about stepping back from the work, I did change my working patterns to force myself to completely disconnect from the pandemic response at least one day per week and encouraged all my team to do the same. Looking back this decision was one of the best things we did for our personal resilience.
Favourite TV programme of the pandemic? RuPaul’s Drag Race.
June Raine
‘I cannot tell you how grateful I am’
Memories of days during the pandemic blur into one. It was never in question that we would simply work and work, and keep working, morning, noon and night, to find safe vaccines and treatments that might be effective against Covid. It never felt like a sacrifice in any way.
Regulators like me are rule-makers and rule-followers and so when the government advice was to go for a half-hour walk every day, that is exactly what I did. The Common in Saffron Walden near my lockdown base was a lovely, tranquil place and where I would go to decompress.
In one corner of the Common is the ancient maze or labyrinth, cut into the turf, which dates from medieval times. It came to symbolise for me the kind of puzzling dilemma and the uncertainty posed by the pandemic.
When little children see the maze, they don’t stand and puzzle. They just run to it, run along the path, never stopping until they solve it and reach the centre. They don’t ever pause or give up, and neither did we. They don’t cut any corners, and neither did we.
I’m often asked, ‘was it a hard decision approving the first vaccine?’ In truth, no, not at all – because of the brilliant science, the clear data showing its efficacy and safety, and the dedication of our review teams and experts.
I was also confident because of the plan we had in place to get the public reporting to us after their jab, so we could see how safe it was in real life. That close to half a million have done so is simply incredible. I cannot tell you how grateful I am, and millions more around the world have reason to give thanks too.
Proudest moment? Giving the green light for the first Covid vaccine.
Protect yourself and your family by learning more about Global Health Security | Vaccine Development |
Mayo Clinic announces $5 billion expansion of Minnesota campus
The Mayo Clinic has announced a $5 billion expansion plan that includes new buildings designed so they can evolve and expand as patient needs change over the coming decades
MINNEAPOLIS -- The Mayo Clinic announced a $5 billion expansion plan for its flagship campus Tuesday that includes new buildings designed so they can evolve and expand as patient needs change over the coming decades.
The project is part of a Mayo strategy to transform both patient care and its campus in downtown Rochester, about 80 miles (130 kilometers) southeast of Minneapolis. This storied hospital is known for its patient care as well as scientific breakthroughs in cancer and gene therapies. It draws patients from around the world.
A key to it will be the creation of “neighborhoods” within the new facilities, where patients can go for all the services they need for their particular condition, such as cancer, without needing to be shuttled between various departments. Another component of that strategy will be integrating in-person and virtual visits, and taking advantage of artificial intelligence, including to accelerate the development of new cures.
The idea is to blur the traditional lines between inpatient and outpatient care, and between digital and in-person care, Dr. Gianrico Farrugia, Mayo's CEO, said in an interview. That requires rethinking how the buildings themselves are designed, he said.
“This is not about making a nicer facility," Farrugia said. "This is making a place that will give a better outcome.”
Mayo will add five new buildings with 2.4 million square feet (223,000 square meters) of space as part of the project. They’ll be designed so their spaces can be easily converted to new uses when needs change, such as from patient rooms to operating rooms.
Much of that space will be in two new clinical buildings at the center of campus. Each will have nine floors but they'll be as tall as a more conventional 16-story building, and they'll be designed strong enough so that more floors could be added in the future. Skyways and tunnels will connect the new facilities with existing buildings
Mayo is funding the project with its own money as part of its long-term plans, Farrugia said. Most construction will begin in early 2024. Some facilities are expected to begin operating as early as 2028, with completion projected for 2030.
Farrugia said Mayo hopes the new facilities will "serve as an example for what a global health care facility should look like.” | Medical Innovations |
Alzheimer’s drug approval unlikely to ease tension over coverage
An ongoing fight among Medicare officials, Alzheimer’s patient groups and lawmakers over coverage of a new Alzheimer’s drug is not likely to abate, despite it getting the green light from federal health officials.
The Food and Drug Administration on Thursday granted full approval to the drug, called Leqembi, based on clinical trial data showing it slowed cognitive decline by about 27 percent compared to a placebo.
Leqembi, developed by Eisai and Biogen, is the first drug approved that can slow the course of Alzheimer’s disease. FDA gave it fast-track approval in January, allowing manufacturers to launch the treatment based on preliminary evidence.
FDA’s full approval also triggered expanded Medicare coverage for patients, but with a major caveat.
Specifically, the Centers for Medicare and Medicaid Services will require patients and clinicians to participate in a registry, which will collect evidence about how the drug works in the real world.
Medicare’s requirement for a registry applies to all so-called anti-amyloid drugs “that may slow the progression of Alzheimer’s disease.” No other FDA-approved medication has that type of requirement.
Patient advocacy and industry groups have been lobbying intensely for no coverage limits and have the support of bipartisan lawmakers. They were incensed by the decision and claim it will be a barrier to widespread treatment access.
Leqembi is just the second drug in its class, and there are more on the horizon. Advocates want Medicare to change its policy before any others get approved.
“I can’t see how they would justify letting a policy stay in place that’s based on such an outdated read of the evidence, based on what we have today,” said Robert Egge, chief public policy officer and executive vice president of public affairs at the Alzheimer’s Association.
In a statement Thursday, Alzheimer’s Association leaders said they felt CMS listened to them by designing a “low touch” registry to be as easy to use as possible.
But Egge said he was disappointed the agency did not start a formal process to reconsider the requirement altogether.
“This reconsideration is extremely important and long overdue. We will continue to work with the administration and Congress to ensure the initiation of this process,” Egge said in a statement.
Congress has also been pushing for broad Medicare coverage.
House Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.) said in a statement on Wednesday, ahead of FDA’s decision, that CMS should already be covering Alzheimer’s treatments that have been cleared under the FDA’s accelerated approval process.
Once the agency grants traditional approval, “there will be no excuses for CMS to effectively deny coverage to Americans in need,” McMorris Rodgers said.
Rep. Anna Eshoo (D-Calif.), the ranking Democrat on the Energy and Commerce health subcommittee, on Thursday said it was “essential for Medicare to provide the broad coverage it has promised for Alzheimer’s treatments that receive traditional approval. I will be watching closely to make sure that promise is delivered. Families and patients deserve access to the life-changing drug without unnecessary burdens on patients or doctors.”
The concern is not merely hypothetical.
Eli Lilly in May released initial results from a clinical trial of its new Alzheimer’s antibody treatment that were comparable to Leqembi, and the FDA could approve it by the end of the year.
Jason Karlawish, a co-director of the University of Pennsylvania’s Penn Memory Center, said he thinks the U.S. health system is unprepared for these new drugs. Fighting over access, he said, misses the point.
“There’s been this rhetoric around the need for wide access to the drug that kind of simply misses the fact that the issue is rational access to a drug,” Karlawish said. “It’s got benefits, it’s got risks. It’s complicated and it’s landing in a health care system that’s not ready for it.”
But others said a registry requirement doesn’t make sense, especially for future drugs.
Dennis Selkoe, co-director of the Center for Neurologic Diseases at Brigham and Women’s Hospital in Boston, who has consulted with Eisai, said having a registry requirement for only Alzheimer’s drugs could send a message to patients that regulators don’t think the drugs work.
“You ask yourself … what was happening here? Why is this so sensitive that it needs a registry of all patients? Because the implication could be, we don’t think this stuff really works. We’re worried that it might not be useful. And of course, that will give pause to patients,” Selkoe said.
“Many of us assume that Medicare cannot say what they really are concerned about, which is the total cost of an extensive therapeutic for arguably the most common brain disease in humanity,” Selkoe said.
Leqembi is expensive; it costs $26,500 a year, and experts said widespread uptake could significantly increase Medicare premiums. Leqembi is an infusion drug administered by a physician, so it is covered under Medicare Part B.
About 6.7 million people in the United States are diagnosed with Alzheimer’s, and that number is expected to rise as the population ages. There about 1.5 million people estimated to be in the early stages of Alzheimer’s.
Drugmaker Eisai has said it expects only about 100,000 patients will be using the drug in its first three years on the market.
“Even if that relatively conservative number turns out to be correct, that’s still $2.7 billion in annual spending for this drug. If the take up rate is higher, the numbers obviously are going to be greater,” said Tricia Neuman, senior vice president of the health research group KFF and executive director of its Medicare policy program.
If just 5 percent of people with Alzheimer’s disease take the drug, the cost would be closer to $9 billion in additional spending annually for Medicare— roughly equal to spending on the top three Part B drugs combined in 2021, Neuman said.
Some Medicare patients could be also responsible for more than $5,000 per year in out-of-pocket copay costs for the drug.
There are also serious safety concerns with Leqembi and Eli Lilly’s drug, called donanemab.
If Medicare requires reporting of the side effects, that can help inform the development and trials of other drugs in the future.
FDA’s approval of Leqembi came with a black box warning on the drug’s label, stating that in rare cases it can cause “serious and life-threatening events” and that there have been cases of brain bleeding, “some of which have been fatal.”
Three people died during the primary trial, and about 13 percent of all participants who took Leqembi showed potentially serious brain bleeding and swelling.
“I think given the controversies, given the costs, given the side effects, it’s important that we keep collecting data, and I think it’s reasonable to require [a registry],” said University of Kansas Medical Center neurologist Jeffrey Burns.
“It will on some level exacerbate access issues, but … I don’t think the registry will be necessary forever. But right now, I think it’s reasonable,” Burns said.
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. | Drug Discoveries |
Early epigenetic instructions anticipate next steps of gene activity during blood cell development
University of Birmingham researchers are working to understand how cells are prompted to develop into different cell types, vital for performing different functions within the body. In this study published in Life Science Alliance, researchers were looking at the differentiation of early cell types, known as embryonic stem cells, into blood.
This study builds on work from a previous Nature Communications publication earlier this year, where the team led by Professor Constanze Bonifer and Professor Jean Baptiste Cazier, developed a new test that functionally identifies all regions in the genome that are responsible for activating genes during the early stages of blood cell development, called enhancers.
More recently, they have studied the activity of these DNA elements in detail and found that many of them are already activated way before the start of gene expression, a process called "chromatin priming." Chromatin is a mixture of DNA and proteins, where the proteins are responsible for packaging the DNA into a unit capable of fitting inside a cell nucleus. Chromatin can be referred to as either "open" or "closed."
This recent study has identified regulatory elements that exist in open chromatin before the onset of expression of their linked gene. Essentially, at each step of development, the next step is already being anticipated.
"Chromatin priming and the precise timing of the activation of enhancer elements driving gene expression at the right time and in the right cell type is at the very heart of all coordinated, synchronized cell differentiation processes that create fully developed multicellular organisms," says Bonifer.
The study used gene editing to take out one of these priming elements and showed that they play a very early role in the instruction booklet for cell development. Without them the process stalls before it starts. Moreover, they also found that outside signals can program the activity of priming elements, thus setting specific developmental pathways in motion.
Professor Jean-Baptiste Cazier, from the Institute of Cancer and Genomics, the University of Birmingham said, "Our priming element resource adds an additional dimension to our ability to interrogate the fine details of hematopoietic specification from embryonic stem cells and model blood cell development in vitro and in silico."
Cell development is a complex process with many steps and scientists have been working to understand the details of these processes for many years. Understanding how these complex processes work will give us a better understanding of when things go wrong, the knock-on effect that can cause, and may even shed light on how to target treatments at these malfunctioning processes to alleviate disease.
More information: Alexander Maytum et al, Chromatin priming elements direct tissue-specific gene activity before hematopoietic specification, Life Science Alliance (2023). DOI: 10.26508/lsa.202302363
B. Edginton-White et al, A genome-wide relay of signalling-responsive enhancers drives hematopoietic specification, Nature Communications (2023). DOI: 10.1038/s41467-023-35910-9
Journal information: Nature Communications
Provided by University of Birmingham | Disease Research |
A loophole allowing retailers to give free vape samples to children is set to be closed under government plans to curb their use among young people.
A new crackdown on vape marketing would prevent the "unacceptable" targeting of children and teens, Rishi Sunak said.
There will also be a review into the rules around the sale of "nicotine-free" products to under-18s.
Labour called the announcement a "baby step" and said urgent action is needed.
The government plans also include a review of rules on issuing fines for shops selling illicit vapes.
By tightening the law, it said it would be easier for local trading standards officials to issue on-the-spot fines and fixed penalty notices to shops who sell vapes to underage people.
While selling vapes to under 18s is illegal, nicotine-free products can be sold.
The government said NHS figures showed a rise in underage vaping, with cheap and colourful products attracting children.
According to the latest NHS figures, nine per cent of 11-15 year olds in 2021 had used e-cigarettes, up from six per cent in 2018.
Two out of five young people said they smoke vapes "just to give it a try", and about one in five because "other people use them so I join in", according to the results of a recent government survey.
A BBC investigation found that a haul of illegal vapes confiscated at a school included some with double the safe levels of lead and even higher with nickel. The Prime Minister said he was shocked by this finding.
There is now a fast-moving debate on how to tackle vaping by children.
Teachers and parents have expressed concerns about the increased availability of the products and that some pupils say they have become addicted to nicotine through vaping.
Under the law, only the sale of nicotine products to people under 18 is banned.
While tobacco products cannot be given out to under-18s for free, this is not currently the case with nicotine products like vapes.
The government said that while most businesses are not carrying out this practice, some rogue traders are taking advantage of the loophole.
In the last year, around 20,000 children in the UK were given a free vape, according to data from Action on Smoking and Health (ASH).
Last week, the PM spoke about his concern about the rise in vape use among younger people, telling ITV's This Morning he did not want his daughters "seduced by these things".
He said it was "ridiculous" that vapes are promoted to children, and pledged to look at ways of strengthening marketing rules.
Announcing the new set of measures aimed at limiting underage vaping, he said he was "deeply concerned" about an increase in children vaping and was "shocked by reports of illicit vapes containing lead getting into the hands of schoolchildren".
"The marketing and the illegal sales of vapes to children is completely unacceptable and I will do everything in my power to end this practice for good," he said.
Chief Medical Officer Professor Sir Chris Whitty called the decision to close the loophole a "very welcome step".
"Whilst vaping can be an effective quitting tool for smokers, it is important that non-smokers are not encouraged to start vaping," he said.
"There has been a particularly worrying rise in the number of children using vapes, with companies clearly marketing these products at children using colours, flavours and cheap disposable options.
"We should continue to encourage smokers to swap to vaping as the lesser risk, whilst preventing the marketing and sale of vapes to children."
The latest announcement comes just weeks after ministers unveiled a new enforcement drive and called for evidence on what further steps to take. Mr Sunak's intervention suggests he feels the need to go further.
Pupils will also be taught about the health risks of vaping in Relationships, Sex and Health Education lessons, as part of the ongoing government review of the curriculum.
And a resource pack for schools on vaping is being developed, which will be rolled out online in July.
Intended for children aged 11-13, the educational resource will inform young people about the addictiveness of nicotine and the evidence that their developing brains may be more sensitive to its effects.
The move follows the government establishing a vape enforcement squad last month to increased education around the dangers of vaping in schools, as well as school police liaison officers to remove e-cigarettes.
Health minister Neil O'Brien called any marketing of vaping products to children "shameful".
He said the government would "review the rules" into vaping knowing that they can be "a gateway" to using other nicotine products like cigarettes.
Labour's shadow health secretary Wes Streeting said: "We have to act now to stop a new generation of kids getting hooked on nicotine.
"But the Conservatives voted down Labour's plan to ban the marketing of vapes to children.
"This new announcement is a baby step when we need urgent action now.
"The next Labour government will come down like a tonne of bricks on those pushing vapes to kids."
The Chartered Trading Institute, which oversees trading standards in the UK, said it welcomes the government's announcement, and that the measures "were necessary".
A spokesman said: "Some retailers are not acting responsibly and continue to knowingly sell to people under 18 years old.
"In addition to reducing the accessibility of vaping we also want to ensure that vaping becomes less attractive to non-smoking young people and welcome the measures to address the youth appeal of vapes through marketing and promotional activities in shops."
Already campaigners are arguing that it needs a bolder approach with taxation to make vapes less affordable, while continuing to promote them as an option for adult smokers wanting to quit the habit.
Deborah Arnott, ASH chief executive, said while it welcomed the government's actions, the PM's proposals were just "baby steps" when it comes to tackling the issue.
She said: "Our surveys show that the growth in youth vaping is primarily in cheap disposables costing as little as £1.99, which is why we called on the government to put an excise tax on single use vapes in the Spring Budget, but to no avail.
"A finance bill could easily be put before parliament to put a fiver on every single use vape, which would make them much less affordable for children, who are very price sensitive."
Ms Arnott added that in 2021, the government refused to accept cross-party amendments to the Health and Social Care bill, which would have given it powers to regulate branding and ban the free distribution of vapes.
"If those powers were in place today action could be taken now without further delay," she added. | Health Policy |
If you have high cholesterol, youâre also at higher risk for heart disease. But the good news is, itâs a risk you can control. You can lower your âbadâ LDL cholesterol and raise your âgoodâ HDL cholesterol. You just have to make some simple changes.
âI tell patients that you have to start somewhere and just keep going,â says Suzanne Steinbaum, DO, an attending cardiologist at Lenox Hill Hospital in New York City. âAs you adopt lifestyle changes, everything starts shifting, and the improvements you see at 6 weeks often increase by 3 months.â
Lifestyle isn't everything -- your genes matter, too. You still may need to take medicine to get your cholesterol back on track. But your daily habits do help. if you make just a few simple changes, you might be able to lower your medication dose and chance of side effects.
Follow these tips to cut your cholesterol and improve your health.
Ban Trans Fats
Thatâs why the FDA has taken steps to remove artificial trans fat from the food supply. But small amounts of trans fat could still be in some products. So when you shop for food, check the Nutrition Facts labels and ingredients. If you see âpartially hydrogenated oilâ on the package, thatâs just a fancy name for trans fat.
Scale Back
You donât have to lose a lot of weight to lower your cholesterol. If youâre overweight, drop just 10 pounds and youâll cut your LDL by up to 8%. But to really keep off the pounds, youâll have to do it over time. A reasonable and safe goal is 1 to 2 pounds a week. The National Heart, Lung and Blood Institute notes that while inactive, overweight women usually need 1,000 to 1,200 calories daily for weight loss, active, overweight women and women weighing more than 164 pounds usually require 1,200 to 1,600 calories each day. If youâre extremely active during your weight-loss program, you may require additional calories to avoid hunger.
Get Moving
âExercising at least 2 1/2 hours a week is enough to raise HDL and improve LDL and triglycerides,â says Sarah Samaan, MD, a cardiologist in Plano, TX. If you havenât been active, start slowly -- even 10-minute blocks of activity count. Choose an exercise you enjoy. And buddy up: An exercise partner can help keep you on track.
Fill Up on Fiber
Foods like oatmeal, apples, prunes, and beans are high in soluble fiber, which keeps your body from absorbing cholesterol. Research shows that people who ate 5 to 10 more grams of it each day saw a drop in their LDL. Eating more fiber also makes you feel full, so you wonât crave snacks as much. But beware: Too much fiber at one time can cause abdominal cramps or bloating. Increase your intake slowly.
Go Fish
Try to eat it two to four times a week. âNot only are the omega-3 fats in fish heart-healthy, but replacing red meat with fish will lower your cholesterol by reducing your exposure to saturated fats, which are abundant in red meat,â Samaan says. The catch? Some types, like shark, swordfish, and king mackerel, are high in mercury. That can increase your risk for heart disease. Instead, choose wild salmon, sardines, and bluefin tuna. Omega 3 vs omega 6: What's the difference?
Opt for Olive Oil
âSubstituting olive oil for butter may reduce LDL cholesterol by as much as 15%, which is similar to the effect of a low dose of medication,â Samaan says. The âgoodâ fats in olive oil benefit your heart. Choose extra-virgin olive oil. Itâs less processed and contains more antioxidants, which help prevent disease.
Go Nuts
Most types can lower LDL. The reason: They contain sterols, which, like fiber, keep the body from absorbing cholesterol, Steinbaum says. Just donât go overboard: Nuts are high in calories (an ounce of almonds packs 164!).
Chill Out
Did you know that when youâre stressed, your cholesterol can go through the roof? Relax. Get lost in a good book, meet a friend for coffee, or take to your yoga mat. Itâll help keep your cholesterol in check.
Spice It Up
If you donât already dust your cappuccino with cinnamon or shake pepper on your pasta, listen up: Spices like garlic, curcumin, ginger, black pepper, coriander, and cinnamon do more than flavor your food, they can also improve cholesterol. Research shows that eating a half to one clove of garlic each day could lower cholesterol up to 9%. Bonus: Adding extra seasoning to your food also reduces your appetite, so itâs easier to drop excess pounds, Steinbaum says.
Butt Out
âSmoking can raise LDL and lower HDL, and quitting often improves those numbers,â Samaan says. In one study, people who stopped smoking saw their âgoodâ cholesterol rise 5% in one year. But if youâre regularly around smokers, take heed: Breathing secondhand smoke every day can also raise levels of bad cholesterol.
Laugh More
Laughter is like medicine: It increases HDL, Steinbaum says. Need to add some comic relief to your life? Check out silly pet videos online, sign up for a joke-a-day email, or watch funny movies. | Nutrition Research |
Researchers discover promising treatment to combat hospital superbug
Cal State Fullerton antibiotic-resistance researcher María Soledad Ramírez and her students have discovered a promising new therapeutic to treat Acinetobacter baumannii, a superbug commonly found in hospitals and resistant to many antibiotics.
Carbapenem-resistant Acinetobacter baumannii, called CRAB, is a pathogen with limited antibiotic treatment options. It has gained attention recently due to its rapid prevalence in hospital and health care settings and global spread. The bacteria, listed as an urgent antibiotic resistant threat by the Centers for Disease Control and Prevention, causes severe infections in vulnerable patients with weakened immune systems.
In their study, the researchers tested different lactic acid bacteria strains, known as LAB, to see how well they prevented A. baumannii growth. One strain, called Lacticaseibacillus rhamnosus CRL 2244, turned out to be effective at stopping A. baumannii from growing—and even causing the bacteria to die, said Ramírez, professor of biological science.
"Lactic acid bacteria are a type of bacteria that could be a promising treatment option. In this study, we looked at how different LAB strains can fight against CRAB using various tests and studying at the genetic level A. baumannii response," Ramírez said.
Ramírez's latest study outlining these findings as a possible solution has been published in Scientific Reports.
The researchers' results show that Lacticaseibacillus rhamnosus CRL 2244 has the power to fight A. baumannii.
"These findings could be a new alternative to treat these infections, either on its own or alongside other treatments," Ramírez added. "Our latest work is an exciting step in the right direction. However, we need to explore these findings further to make this a real option for treating carbapenem-resistant Acinetobacter baumannii infections."
Co-authors of the paper include CSUF's Nicholas Salzameda, chair and professor of chemistry and biochemistry; biological science undergraduates Briea Gasca and Nardin Georgeos, a Bridges to Stem Cell Research program scholar; and alumna Dema Ramlaoui (B.S. biological science-molecular biology and biotechnology), who is applying to medical school.
Salzameda is assisting with extracting the active chemical components and will contribute to upcoming experiments.
Gasca has worked alongside Ramírez the past year, studying molecular biology and biotechnology. The undergraduate research experience has expanded her knowledge, improved her laboratory skills, and boosted her confidence and drive toward a career in science.
"It has been the best opportunity of my academic career and has fueled my desire to keep contributing to discovering new ways to battle against multidrug-resistant pathogens to advance public health," said Gasca, a past scholar in the university's Research Careers Preparatory Program, which raises student awareness about research and mentoring opportunities.
While this is Gasca's first published research paper, she is looking forward to future research experiences that will prepare her for graduate studies and a career in biotechnology.
"Being a co-author on this paper is such a big accomplishment, and I hope it goes to show my future employers the dedication and credibility I have for this kind of research."
Research collaborator and first author Cecilia Rodriguez, a visiting scholar from Argentina from late 2021 to March 2022, also played a key role in the project.
Rodriguez, an assistant researcher at CONICET-CERELA (Centro de Referencia Para Lactobacilos), is an expert in working with lactic acid bacteria, including exploring various aspects of their functionality. Her research group at CONICET-CERELA provided the LAB strains to do the project.
"During her visit to Cal State Fullerton, we tested the activity of various LAB strains against resistant A. baumannii strains. She also contributed to RNA extraction experiments and helped write the paper," Ramírez said.
Ramírez underscored the importance of research to create new and effective antibiotics to fight infections caused by multidrug-resistant bacteria—and save millions of lives lost worldwide.
"It's important to continue studying and developing LAB as a potential treatment to fight against CRAB infections to give us more options to deal with these difficult-to-treat infections," she said.
More information: Cecilia Rodriguez et al, Antimicrobial activity of the Lacticaseibacillus rhamnosus CRL 2244 and its impact on the phenotypic and transcriptional responses in carbapenem resistant Acinetobacter baumannii, Scientific Reports (2023). DOI: 10.1038/s41598-023-41334-8
Journal information: Scientific Reports
Provided by California State University, Fullerton | Drug Discoveries |
If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing "988," or the Crisis Text Line by texting "HOME" to 741741.
After her teenage daughter attempted suicide and began to cycle through emergency rooms and mental health programs during the past three years, Sarah Delarosa noticed her own health also declined.
She suffered from mini strokes and stomach bleeding, the mother of four in Corpus Christi, Texas, said. To make things worse, her daughter's failing behavioral and mental health caused Delarosa to miss hours from her job as a home health aide, losing out on income needed to support her family.
"Access to help, when it's needed, it's not available," said Delarosa, about the hopelessness she felt as she sought support for Amanda, 16, who has been diagnosed with bipolar disorder, oppositional defiant disorder, and attention-deficit/hyperactivity disorder. Amanda has at times lashed out in anger or shattered light bulbs and used the broken glass to cut herself.
Delarosa often feels overwhelmed, and she has noticed her youngest son acting out. "Now we have a whole family that needs help," she said.
A national shortage of mental health care providers, and the search for affordable care, has exacerbated strain on parents, often the primary caregivers who maintain the health and well-being of their children. Their day-to-day struggle has led to its own health crisis, say psychologists, researchers, and advocates for families.
As parents navigate the mental health care system's shortcomings, stress can start to take a physical and mental health toll that disrupts their ability to continue providing care, said Christine Crawford, the associate medical director at the National Alliance on Mental Illness, an advocacy group that helps families find care. Parents pour their energy into helping their kids, often at the expense of their own health, Crawford said.
"When you are worrying about whether or not your child is going to survive the day, you are constantly living on edge," she said. "Your fight-or-flight is constantly activated."
And the number of parents in crisis is greater than it seems.
Recent reports from the Centers for Disease Control and Prevention, the surgeon general's office, and medical providers all show an alarming number of kids in the U.S. are experiencing severe mental health challenges. About 40% of U.S. parents with children younger than 18 say they are extremely or very worried their children might struggle with anxiety or depression at some point, according to a January study from the Pew Research Center.
Evidence-based therapies to address a child'sshould include the parents, say researchers and pediatric mental health specialists. But the focus on the adult caregivers and their anxiety and stress too often falls short. For example, parent-child interaction therapy coaches parents to manage their young child's behavior to prevent more severe problems in the child later on. While this may help the child, it doesn't directly support the parent's health.
"I have so many parents sit across from me on the couch and cry," said Danielle Martinez, a behavioral health specialist at Driscoll Children's Hospital in Corpus Christi. The hospital is creating peer support groups, to launch by the fall, for family members whose children are under the facility's care.
"They felt so alone, felt like bad parents, felt like giving up," Martinez said, "and then felt guilty for wanting to give up."
When the parent's mental and physical health deteriorates, it complicates their ability to prevent the child's condition from getting worse, said Mary Ann McCabe, a member of the board of directors at the American Psychological Association, an associate clinical professor of pediatrics at the George Washington University School of Medicine, and a psychologist in independent clinical practice. Parents are a kid's most important resource and need to be a concern, she said.
Delarosa said many residential treatment centers cited a shortage of providers in refusing to admit her daughter. Amanda, who is covered through Medicaid, would be on weeks-long waiting lists while she "spiraled out of control," running away from home and disappearing for days, said her mom.
In April, Amanda was admitted to an inpatient residential treatment facility nearly 200 miles away, in San Marcos, Texas. With Amanda away, Delarosa said, she had a "chance to breathe," but the reprieve would be temporary. She wants to see a therapist but hasn't had time amid the demands of caring for Amanda and her youngest child, a son. Before Amanda left for treatment, her 7-year-old brother started cussing, throwing and breaking objects in the home, and saying things like he wished he weren't alive, though his behaviors settled down while his sister was away.
Other parents also said they are feeling the strain on their mental and physical health.
"The children are in crisis. But the families are also in crisis," said Robin Gurwitch, a professor in psychiatry and behavioral sciences at Duke University. "They are struggling to figure out how best to help their children in a system that doesn't come with a manual."
Brandon Masters, a middle school principal in San Antonio, developed a rash on the back of his arms and neck last year that he says his doctor told him was connected to stress.
Even though he is insured through his job, Masters estimates he paid about $22,000 last year on care for his teenage son Braylon, who spent 60 days in residential treatment centers in Texas and California following a diagnosis of bipolar disorder. Braylon spent an additional month in juvenile detention later in 2022 after he bit his dad and brandished a knife. So far this year, Braylon, now 17, has attempted suicide twice, but Masters has been unable to find a residential treatment center he can afford and that will admit Braylon.
"There is this huge wave of anxiety that comes over me that makes it difficult to be around him," Masters said.
Anne Grady's 20-year-old son has autism, severe mood disorder, developmental delays, and other conditions. For nearly 17 years he has been on a Texas waiting list to receive full-time care.
Grady, who lives in a suburb of Austin, Texas, developed a tumor in her salivary glands and temporary facial paralysis, which added to the stress she faced navigating care for her son.
"It's mentally exhausting for families," Grady said. The lack of care is "punishing the kids and punishing for families," she said.
Medicaid is the state-federal program that pays medical and other health-related bills for low-income and disabled people. Yet while many state Medicaid programs pay for family therapy and parenting programs, they don't address the parent as an individual patient affected by their child's health under a child's plan, said Elisabeth Burak, a senior fellow at Georgetown University's Center for Children and Families. Parents who live in one of the 10 states that haven't expanded Medicaid, including Texas, face an additional challenge getting care for their own mental health.
Still, states are starting to recognize that caregivers need more support. Many states allow Medicaid to cover services from certified family peer specialists or navigators, who have experience raising a child with mental illness and additional training to guide other families. In July, California awarded money to support parents as part of a child mental health initiative.
"The most important thing that we should give families is a sense of hope that things will get better," said Gurwitch. Instead, the lack of quality mental health care services for youth exacerbates their risk for illnesses. Without appropriate help, these conditions follow a child — and their parents — for years, she said.
With Amanda returning home from the residential treatment program this month, Delarosa worries she won't be equipped to manage her daughter's bouts of depression.
"It's the same thing over and over, nonstop," Delarosa said. "I have driven myself crazy."
When Grady's son turned 18, she acquired continued guardianship so she could continue arranging his care outside their home. "I love him more than anything in the world, but I can't protect him," she said.
Masters, whose skin conditions have worsened, is just trying to get Braylon through his final year of high school, which starts this month. He's also renewing his search for a residential treatment center, because Braylon's negative behaviors have escalated.
"When they are born, you have all these dreams for your kids," said Masters. Instead, health professionals who have cared for Braylon told Masters, he needs to be prepared to look after his son even after he finishes high school. "No parent wants to hear that," he said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
for more features. | Mental Health Treatments |
Advocates applaud DEA for being open to relaxing virtual prescribing rules
Telemedicine advocates are applauding the Drug Enforcement Agency for being open to relaxing its rules on allowing controlled substances to be prescribed via telemedicine.
The DEA on Friday in a notice said it is open to creating a special registration process that would allow providers to prescribe certain controlled substances for patients without requiring the patient to ever have an in-person medical evaluation.
The agency will hold a listening session next month to allow the public to weigh in on the issue. In-person attendance requests will be granted via a lottery, and the agency said it will “exercise its discretion” in selecting presenters “to select a cross-section of persons and organizations.”
Stakeholder groups and lawmakers have been pressing DEA to change its policy, and said the meeting is a positive sign.
“Given the shortage of mental health providers and the increased need for access to prescribers through telehealth, I’m pleased that the DEA is finally looking into establishing a rule to allow specially trained prescribers to continue administering controlled substances virtually without requiring an in-person visit,” Sen. Mark Warner (D-Va. ) said in a statement.
Telehealth lobbying group ATA Action said it “welcomed” the announcement that DEA would consider a special registration process, as well as the listening session. Kyle Zebley, executive vice president of ATA Action, in a statement said the group will “do everything possible to fully represent the voices of the telehealth community.”
During the COVID-19 public health emergency, DEA relaxed its restrictions on controlled substance prescriptions. Previously, patients needed at least one in-person visit, but the DEA changed the rule in order to prevent lapses in care.
Controlled substances covered by the rule include stimulant medications for attention-deficit hyperactivity disorder, anxiety medicines, or medications for opioid use disorder.
In February, the agency proposed new rules rolling back those flexibilities ahead of the public health emergency declaration ending May 13. The agency said it received nearly 38,000 comments on the proposal, a record number.
“A significant majority expressed concern, with respect to at least some controlled substances, that the proposed regulations placed limitations on the supply of controlled substances that could be prescribed via telemedicine prior to an in-person medical evaluation,” DEA said in its Friday notice.
In May, just before the emergency expired, the DEA said it would temporarily extend the pandemic’s telehealth flexibilities through Nov. 11.
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. | Health Policy |
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Minutes after Lainey Arebalo gave birth to her third child last September, hospital staff noticed her son was having trouble breathing. They recommended placing the infant in an ambulance so he could receive care at a better-equipped pediatric facility 23 miles away. Within days of receiving that extra care, Avebalo was able to bring her healthy baby home where their waiting family welcomed him.
But a few weeks later, as everyone adjusted to the newborn’s fickle schedule and Arebalo continued her own recovery, letters began to show up. They said she now owed $4,400 for her son’s ambulance ride.
She called her insurer, only to learn they did not cover transportation from this company. It was the only ambulance company in her county. Arebalo still tried to get the two parties to talk to each other. By October, the ambulance company threatened to turn her over to a collections agency if she did not pay.
“The ambulance bill was an actual surprise bill,” said Arebalo, 29, a special education teacher in San Luis Obispo County, California. “We did not think it was going to be as much as it was.”
Arebalo and her family are not alone. To access emergency care, one in 10 non-elderly people who are privately insured take an ambulance, according to the Peterson-KFF Health System Tracker. But in most places, there is virtually no way to know how much that ride will cost. While 13 states have taken steps to protect patients against surprise bills for ambulance care, there are no national protections.
When Congress passed the No Surprises Act in 2021 to curb such billing elsewhere in health care, lawmakers dropped measures that could have reined in how much an ambulance would cost. Some lawmakers and advocates feared the deal could collapse altogether if there was too much political haggling. As a result, the price of an ambulance trip can still vary widely for reasons that no patient can reasonably foresee or control.
In a study published this year in the journal Health Affairs, researchers looked at data of emergency trips via ground ambulance between 2014 and 2017 for people who were commercially insured. They found that 28 percent of those trips resulted in surprise bills.
Following a single ambulance ride, people could be confronted with astronomical bills, debt or even medical bankruptcy. To sidestep the risk of racking up costs, some people avoid ambulances altogether, gambling with time, transportation and their own health.
Ambulance providers are “eager to get the patient out of the middle of this scenario,” according to Wayne Jurecki, who serves on the board of directors for the American Ambulance Association, a trade organization. But insurance companies very often “have been under-reimbursing for critical life-saving services for quite a period of time” at rates that do not cover costs of having trained staff ready to respond to an emergency. So they turn to patients to foot the bill. This take-it-or-leave-it practice has continued even as major health insurance companies reported record profits, Jurecki said.
Ambulance companies also don’t choose who they pick up – in some states and jurisdictions, they are compelled by law to respond when they get a 911 call for a medical emergency, he explained.
“The model is ‘They call, and we show up,’” Jurecki said.
A 2022 report from AHIP, a lobbying group that advocates on behalf of health insurance companies, pointed out that too few ground ambulance providers participate in health plan networks, labeling that absence as a “market failure” and calling for more federal regulation. In the past, AHIP supported Congress’ decision to include price regulation for air ambulance services (i.e. emergency transportation on an airplane or helicopter) through the No Surprises Act.
Despite the lack of a ground ambulance provision in the final law, lawmakers agreed that they would pick up the matter at a later date. So Congress created the Ground Ambulance and Patient Billing Advisory Committee.
This week, that committee examined what can be done to reduce the systemic complexities and costs associated with ambulance services, and asked the public for input. Made up of experts on emergency health, transportation, state and local governments, and insurance regulation, in addition to consumer and patient advocates, the group is expected to issue a report with recommendations in November. (Members of the public have until Sept. 5 to submit comment via email at [email protected]).
When there is only one ambulance company serving a community (like in Arebalo’s case), individuals “can’t make a choice,” said Patricia Kelmar, a consumer advocate who directs health care campaigns for the U.S. Public Interest Research Group, during the committee’s Aug. 16 meeting. Patients are “doing the best they can to call the ambulance” when they are caught in a medical emergency, Kelmar said. They are in no position to choose who helps them – or whether an ambulance is considered out-of-network by their insurance – in a life-or-death situation, she said.
“The most important thing from the patient’s perspective is taking them out of the problem,” said Kelmar, who also serves on the committee.
So far, the panel has surveyed the complexities of the nation’s patchwork system of ambulatory care, as well as the existing rules that govern care and dictate who pays what. Typically, ambulance companies use trip mileage to charge patients, but those rates can vary between $20 per mile and $90 per mile, depending on where the patient was picked up and dropped off, Kelmar said.
The level of physical trauma, such as having a heart attack or sustaining multiple gunshot wounds, a person is experiencing during that ambulance ride can also add extra costs. Fire departments, hospitals, local governments or even private companies may offer these services, and those lines of responsibility may change by jurisdiction or availability at the time of an emergency dispatcher’s request for services. Some ambulance services are not reimbursed if crews who treat and stabilize a person on the scene no longer need to go to the hospital.
And as with so much in the U.S. health care system, an ambulance provider and its staff may or may not be considered in-network for those covered by insurance, which could inflate the price of a ride.. And In seven states, including California where the Arebalo family lives, more than two-thirds of ambulance rides included out-of-network related services, exposing patients to even greater risk of surprise bills.
Many standing rules are tied to outdated policies borne out of the 1960s, when the federal government launched Medicare. With so much variability, “there’s no one-size-fits-all for how emergency transportation is offered and paid for in the U.S.,” Kelmar said. The goal should be to drive toward the least costly forms of care, she added, but the system in place can foster “perverse incentives” to deliver care that doesn’t holistically meet a patient’s needs.
Roughly 13,000 ambulance providers operate nationwide, Jurecki said, and he said four in five of those providers carry less than 1,000 Medicare-billable trips per year. That means most ambulance providers may operate a pair of response vehicles driven by volunteers. That also often means these companies are too small to negotiate with major insurance companies, Jurecki said. Early on during the COVID pandemic, he noted, health care workers and first responders were revered for working so hard to keep people alive. Many first responders, including ambulance crews, are leaving the profession after years of working through a pandemic, Jurecki said.
Economist and health policy expert Loren Adler, who serves on the committee and worked to produce the study in Health Affairs, said that the hope is that their work will improve a system that is clearly broken.
There are many questions left for the panel to tackle. Should protections against surprise billing apply to all ambulance trips, emergency or not? What protections should be in place for transportation between health care facilities? When people are struggling in a medical emergency, should the concept of in-network versus out-of-network ambulance services be suspended altogether and instead be regarded as a universal benefit? These problematic scenarios – and the policy questions they pose – are pervasive, Kelmar said, and the public demands answers.
“The country is ready to solve” surprise billing on ground ambulances, she said.
It is hard to predict how a divided Congress will act. Adler, who serves as associate director for the USC-Brookings Schaeffer Initiative for Health Policy, said he remains “optimistic” that meaningful action can be taken on this issue, especially when so many people agree the current system is not working, including those who need it most.
Arebalo does not want anyone else to endure what she and her family have had to go through. While her insurance eventually agreed to pay for part of her son’s ambulance ride, that still left Arebalo on the hook for more than $2,000. As a teacher, she said she does not receive paid parental leave, so she had to cut short her time to recover at home with her son. She returned to the classroom a month early and has taught summer school to earn enough money to pay down that debt, $200 each month.
Because the ambulance company does not have a way for her to check how much of her bill is left, Arebalo said she will make those monthly payments until the ambulance company says the debt is satisfied.
“You get hit with a huge bill, and there’s nothing that can be done about it,” she said. “It’s not a good spot to be in financially. Some sort of heads-up would have been helpful.”
Laura Santhanam is the Health Reporter and Coordinating Producer for Polling for the PBS NewsHour, where she has also worked as the Data Producer. Follow @LauraSanthanam
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Mythical mothers, divine mothers and royal mothers. Ancient clay statuettes of pregnant women and contemporary explorations of birth. As an art historian of 20 years, I’ve seen a lot of representations of motherhood. And from Renoir’s wholesome portraits of his wife nursing their son to countless versions of the Madonna and Child, many of these images depicted blissful breastfeeding scenes. A few years ago, with my new baby asleep on my chest and unable to relax into sleep myself, I began obsessively searching for historical fragments of mothering lives – because I felt as if I was failing and needed something to tether myself to.When I decided to get pregnant, I already knew I wanted to breastfeed. Other parents decide it’s not for them – a decision I respect now more than ever – but it was how I pictured my motherhood. I carried these idealised artistic representations of breastfeeding with me into antenatal classes, where I watched a woman hold a doll to a knitted boob and made notes on the best feeding positions. In these classes, we were never told about formula milk or preparing bottles or about how we might feel if our feeding hopes didn’t go as planned.For the first days of my son’s life, just over four years ago, breastfeeding was as easy and brilliant as I had imagined. I forgot about the tiny amount of formula he’d been given at birth. About how, on the post-labour ward the following morning, a midwife told us formula is akin to feeding our newborns junk food. I forgot how jarring I found that comment, how it made me feel, as if, by letting my son have formula at birth, I’d already let him down.After we got home, I went to every breastfeeding support group I was fortunate enough to have locally and took all the advice given by the kind experts there. But still, feeding was often painful and I’d bite down on my knuckles, wondering why I felt so unprepared for this. What was perhaps even more surprising was the depth of my desire to continue. My niggling concerns that something wasn’t right were dismissed by GPs. Then, at four weeks old, my son was briefly admitted to hospital due to losing too much weight.Tests thankfully ruled out anything serious. The cause of his weight loss was “simply” too little milk. Overcome by guilt, I could blame only myself. We were sent home with instructions to buy formula, bottles and a breast pump and left to navigate bewildering and sometimes inconsistent advice. I was full of self-doubt, which seeped into the rest of my life, leaving me an unsure mother and broken wife. I spent hours expressing milk when I should have been sleeping and scrawled down equations to work out how much formula “top up” we needed. I meticulously logged feeding times, resulting in the kind of documentation I later found in Milk Report, by art duo Conway and Young, which calculates the economic value of the work of breastfeeding.The anger I felt towards myself for “failing” to feed my baby properly was only matched by the newfound awe and appreciation I had for my body, which had grown and birthed a baby, and which continued to make one of the most incredible substances on earth. So, with the support of a loving partner and empathic family and friends, I steadfastly and determinedly continued.Yet somehow focusing on the most vital task of my life made me feel small and inconsequential in the world. It was visual art that offered me solace in that tumultuous first year of new motherhood. Just looking at images helped me to make sense of my breastfeeding experience, providing pathways to reconnect to myself and helping me to understand why, at times, my breastfeeding body felt like a personal and societal battlefield.Louise Bourgeois said that “an artist can show things that other people are terrified of expressing”. In those early days I returned to her again and again, finding poignant humour in her work. Red pregnant bodies bleed across the white page with astronaut babies floating within them. Globular multi-breasted figures captured the strange, ever-changing landscape of a birthing body.In her Good Mother sculpture of a nursing woman encased in a bell jar, I recognised the depth of love in the gaze between mother and baby. I also saw myself in the tired mother’s isolation. But, more than that, the glass jar finally made me see how much we are expected to mother in a detached world. A world in which motherhood as an ideal is exalted, while mothers themselves are too often sidelined, unsupported and filled with doubt.This immediate, visceral response to art led me to other questions brewing in my sleep-deprived mind. What did mothers before me do? Why did wet nursing fall out of favour in western Europe? Why did I feel nervous when I first fed my baby in public, when our art galleries are full of images of breastfeeding? As I began what would become the initial research for my book, Milk, I learned that while breastfeeding defines us as mammals, beliefs around it change, influenced by social, political and religious factors. I started to understand just how confused and contradictory our culture is when it comes to breasts and breastfeeding.Meanwhile, I continued to struggle, making weepy calls to the fantastic breastfeeding helpline and finding a chorus of solidarity and encouragement in mums’ groups and internet forums. Yet, when I went to the GP with a serious breastfeeding injury, she told me she had never heard of that happening before and suggested I switch to formula. I once again collapsed into shame that apparently my body was still doing it wrong.It was only when I idly searched the archives of the Wellcome Collection and happened across Victorian nipple shields that I realised some women would have always needed to find ways to mitigate breastfeeding pain. As I looked at examples made from tin, glass or wood, I gave wry thanks for the slippery silicone shields I had previously so resented.The more I looked, the more I felt myself being stitched into a larger history. I pored over different remedies offered to lactating women across the world, from cabbage leaves and seashells to jasmine flowers and spicy foods. I became entranced by a rare, 6th-century Indonesian bronze statue of a seated weaver who has paused her work at her loom to breastfeed, captivated by the detail of the baby tweaking a bare nipple while they fed. In the ancient Woman of Willendorf, I saw, for the first time, a postpartum woman in all her vulnerability and supreme power. I studied paintings depicting a startling moment in history when, during the late 18th century, it was more economically viable for Parisian parents to send their babies to wet nurses in the countryside while they worked in the city. I found Bronze Age infant bottles, unearthed at burial sites and which contain traces of animal milk. In the performance art of the MAMA project, Lynn Lu and Jess Dobkin, I revelled in the unapologetic investigations of motherhood, sexuality, labour and taboo. The intimacy between mother and child in paintings by the impressionist artist Mary Cassatt helped me realise that, when it came to my son, what mattered most was that he always felt held by my deep love for him. That our relationship was nurturing and nourishing in many other ways.This sense of connection and understanding I found in history and art has continued to guide me through motherhood. Knowing that these parts of my identity are fully intertwined brings me comfort and confidence. It has made me a better parent and art historian. Though breastfeeding became much easier and we continued until my son was 18 months old, I now know where to look when navigating life’s other difficult times.Two years after my son’s last feed, I stood in a London gallery, my eyes unexpectedly wet with tears as I looked at another Bourgeois sculpture. Encased in a large vitrine, on a cold steel plinth, knelt a small pink woman, her head slightly bowed. White threads from her nipples connected to five spools fanned out in front of her. I recalled the long nights when I felt desperately alone, realising my struggles were never mine alone. I had always been stitched into a vast and elaborate historical tapestry.Milk: An Intimate History of Breastfeeding by Joanna Wolfarth (Weidenfeld & Nicolson) is out now at £18.99, or buy it for £16.52 at guardianbookshop.com. It’s also available as an ebook, £9.99, and audiobook, £21.99 | Women’s Health |
I have had to go through 10 pregnancies to give me my three precious sons.
The losses ranged from multiple early miscarriages to two late miscarriages, which were almost a year to the day apart.
The care that I received for the losses varied but none of it, unfortunately, was what I would have wanted.
Sometimes I had poor physical care but excellent compassionate care, other times I had good physical care, but the compassion was just not there.
When I had my second late-term miscarriage, I still had to give birth into a commode and that for me was awful.
It felt like my child was being treated as waste.
This was my child, and the midwife essentially just told me: "Come on - on you get."
It was horrific, and I think that experience traumatised me more than nearly dying the year before because that part I felt they understood.
That my child had died but this time that understanding wasn't there - yet clinically it was perfect... physically I was safe but mentally I wasn't.
Having all my losses before 24 weeks meant that some care and charities were not available to me - then I found Saying Goodbye and the Mariposa Trust.
I have been very emotional about this government review, with feelings of such enormous joy, but tinged with a little sadness, and pride, for those many women and men who have volunteered their own experiences of heartache to try to improve the experience for others.
I became involved thanks to my connection with Saying Goodbye founder Zoe Clark-Coates and the Mariposa Trust, where I now volunteer.
Very early on in the Pregnancy Loss Review, Zoe and midwife Sam Collinge, the co-leads of the review, invited some bereaved parents to tell their stories and I was honoured to tell them about my seven babies.
But I had another hat on that day, as a pharmacist in the Emergency Department at Northampton General Hospital.
Every story told of how women did not get appropriate pain relief, but also the difference that kindness made to their experience and recovery.
The Mariposa Trust asked if I could look at this further and that is where the guideline for acute pain started.
These recommendations are going to make a huge difference to so many people.
My losses have not just affected me but also my wider family - my youngest son thought that everyone had a brother in the graveyard and was surprised when he started school and found that was not true.
Read more:
Call for three days' paid leave from work for parents grieving after a miscarriage
Blood thinners do not reduce miscarriage risk, study suggests
I am delighted that the review is so wide-ranging, and that Zoe and Sam have thought of so many aspects of the losses people feel when they experience this particular tragedy.
It is unquestionably so important to look at the practical side of the care, but compassion is equally important, as this is where the dignity and future mental health of the bereaved parents is considered and understood.
I am particularly excited by the recommendations on education in schools, as I believe the earlier people know about the help that is available, the better.
I am also so happy about the continued work that Zoe and Sam will be doing about information and signposting for women during loss, as I know from friends and family that it is often an added stress that people just don't know what to do or where to go for help.
This is such a special day.
Zoe Clark-Coates and Sam Collinge have done such an amazing job that will change the lives of so many of us.
For that, I shall be forever grateful. | Women’s Health |
They rise up in our eyes when we're mourning the loss of a loved one, getting the "feels" from a touching scene in a rom-com or simply chopping onions for dinner: Tears, whether you shed them often or hardly at all, are a ubiquitous part of the human experience.
You may think of tears as just water — after all, as Justin Timberlake demonstrated in his hit song "Cry Me a River," these droplets of sadness are often likened to bodies of water, raindrops or even storms.
But what are tears actually made of?
It turns out that there are three distinct types of tears, which vary in their composition, Daniela Oehring, an associate professor of optometry at the University of Plymouth in the U.K., told Live Science.
You're probably most familiar with the emotional tears that people shed in sadness after a breakup or in joy when seeing a friend after years spent apart. But humans produce two other types of tears: basal tears, which cushion the eye, supply the tissue with nutrients and remove debris; and reflex tears, which are produced in response to irritants, such as smoke or the chemicals released when you chop an onion.
Basal tears have lots of salt ions and other electrolytes, as well as proteins with antimicrobial properties, Oehring said. These proteins include lipocalin, which binds and disrupts certain compounds in microbes, and lysozyme, an enzyme that kills bacteria by breaking down their cell walls, she said.
Reflex and emotional tears, on the other hand, have a higher water content, and a lower concentration of fats and proteins, than basal tears do. Some scientists have reported that, compared with reflex tears, emotional tears carry higher concentrations of hormones typically released when the body is under stress.
Upon being made, all these tears are added to a thin film that covers and nourishes the cornea, the transparent tissue over the front of the eye. This tear film has three distinct layers. On the outside is an oily layer produced by the meibomian glands in the eyelids that stops the eyes from drying out. The next layer is watery and lubricates the eye; it's made mostly by the lacrimal gland, which also adds proteins, oxygen and electrolytes. The inner layer, closest to the cornea's surface, contains a slime-like protein called mucin, which helps the tear film stick to the eye's surface.
According to Oehring, people produce about 1 to 4 microliters of tears a minute — or about 1.44 to 5.76 milliliters per day — on average. These are primarily basal tears, which shed constantly, rather than emotional and reflex tears made in response to stimuli. However, this volume can vary significantly depending on what you're doing.
"If you drive a bike, for example — and you have a lot of air, so you have a high evaporation rate — your tear production changes," she said. "If you are in a steam room, then your tear production decreases, because generally, there is no need to produce the water." Tears drain from the eyes via tear ducts. But because emotional and reflex tears are typically released in a flood, not in a trickle, these can often spill out of the eye rather than draining normally.
If the quantity or quality of your tears declines such that your eyes don't stay lubricated, you may develop dry eye, which affects 16 million Americans.
Many factors raise the risk of this common condition, Oehring said, including smoking, poor nutrition, and excessive time spent staring at computer screens and not blinking enough. As we age, we also become more susceptible to developing the condition, because our tear glands stop working as well. Some diseases can also increase the likelihood of having dry eyes, such as Sjögren's syndrome, an autoimmune condition in which the body's own immune cells damage the lacrimal glands that moisturize the eyes.
People with Sjögren’s syndrome cannot even produce reflex tears. "Even if they get something in their eye, like an eyelash or something," Oehring said, "there is just not enough capacity to produce tears."
This article is for informational purposes only and is not meant to offer medical advice.
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Emily is a health news writer based in London, United Kingdom. She holds a bachelor's degree in biology from Durham University and a master's degree in clinical and therapeutic neuroscience from Oxford University. She has worked in science communication, medical writing and as a local news reporter while undertaking journalism training. In 2018, she was named one of MHP Communications' 30 journalists to watch under 30. ([email protected]) | Medical Innovations |
“Tens of millions of Americans live in communities where they cannot find a doctor while others have to wait months to be seen.”
Sen. Bernie Sanders (I-Vt.), in a July 19, 2023, press release
Sen. Bernie Sanders (I-Vt.) has long been a champion of a government-sponsored “Medicare for All” health program to solve long-standing problems in the United States, where we pay much more for health care than people in other countries but are often sicker and have a shorter average life expectancy.
Still, he realizes his passion project has little chance in today’s political environment. “We are far from a majority in the Senate. We have no Republican support … and I’m not sure that I could get half of the Democrats on that bill,” Sanders said in recent remarks to community health advocates.
He has switched his focus to include, among other things, expanding the primary care workforce.
Sanders introduced legislation in July that would invest $100 billion over five years to expand community health centers and provide training for primary care doctors, nurses, dentists, and other health professionals.
“Tens of millions of Americans live in communities where they cannot find a doctor while others have to wait months to be seen,” he said in a press statement issued when the bill was introduced. He noted that this scenario not only leads to more human suffering and unnecessary deaths “but wastes tens of billions a year” because people who “could not access the primary care they need” often end up in emergency rooms and hospitals.
Is that true? Are there really tens of millions of Americans who can’t find a doctor? We decided to check it out.
Our first stop was the senator’s office to ask for the source of that statement. But no one answered our query.
Primary Care, by the Numbers
So we poked around on our own. For years, academic researchers and policy experts have debated and dissected the issues surrounding the potential scarcity of primary care in the United States. “Primary care desert” and “primary care health professional shortage area” are terms used to evaluate the extent of the problem through data — some of which offers an incomplete impression. Across the board, however, the numbers do suggest that this is an issue for many Americans.
The Association of American Medical Colleges projects a shortage of up to 48,000 primary care physicians by 2034, depending on variables like retirements and the number of new physicians entering the workforce.
How does that translate to people’s ability to find a doctor? The federal government’s Health Resources and Services Administration publishes widely referenced data that compares the number of primary care physicians in an area to its population. For primary care, if the population-to-provider ratio is generally at least 3,500 to 1, it’s considered a “health professional shortage area.”
Based on that measure, 100 million people in the United States live in a geographic area, are part of a targeted population, or are served by a health care facility where there is a shortage of primary care providers. If they all want doctors and cannot find them, that figure would be well within Sanders’ “tens of millions” claim.
The metric is a meaningful way to measure the impact of primary care, experts said. In those areas, “you see life expectancies of up to a year less than in other areas,” said Russ Phillips, a physician who is director of Harvard Medical School’s Center for Primary Care. “The differences are critically important.”
Another way to think about primary care shortages is to evaluate the extent to which people report having a usual source of care, meaning a clinic or doctor’s office where they would go if they were sick or needed health care advice. By that measure, 27% of adults said they do not have such a location or person to rely on, or that they used the emergency room for that purpose in 2020, according to a primary care score card published by the Milbank Memorial Fund and the Physicians Foundation, which publish research on health care providers and the health care system.
The figure was notably lower in 2010 at nearly 24%, said Christopher Koller, president of the Milbank Memorial Fund. “And it’s happening when insurance is increasing, at the time of the Affordable Care Act.”
The U.S. had an adult population of roughly 258 million in 2020. Twenty-seven percent of 258 million reveals that about 70 million adults didn’t have a usual source of care that year, a figure well within Sanders’ estimate.
Does Everyone Want This Relationship?
Still, it doesn’t necessarily follow that all those people want or need a primary care provider, some experts say.
“Men in their 20s, if they get their weight and blood pressure checked and get screened for sexually transmitted infections and behavioral risk factors, they don’t need to see a regular clinician unless things arise,” said Mark Fendrick, an internal medicine physician who is director of the University of Michigan Center for Value-Based Insurance Design.
Not everyone agrees that young men don’t need a usual source of care. But removing men in their 20s from the tally reduces the number by about 23 million people. That leaves 47 million without a usual source of care, still within Sanders’ broad “tens of millions” claim.
In his comments, Sanders refers specifically to Americans being unable to find a doctor, but many people see other types of medical professionals for primary care, such as nurse practitioners and physician assistants.
Seventy percent of nurse practitioners focus on primary care, for example, according to the American Association of Nurse Practitioners. To the extent that these types of health professionals absorb some of the demand for primary care physician services, there will be fewer people who can’t find a primary care provider, and that may put a dent in Sanders’ figures.
Finally, there’s the question of wait times. Sanders claims that people must wait months before they can get an appointment. A survey by physician staffing company Merritt Hawkins found that it took an average of 20.6 days to get an appointment for a physical with a family physician in 2022. But that figure was 30% lower than the 29.3-day wait in 2017. Geography can make a big difference, however. In 2022, people waited an average of 44 days in Portland, Oregon, compared with eight days in Washington, D.C.
Our Ruling
Sanders’ claim that there are “tens of millions” of people who live in communities where they can’t find a doctor aligns with the published data we reviewed. The federal government estimates that 100 million people live in areas where there is a shortage of primary care providers. Another study found that some 70 million adults reported they don’t have a usual source of care or use the emergency department when they need medical care.
At the same time, several factors can affect people’s primary care experience. Some may not want or need to have a primary care physician; others may be seen by non-physician primary care providers.
Finally, on the question of wait times, the available data does not support Sanders’ claim that people must wait for months to be seen by a primary care provider. There was wide variation depending on where people lived, however.
Overall, Sanders accurately described the difficulty that tens of millions of people likely face in finding a primary care doctor.
We rate it Mostly True.
Source List
Sen. Bernie Sanders, “NEWS: In Remarks to Advocates, Sanders Proposes Major Expansion of Community Health Centers,” Feb. 8, 2023.
Sen. Bernie Sanders, “NEWS: Chairman Sanders Introduces Major Legislation on Primary Care and Announces HELP Markup Next Week,” July 19, 2023.
Senate bill, “To improve access to and the quality of primary health care, expand the health workforce, and for other purposes,” accessed July 21, 2023.
Association of American Medical Colleges, “AAMC Report Reinforces Mounting Physician Shortage,” June 11, 2021.
Health Resources and Services Administration, “What Is Shortage Designation?” June 2023.
Health Resources and Services Administration, “Health Workforce Shortage Areas,” accessed July 24, 2023.
Health Resources and Services Administration, “Designation of Health Professional(s) Shortage Areas,” accessed July 26, 2023.
KFF, “Primary Care Health Professional Shortage Areas (HPSAs),” Sept. 30, 2022.
The Milbank Memorial Fund and the Physicians Foundation, “The Health of US Primary Care: A Baseline Scorecard Tracking Support for High-Quality Primary Care,” Feb. 21, 2023.
The Milbank Memorial Fund, “The Effectiveness of Policies to Improve Primary Care Access for Underserved Populations: An Assessment of the Literature,” Jan. 24, 2022.
American Association of Nurse Practitioners, “NP Fact Sheet,” November 2022.
Meritt Hawkins, “Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates,” 2022.
Interview with Mark Fendrick, physician and director of the University of Michigan Center for Value-Based Insurance Design, July 21, 2023.
Interview with Christopher Koller, president of the Milbank Memorial Fund, July 21, 2023.
Interview with Jacquelyn Resnik, Teladoc Health, July 21, 2023.
Interview with Russ Phillips, physician and director of Harvard Medical School Center for Primary Care, July 24, 2023.
Interview with Michael Dill, director of workforce studies at the Association of American Medical Colleges, July 24, 2023.
Email interview with Martin Kramer, director of communications at Health Resources and Services Administration, July 25, 2023.
Email interview with Jewel Jordan, public affairs specialist, U.S. Census Bureau, July 26, 2023. | Health Policy |
A 21-year-old man was waiting for a counselling appointment when he took his own life, an inquest heard.
Twm Bryn, from Chwilog, Gwynedd, had been feeling "low with his mood deteriorating" after he was the victim of a violent attack months earlier.
He had told a mental health nurse he was feeling suicidal and was placed on a waiting list for counselling.
Coroner Sarah Riley said she would write to Betsi Cadwaladr health board to express concern over long lists.
Mr Bryn was found hanged near his home in October 2021.
At a hearing at Caernarfon Coroner's Court, Ms Riley concluded Mr Bryn died by suicide.
She said she would issue the health board with a prevention of future deaths report, which allows coroners to call for action to be taken to prevent future deaths.
In addition to her concern over waiting lists, Ms Riley said her report would also highlight a lack of support available to those not considered at high risk of suicide.
Betsi Cadwaladr health board said it had responded with an action plan to address the issues raised by the coroner.
Mr Bryn was attacked in July 2021 and had suffered a concussion, which his mother said had left him scared to leave the house at times.
Mr Bryn's referral for a mental health assessment took 40 days, missing the health board's 28-day target, the inquest heard.
His mother said a phone assessment was not enough to deal with his needs at the time.
His family raised concerns regarding the accessibility of mental health services in north Wales, emphasising the fact patients had to self-refer.
Representing the health board at the hearing, Tom Regan, its head of nursing for north-west Wales, said at the time counselling waiting lists were longer and staffing shortages were an issue.
Reading from an internal report into the death, Mr Regan said Mr Bryn was identified as being at "medium" risk of suicide.
Mr Regan said some weekend clinics were now being offered to cope with increased pressures and targets were being met more consistently.
Counselling waiting times are currently between four to six months, he added. | Mental Health Treatments |
Doctors should ask people with a mental-health problem about their gambling habits to identify those who need help, draft health guidance says.
It adds that with problem gamblers, GPs should discuss software to limit online gambling and talking therapy treatment at an early stage.
Patients can be referred to one of 12 NHS gambling-treatment clinics in England, with three more planned.
Some 300,000 UK adults are problem gamblers, a recent review found.
And their addiction affects another 3.8 million people, including children.
Men are more likely to gamble than women, the review says, especially online, where 15% of men but only 4% of women gamble.
'I was a good liar'
David Quinti, 49, stopped gambling eight years ago but not before he'd lost £30,000 and hit rock bottom.
"I was in a dark place. I was gambling most of the day, and at work," he says.
"I kept it hidden from everyone and became a very good liar."
It started with football betting and moved on to online roulette, where he started taking bigger and bigger risks.
David went to his GP feeling depressed, and mentioned he was spending too much time gambling.
But his GP focused on his drinking instead and offered him anti-depressants.
Eventually, it was his eight-year-old son's plea to stop that made David change his ways.
"The thought of what I could have lost means I've never relapsed," he says.
'Immense misery'
People with depression, anxiety or thoughts about suicide or self-harm are currently asked about their drinking and drug habits, to see if they have a possible addiction.
And the draft guidance, from the National Institute for Health and Care Excellence (Nice), says healthcare professionals should also ask about their gambling habits, to help identify those who need support and treatment.
Nice interim director for guidelines Prof Jonathan Benger said: "Harmful gambling causes immense misery to all those who experience it.
"We want those needing help or who are at risk to be identified sooner and receive appropriate help.â¯"
'Important role'
NHS gambling clinics can see 3,000 people each year.
And GamCare, a charity which runs the National Gambling Helpline, said healthcare professionals could play "an important role" preventing harm by helping people find support.
"We believe these recommendations, if implemented, will present a greater opportunity to prevent gambling harms from occurring in the UK," director of services Fiona MacLeod said.
Earlier this year, the government published a White Paper on gambling, including plans for a statutory levy on operators, to fund harm prevention and treatment.
A consultation on the draft guidance will run until on Wednesday, 15 November. | Mental Health Treatments |
Experts say ticks are out earlier this year and sticking around longer than usual thanks to warming temperatures — making it more important than ever to be aware of how to avoid their potentially disease-carrying bites.
In Connecticut, for example, ticks are already showing up in greater numbers this year, Goudarz Molaei, a tick expert for the state, told The Associated Press. Since Jan. 1, more than 1,000 ticks have been sent in for the state's testing program, the second-highest number in recent years.
"It's going to be an above-average year for tick activity and abundance," Molaei warned.
To help you prepare, here's what you should know about protecting yourself:
Which ticks carry Lyme disease?
Lyme disease is caused by borrelia bacteria, which humans usually contract from the bite of a tick carrying the bacteria.
Ticks that can carry borrelia bacteria live throughout, though Lyme disease is most common in the upper Midwest and the northeastern and mid-Atlantic states.
An estimated 476,000 Americans are diagnosed with Lyme disease each year, according to the Centers for Disease Control and Prevention.
Different types of infected ticks can spread other bacteria, viruses and parasites that make people sick. For example, black-legged ticks, also called deer ticks, can carry more than Lyme-causing bacteria. They can also spread, anaplasmosis and .
What do tick bites look like?
A tick bite may look like a "tiny, itchy bump on your skin" similar to a mosquito bite, according to the Mayo Clinic. But some people may not even notice they've had a tick bite.
Being bitten doesn't necessarily mean you have a tick-borne disease. However, if the tick was carrying the bacteria that causes Lyme disease, early symptoms usually happen within 3 to 30 days after a bite, the Mayo Clinic explains.
A bull's-eye-shaped rash is a common sign, Bryon Backenson, an assistant professor at the University of Albany School of Public Health, recently told CBS News.
"It's a rash that doesn't always look just like a bull's-eye, but it's a red patch. It's relatively large, usually at least 2 inches or so across," he explains. "Oftentimes it doesn't hurt or itch, it's just there."
What are the symptoms of Lyme disease? Is there a treatment?
Early symptoms of a Lyme disease infection may include:
- headache
- fatigue
- muscle aches
- joint aches or stiffness
- chills
- fever
- swollen lymph nodes
"Early diagnosis and proper antibiotic treatment of Lyme disease is important," the CDC advises. "Patients treated with antibiotics in the early stages of the infection usually recover rapidly and completely." However, the health agency notes some people may experience lingering symptoms, and that more research is needed on the disease.
Without treatment, the Mayo Clinic warns the illness can get worse, with more severe symptoms developing over a period of several weeks or months.
There is no Lyme vaccine on the market for people in the U.S., but
Does bug spray work on ticks?
There are several methods to protect yourself from ticks, both before you go outside and once you return indoors. Here are some expert tips:
Know where to expect ticks: "Ticks live in grassy, brushy or wooded areas, or on animals. Spending time outside walking your dog, camping, gardening or hunting could bring you in close contact with ticks," the CDC says, adding many people get ticks from their own yard or neighborhood.
Wear long-sleeved clothing: "It's easier said than done, of course, when it's really warm out," Backenson admits. He says lighter-colored clothing can also help you more easily spot the small parasites. Also consider wearing long pants tucked into your socks in tick-infested areas.
Prep yourself and your clothing: Consider insect repellant if you're going to be outdoors for an extended period. The CDC advises using an Environmental Protection Agency (EPA)-registered insect repellent containing DEET or other insect-repelling ingredients listed on the organization's website.
You can also. For example, Backenson suggests treating things like your gardening shoes and hiking gear. The CDC recommends using products containing 0.5% permethrin, which can remain protective through several washings.
Once home, take a shower: The CDC says showering within two hours of coming indoors has been shown to "reduce your risk of getting Lyme disease and may be effective in reducing the risk of other tickborne diseases." Showering can also help wash off unattached ticks.
Do a tick check: "If you check yourself every 24 hours when you're getting into the shower... you can really find these ticks and pull them off," Backenson says.
During tick checks, the CDC advises looking in spots that ticks can hide, including:
- under the arms
- in and around the ears
- inside the belly button
- behind the knees
- between the legs
- on the hairline and scalp
Having someone help check your back and scalp, where you might have trouble seeing yourself, is also a good idea.
What are the best ways to kill ticks?
Worried you're bringing ticks inside via your clothes?
Putting your outdoor clothes in a hot dryer for about 10 minutes is "enough to kill a tick," Backenson says.
If you find a tick on you, you'll want to remove it quickly and correctly.
"Don't wait to have it removed," Backenson says. "With a fine-point pair of tweezers, get as close to the skin as you possibly can and gently and firmly pull straight up and that tick will pop right out."
After removing the tick, the CDC suggests cleaning the bite area and your hands with rubbing alcohol or soap and water.
You should also never crush a tick with your fingers. Instead, the CDC says to dispose of a live tick by putting it in alcohol,
putting it in a sealed bag, wrapping it tightly in tape or flushing it down the toilet.
Lastly, keep an eye on the area. If symptoms occur, see a doctor.
The Associated Press contributed to this report.
for more features. | Epidemics & Outbreaks |
A nurse has said strikes are taking place because "patients are dying".
Cardiff-based Katharine Davies is on the picket line and said there simply is not enough staff.
Nurses across nearly all parts of Wales will strike for 12 hours on Tuesday and Wednesday in an ongoing dispute over pay.
The industrial action means thousands of planned care appointments will be impacted.
The Royal College of Nursing (RCN) Wales' chief Helen Whyley said members needed "more commitments" from the Welsh government.
She added that the ballot for further action would reopen in July.
The Welsh government said it was "disappointed" that strike action was continuing.
The lack of staff makes it difficult to spot when patients deteriorate, which can be a matter of life and death in cases like sepsis, Ms Davies said.
Katharine Davies who works at the University Hospital of Wales in Cardiff said: "We just don't have enough staff."
Ms Davies who has been a nurse for 32 years said the pressures have meant she has "neglected" her patients.
She is striking on the picket line with fellow Cardiff and Vale workers outside the Heath Hospital.
"I have not given them the attention they deserved," she said.
"I have thought about them on the drive home and what I haven't been able to do. That's not a good feeling.
"Five, ten years ago it was different. Now, we have to choose, who is the least ill.
"The least ill person might just want someone to sit with them at the start of the day, to talk through their diagnosis, their treatment but we can't do that.
"It wasn't perfect in the past but we could wash patients, do something and put moisturiser on someone's face or legs, we can't do that any more. We're lucky if we can wash their faces."
People are picketing across Wales including Bronglais Hospital, Aberystwyth, Ceredigion.
Aneurin Bevan health board, in south east Wales, is the only one not to be affected by the strikes.
Marcus Longley, a former chairman of Cwm Taf Morgannwg University Health Board, told that there is a "real toxic mix" of factors that have come together, from pay, working conditions and staffing issues.
"There is a danger of salami slicing - you chop a little bit off and a little bit off - and you end up with an institution that nobody is proud of," he said.
"That is a recipe for constant crisis."
The strike is due to take place between 07:00 and 19:00 BST on both days, though there are exemptions where certain units will be staffed.
These include critical care units, dialysis and chemotherapy services, life-threatening cancer treatments, neonatal and paediatric intensive care units and standalone paediatric emergency departments.
Night duty levels of staffing will also be in place for A&E, 24-hour in-patient areas and community services.
It means elective and routine procedures involving Royal College of Nursing members - such as operations and outpatient appointments - will not take place.
The RCN in Wales has more than 17,000 members but it is not clear how many will withdraw labour during the strike.
Managers are planning around that uncertainty, which is why many clinics and procedures will not have been booked for the two days.
'Better and bigger commitments'
Helen Whyley, director of the Royal College of Nursing in Wales, said members wanted better working conditions and a further rise in pay.
"We need some more commitments from the Welsh government about things that will influence and affect nursing," she said.
"It keeps people retained, it makes them want to come into the profession. But alongside that we're also looking for better and bigger commitments about terms and conditions, recruitment and retention, things that will keep nurses working not just today or tomorrow, but for the next five, 10, 15 years.
"My members don't want to be out on picket lines, they want to be doing what they do well and that's looking after patients."
An improved pay deal for most NHS staff was recently announced by the Welsh government, but RCN members in Wales voted to reject the offer and these two days of industrial action were scheduled.
The union went on strike twice in December last year, but suspended further action in February while talks with the Welsh government continued.
Their current mandate for strike action runs out on 1 August, though the RCN said it had already set plans in motion to renew that support among its membership.
Ms Whyley added that members were "not doing this lightly".
"My members don't want to be out on picket lines, they want to be doing what they do well and that's looking after patients," she said.
But she added that any solution needed to mean "they'll go to work and they won't be the only person on duty that's substantive, that they'll take their pay packets and be able to pay to feed their families and take their children out.
"And that they'll have a profession that other people want to join."
A Welsh government spokesperson said: "While we recognise the strength of feeling among members, we are disappointed that strike action is continuing despite the collective decision to accept the Agenda for Change pay offer by the Wales Partnership Forum Business Committee.
"We are working with the NHS, unions and partners to ensure life-saving and life-maintaining care is provided during the industrial action, patient safety is maintained and disruption is minimised.
"But it is vital that all of us to do all we can to minimise pressure on our health service during the industrial action and consider carefully what activities we take part in."
The Welsh Government urged people to call 999 if "in immediate danger" but to use the NHS 111 website or a local GP or pharmacy for health advice "where there is no immediate threat to life".
When nurses took to the picket lines in December, the wider mood was a little different.
They were soon followed by two other large unions representing ambulance staff. Discontent hung heavy in the air.
But six months on and a majority of unions representing healthcare workers have accepted the improved pay offer from the Welsh government - for both the current and previous financial years.
While all health workers, aside from doctors, therefore benefitted from the deal, the RCN said its members were not bound by that collective decision - and were still exercising their right to strike. | Health Policy |
Feeling peckish one day in 2017, Darshna Yagnik, an immunologist and lecturer in biomedical science at Middlesex University, took a punt on something that had been lurking at the back of the fridge. She soon regretted it and started feeling queasy. Desperate to avoid food poisoning, she racked her brains for something that might help – and remembered the bottle of apple cider vinegar (ACV) in the cupboard. She decided to glug a diluted shot. “Immediately, I felt like there was something going on, combating the bacteria,” she says. “My stomach was gurgling and after about 10 minutes it started feeling soothed. After about half an hour or an hour, I felt much better.”
At that moment, she realised she was using her own body for research. “I was thinking: what is going on with this apple cider vinegar? This is possibly having an effect on E coli. Let me test it in the laboratory.” She went on to do “a multitude of experiments” throughout the pandemic, resulting in a 2021 paper demonstrating that ACV kills E coli and MRSA in petri dishes almost as effectively as common antibiotics. However, it is not clear how this would translate to the human body.
Nonetheless, this is one of the many promising results in recent studies into the benefits of ACV, once the preserve of health-food-shop aficionados. It is said to help normalise blood-sugar levels, reduce inflammation, aid weight loss and improve cholesterol levels. Even before the research, its popularity as a folk cure-all was growing quietly, but it is now being touted by health influencers as a quick fix for gut health.
Deep down, of course, we all know that there are no quick fixes when it comes to health. A few swigs of vinegar can’t counter a sedentary lifestyle spent munching ultra-processed foods.
Nevertheless, research into some of the health claims made for the fermented apple juice is promising, but without large, robust clinical trials, medical staff can’t countenance recommending the stuff. Nichola Ludlam-Raine, a registered dietitian, says that while ACV has a reputation for aiding digestion, “there is no evidence supporting that”. However, organic, unfiltered ACV is probiotic, she points out, as long as there is a brown, blobby fog called “the mother” floating around in it. This, she says, “includes different proteins, enzymes and bacteria. Some people believe that this is responsible for the health benefits of consuming apple cider vinegar, although there are no studies documenting this.”
ACV also contains 5% to 6% acetic acid, says Ludlam-Raine. “Some believe this plays a key part in the health claims. Acetic acid is found in most fruits, which are also key sources of vitamins, minerals and fibre – unlike apple cider vinegar.”
With Yagnik’s work, too, much more research is needed before the vinegar can be recommended officially for fighting pathogens, but what she has found so far is compelling. “I started researching different ways the vinegar might be acting on the bacteria,” she says. “I wasn’t surprised at the results, but it was amazing how it was working – it just destroyed them. Even my microbiologist friends were amazed.”
Handily, so far, it seems only to kill nasty bugs. “It has different effects on different microbes,” she says. “The effects seem to vary according to the microbe type, whether it is E coli or candida.”
Yagnik also doused white blood cells in ACV. Lo and behold, they were able to clear infections much more quickly than normal, “so it seems to be working on immunity as well”, she says. Her hypothesis may explain why so many people claim anecdotally that ACV makes them feel better in general (although this could be the placebo effect): “Vinegar that contains the mother has enzymes and antioxidants that support cell metabolism and function ... It’s high in flavonoids and beneficial bacteria, which contribute to the human microbiome – vital for cellular immunity and defence.”
In a nutshell, she is suggesting that ACV has a two-pronged approach to fighting bugs: killing the bugs and strengthening our cellular defences. That said, the effects always depend on the individual, she says: “Everyone’s got a different immunity.”
While studying the effects on cells, she saw signs that ACV could help reduce inflammation, too. Again, Yagnik suspects this is due to many components working together, from the enzymes to the flavonoids. “All of these in combination would optimise cells, boosting their function, and bring immune balance.”
The evidence on ACV controlling blood sugar is also intriguing. A 2019 meta-analysis of six small studies found that taking it daily resulted in lower fasting blood-glucose levels, as well as reduced cholesterol. A study in 2004 of people with insulin resistance or type 2 diabetes found that taking ACV after a high-carb meal reduced blood-sugar spikes (regular blood-sugar spikes and subsequent crashes are associated with chronic disease).
This means that it could be helpful, alongside medication, in controlling blood sugar for people with type 2 diabetes. At present, however, it is not medically recommended and could cause problems in blood-sugar control for people with type 1 diabetes.
The cholesterol finding from one of the blood-sugar studies is backed up by a meta-analysis of nine trials, which concludes that taking one tablespoon of ACV daily is most effective after doing so for eight weeks or more.
While the weight-loss studies are small and inconsistent, and give only a short-term picture, one found that, with two groups on a calorie-controlled diet for 12 weeks, the half that also took 30ml of vinegar every day lost on average 1.5kg more. Another found that overweight participants lost 1kg to 2kg over 12 weeks with no dietary restrictions. But all of these results should be interpreted with caution.
“Drinking apple cider vinegar should not replace medicines for diabetes management and could be bad news for teeth health,” says Ludlam-Raine. “Apple cider vinegar is strongly acidic, so there are risks of enamel erosion – and reflux [heartburn], too.”
There have also been warnings that people with kidney disease or ulcers should avoid such acidity. Ludlam-Raine says: “Evidence is minimal at present regarding appetite suppression and improving blood-sugar levels following a high-carb meal. You’re better off eating an apple (there’s more fibre, to keep gut bacteria happy, and it contains antioxidants, too).
“However, if you want to include AVC in your diet, use it in a salad dressing – alongside olive oil and black pepper – rather than drinking it.”
Of course, it is up to individuals whether they want to experiment on themselves with ACV. The key is to know the risks, to keep exercising and to eat a varied diet.
Yagnik – along with many others – now swears by a daily dose of ACV. “I carry it around with me in a small bottle,” she says, in case she feels suddenly as though she is coming down with an infection. “I just feel better with it. I think it’s really important to have the right nutrition and to boost your immunity, because of what we’ve seen with the pandemic – it has affected a lot of people’s immunity.”
She dilutes it one to one with water or juice and takes it after a meal, “so I’m not absorbing it on an empty stomach. Because some people might feel a little bit sick.”
Since her first study, Yagnik has started testing ACV’s impact on healthy people and those with infections; she says her findings show that “it does help clear infections, with no side-effects” – unless you count not enjoying the strong taste.
Informally, too, since her lab experiments, friends, family and colleagues have started taking it. “And they haven’t stopped. They just take it routinely, like a supplement, every day, because they feel the health benefits,” she says.
She concedes that much more research needs to be done; her own work continues. “There are so many different pathways that it’s acting on and it’s very exciting,” she says. “I think we’ve only scratched the surface.” | Nutrition Research |
After two years in which many travelers stayed home, 2022 was supposed to be the year of Big Travel, when trips were checked off bucket lists and the word “staycation” was retired forever.Then came the spring’s rising COVID-19 numbers, record-high gas prices, rapidly escalating airfares — and the war in Ukraine. Plus, last year’s chaos of airline cancellations and delays persist. For some people, that made the idea of staying closer to home — whether truly staycationing in their own towns, or settling for scaled-back plans — more attractive. And suddenly, American travelers are once again racing to book local hotels, restaurants and activities.Milan Jones and his girlfriend, Catherine Wilson, are among them. During 2020 and 2021, the couple made do with day trips to nature spots, museums and spas near their home in Georgia. This spring they had planned to go to the Maldives for their first blowout trip in more than two years.[ 7 Midwest cities to visit in 2022 for history buffs, nature enthusiasts, foodies and more ]Then came the constant feelings of uncertainty — what would happen if they got sick abroad, didn’t the world seem too unstable?Out went the daylong flight to that remote archipelago. The new plan: a week at a local spa resort to take a mental and physical break from the past two years of accumulated stress.“We would only decide to go on a big vacation in the future if we had some reassurances that it was thoroughly planned and safe,” said Jones, 24, a content writer and editor. “We probably wouldn’t plan anything more than three months in advance, and the more secluded the area we are traveling to is, the more at peace we would feel going there.” Their priorities: a stable region and a spot with less risk of a coronavirus outbreak.They are hardly the only ones rethinking things.An April study by Bankrate, a personal finance site, found that 69% of American adults who say they will vacation this summer anticipate making changes to their plans because of inflation, with 25% traveling shorter distances and 23% planning less-expensive activities. Among people planning to take time off, a staycation was the second most-popular option, behind heading to the beach.A different report released in May by TripAdvisor, the travel review site, found that 74% of American travelers were “extremely concerned” about inflation; 32% were planning to take shorter trips this summer and 31% were planning to travel close to home.While this doesn’t mean that travel is completely axed, it does reflect that, for the third summer in a row, staycations are expected to be a significant part of the mix, and “revenge travel” — an all-out trip to make up for lost time — may have to wait a little longer, said Amir Eylon, president and CEO of Longwoods International, a travel market research consultancy in Columbus, Ohio.[ Hamburgers, a history: How a small Wisconsin town got credit for birth of the burger ]An optimistic May report from the Mastercard Economics Institute found that in the first quarter of 2022, Americans were booking domestic and shorter international flights above 2019 levels by about 25%, although long-haul flights were still depressed. But, the report warned, “While the tail winds of COVID-related pent-up demand are pushing the travel recovery forward, the headwinds of inflation, supply chain constraints, geopolitical uncertainties and COVID infection rates are also shaping 2022.”The impact of rising prices might be uneven, the report said: “More price-sensitive travelers may stick closer to home, while less price-sensitive travelers, who are more likely to have more excess savings, may be less concerned with higher prices and eager to travel.”Domestic hotels booking upFor those who aren’t jumping on long-distance flights, the winners appear to be nearby vacation spots, where hotels and short-term rentals are booking up. Airbnb’s U.S. bookings from people staying within their own region were up 65% in the first quarter of 2022 over the first quarter in 2019, said Haven Thorn, an Airbnb spokesperson.“The demand for domestic leisure travel is higher than it’s ever been post-pandemic,” said Emily Seltzer, the marketing manager at River House at Odette’s, a small luxury hotel in New Hope, Pennsylvania, which draws most of its guests from Philadelphia and New York. “Rather than having to fly, guests are more inclined to hop in their cars and begin enjoying their vacation.”[ 8 family-friendly trips for summer within driving distance of Chicago ]Amanda Arling, president of The Whaler’s Inn, a luxury hotel in downtown Mystic, Connecticut, said the hotel is filling up quickly for summer, much faster than in prior years. Weekends are already almost sold out through Labor Day, and she said she was beginning to see midweek business pick up as well. Arling estimated that 20% of the bookings are locals from Connecticut and Rhode Island on staycations.“Domestic travel and staycations seem to satisfy a desire to explore new places,” she said.“Staycations have opened a new offering for the travel industry, and going forward, we will see an industry rise to offering staycations in major metropolitan areas,” said Peter Vlitas, the executive vice president of partner relations for Internova Travel Group, which represents more than 70,000 travel advisers worldwide.Some have already started. Virgin Hotels in Chicago offers up to 30% off hotel stays for Illinois residents, for example.Amy Lyle, 51, an author, and her husband, Peter Lyle, 56, a health systems consultant, who live near Atlanta, are looking at what may be their third year of staycationing. Their first planned trip, to the Amalfi Coast, was booked to celebrate their 10th wedding anniversary in April 2020.Amy and Peter Lyle at the dock where they keep their boat in Georgia, May 8, 2022. The couple has booked and canceled three trips since the start of the pandemic, choosing to staycation instead. (Kelly Blackmon/The New York Times/Kelly Blackmon/The New York Times)Lyle canceled it when international travel all but shut down at the start of the pandemic. Instead, the couple took a staycation 30 minutes north of their home, enjoying time on Lake Lanier.Then, in April 2021, they tried again, booking a vacation with friends to Greece, Egypt and Israel. But in March, a month before they were set to depart, the travel agent informed them that Israel was cut from the itinerary because of an uptick in violence there.The Lyles went back to the lake.They have already canceled one trip this year, to Rome and Nice, because of worries over the war in Ukraine. But they are hoping to go to Greece this month to finally celebrate their 10th anniversary. If that gets canceled, they will settle for a staycation in Darien, Georgia, a tiny fishing village on the coast.“I’m an author of ‘The Book of Failures,’ so getting three European vacations canceled is the story of my life,” Lyle said.Meaghan Thomas, 29, of Louisville, Kentucky, will be having a staycation after she canceled her May trip to London, which she planned more than a year ago.Meaghan Thomas and Thomas McGee at home in Louisville, Ky., May 9, 2022. The couple stayed home instead of traveling to London because they were worried about a rise in COVID-19 numbers. (Luke Sharrett/The New York Times/Luke Sharrett/The New York Times)“We were hopeful that COVID would be simmered down by then,” said Thomas, who canceled the trip in April after the numbers spiked there in March. Instead, she’ll take a road trip to visit a friend in Asheville, North Carolina.[ Roaring good time awaits at Indianapolis children’s museum newly expanded dinosaur exhibit ]Thomas owns an organic spice company and more upsetting to her than canceling her trip to the United Kingdom is the further delay of her business travel, which was planned this year for Tunisia, India and Sri Lanka, to meet with spice farmers.“I’m really hoping for a late summer trip, but my confidence in flying and keeping safe from COVID has dropped significantly,” she said.Wherever you go, it’s a vacationBut for many people, even a second choice vacation is better than no vacation, and they are just grateful that they will be leaving their homes, said Brian Hoyt, the head of global communications and industry affairs for TripAdvisor.“Travelers overwhelmingly said that they have been stuck in their homes for 24 months, and they will be getting out there this summer,” Hoyt said, referring to the report released in May.And the staycation isn’t truly so bad. Especially, some travelers say, when you factor in things like the seemingly ubiquitous flight delays and cancellations, long flights that may no longer require masks and COVID regulations that come with international travel, like having to test negative to return to the United States.[ 7 Midwest state, national parks worth exploring this summer ]Heather Fremling, 55, a self-employed financial consultant in Merritt Island, Florida, had traveled throughout her life for work, family and pleasure. But during the pandemic, when Fremling drove cross-country to help her older parents, she realized how much less stress she felt driving rather than flying.“I was reminded, during a pretty bad time, of the freedom and happiness of controlling your own travel,” she said.Now, Fremling is sticking with staycations, relying on resort passes and same-day hotel bookings to take advantage of luxury destinations without the stress and hassle of actual travel.Steve Schwab, 49, CEO of Casago, a vacation rental company, said he typically travels someplace new every summer, but this year, with rising gas prices and inflation, he couldn’t justify the cost. So he and his family are doing a staycation in Scottsdale, Arizona, where they live, for a week.“We spent some time writing down our top preferred activities,” Schwab said. “And just listing them and thinking about what we want to do made me far more excited for this than I had been. Sometimes, all it takes is a little planning to make you feel excited about what’s to come.”This article originally appeared in The New York Times. | Epidemics & Outbreaks |
The U.S. is currently facing a surge in sexually transmitted infections (STIs). To address that rise, doctors have raised the possibility of prescribing some people an antibiotic to take after risky sexual encounters to prevent such infections.
The drug regimen, known as doxy-PEP, uses an old antibiotic called doxycycline and may reduce the risk of developing three major STIs — syphilis, gonorrhea and chlamydia — in people who are at high risk of repeated infection, evidence suggests. The Centers for Disease Control and Prevention (CDC) is currently evaluating these data and is expected to announce new guidance this summer. If that goes through, the FDA may expand the list of ways the doxycycline should be prescribed to include post-exposure prophylaxis (PEP) in certain populations.
Here's what we know so far about doxy-PEP, including who it might work for and whether it could fuel antibiotic resistance.
What is doxy-PEP, and how does it work?
Doxy-PEP gets its name from both its main active ingredient, the antibiotic doxycycline, and the type of therapy, post-exposure prophylaxis (PEP).
Doxycycline belongs to a group of antibiotics known as tetracyclines, which inhibit the growth of bacteria by stopping them from making essential proteins. Doxycycline is a mainstay in treating bacterial infections such as acne, urinary tract infections, eye infections and STIs. Normally taken as a tablet once or twice a day, doxycycline can start to improve a patient's symptoms within two days.
In the case of doxy-PEP, this would mean taking doxycycline within three days of having sex without a condom to stop the development of certain STIs. This would prevent bacterial growth before symptoms emerge, as opposed to treating the symptoms afterward.
How effective is doxy-PEP?
So far, most research into doxy-PEP has been in men who have sex with men (MSM) and transgender women and has focused on preventing the spread of gonorrhea, chlamydia and syphilis.
A 2018 study in France, for example, found that taking a single 200-milligram dose of doxy-PEP within 24 hours after having condomless sex could reduce the risk of chlamydia and syphilis by around 70% in MSM. Another study looked at gay and bisexual men, transgender women and nonbinary people assigned male at birth who'd already been diagnosed with an STI. When they were prescribed doxy-PEP for one year after having an STI diagnosis, future infections dropped by more than 40%.
In April, a study published in The New England Journal of Medicine (NEJM) also found that treatment with one 200-mg pill of doxycycline within 72 hours after condomless sex lowered the risk of new STI infections by two-thirds compared with standard care in a trial of over 500 MSM and transgender women.
But the drug is still far from being a one-size-fits-all solution.
"Our study does not inform everybody," Dr. Annie Luetkemeyer, lead author of the NEJM paper and a professor of medicine and infectious diseases at the University of California, San Francisco, told NPR. "It informs a group of people who already had an elevated risk of sexually transmitted infections."
Moreover, in cisgender women, a small study did not find a lower rate of STIs with doxy-PEP, although trials are ongoing. Because antibiotics only work against bacteria, doxy-PEP also cannot treat HIV or other infections caused by viruses, such as herpes or mpox.
What are the side effects of doxy-PEP?
According to the CDC, potential side effects of doxycycline include phototoxicity, meaning greater sensitivity to sunlight, gastrointestinal symptoms and, in rare cases, the development of ulcers in the esophagus. Other possible complications include a loss of appetite, nausea and diarrhea.
Has doxy-PEP been approved, and if so, who should take it?
Doxy-PEP is still currently classified as "off-label" by the Food and Drug Administration, meaning preventive treatment for bacterial STIs is not one of the listed uses on its approval label. (Doctors can and frequently do prescribe medicines off-label for all sorts of reasons.)
However, the CDC is currently considering the mounting evidence, including the positive results of the most recent NEJM trial this year, and is expected to announce clinical guidance for doctors and health care providers this summer. The FDA usually follows the guidance of the CDC on such matters.
"The evidence is very strong," Dr. Leandro Mena, director of the CDC's division of STD [sexually transmitted disease] prevention, told NPR. The new guidance will likely focus on groups that are at a higher risk of repeatedly contracting STIs — namely, MSM and transgender women.
In the meantime, the CDC acknowledges that some people are already using doxy-PEP and, in response, has issued protective interim guidance. This includes being aware of the target populations studied in recent trials, the dosage and the fact that other antibiotics should not be considered for PEP. (If someone shows symptoms of an STI and has had a recent exposure, they should get evaluated by a doctor.)
Could doxy-PEP worsen antibiotic resistance?
One risk of using doxy-PEP is that it may worsen the "urgent public health threat" of antibiotic resistance, in which bacteria evolve such that antibiotics work less effectively or no longer work at all against the germs.
Infectious-disease doctors are particularly worried about Staphylococcus aureus bacteria, which normally live harmlessly in the nose and skin but can cause deadly infections if they get into the blood, NPR reported. Indeed, in the NEJM trial, the prevalence of doxycycline-resistant S. aureus increased by 8% among people taking doxy-PEP.
Similarly, Neisseria gonorrhoeae, the species of bacteria that causes gonorrhea, can quickly develop resistance to tetracyclines, the class of antibiotics that includes doxycycline. In fact, 25% of cases of gonorrhea in the U.S. are already caused by tetracycline-resistant bacteria.
However, Luetkemeyer pointed out that people who get frequent STIs will also have to use antibiotics to clear them up.
"This isn't a choice between antibiotics and no antibiotics in men and transgender women with a history of recurrent STIs," she said in a statement. "The alternative here for many is repeated STIs that lead to recurrent antibiotics."
Others are similarly optimistic. Dr. Jeffrey Klausner, a professor of clinical population and public health sciences at the University of Southern California, told Live Science in an email that doxycycline is a "breakthrough in sexual health" and offers a "new choice for sexually active adults to protect themselves from STIs" such as syphilis, chlamydia and gonorrhea.
This article is for informational purposes only and is not meant to offer medical advice
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Emily is a health news writer based in London, United Kingdom. She holds a bachelor's degree in biology from Durham University and a master's degree in clinical and therapeutic neuroscience from Oxford University. She has worked in science communication, medical writing and as a local news reporter while undertaking journalism training. In 2018, she was named one of MHP Communications' 30 journalists to watch under 30. ([email protected]) | Disease Research |
- BNT211 combines two innovative approaches in one regimen with first-in-class potential: an autologous CAR-T cell therapy targeting the oncofetal antigen Claudin-6 (CLDN6) and a CLDN6-encoding CAR-T cell amplifying RNA vaccine (“CARVac”)
- Data presented at ESMO Congress 2023 demonstrates that the application of CARVac increases the persistence of the adoptively transferred autologous CAR-T cells
- BNT211 continues to show encouraging antitumor activity in patients with CLDN6-positive relapsed or refractory advanced solid tumors
- Follow-up of efficacy data at 1x108 CAR-T cells with or without CARVac shows an overall response rate (“ORR”) of 59% and a disease control rate (“DCR”) of 95%, with the CARVac cohort demonstrating a prolonged persistence of CAR-T cells
MAINZ, Germany, October 23, 2023 (GLOBE NEWSWIRE) – BioNTech SE (Nasdaq: BNTX, “BioNTech” or “the Company”) today announced follow-up data from its ongoing first-in-human Phase 1/2 trial (NCT04503278; 2019-004323-20) evaluating the safety and efficacy of the Company’s Claudin-6 (CLDN6)-directed CAR-T cell therapy candidate BNT211 in patients with CLDN6-positive refractory/relapsed solid tumors. The data show encouraging signs of clinical activity and an increased persistence of cancer-specific CAR-T cells when combined with CARVac. At the ESMO Congress 2023 in Madrid, Prof. John Haanen, M.D., Ph.D., Netherlands Cancer Institute (NKI), Amsterdam, Netherlands presented the data in an oral late-breaking data session which confirms the positive interim data presented at this year’s American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, USA.
“Our goal is to unlock the potential of CAR-T for solid tumors and to help improve the outcomes for a broad range of hard-to-treat tumors,” said Prof. Özlem Türeci, M.D., Co-Founder and Chief Medical Officer at BioNTech. “BNT211 aims to address two of the key limitations of CAR-T cell approaches in solid tumors, namely the lack of suitable cancer-specific cell surface targets and the limited persistence of CAR-T cells. To address this challenge, we have designed a CLDN6-specific autologous CAR-T cell therapy that we combine with our mRNA-based vaccine CARVac.”
The data update included 44 patients who received CLDN6 CAR-T cells at four dose levels alone or in combination with CARVac. Patients with germ cell tumors (n=16), ovarian cancer (n=17) and other solid tumor types (n=11) were treated. In course of the dose escalation, a dose-dependent increase in adverse events was observed, with cytokine release syndromes occurring in 23 of 44 safety evaluable patients. In most cases, these were of grade 1 and 2, with one patient with a grade 3 and one with a grade 4 event. Neurotoxicity was mild and self-limiting in two patients. Of the total 44 patients, 38 were efficacy evaluable. The overall response rate (“ORR”) for these 38 patients was 45% and the disease control rate (“DCR”) 74%. Further, 27 patients were treated with CLDN6 CAR-T cells at dose level 2 (1x108 CAR-T cells) with or without CARVac. At this dose level, 13 patients showed partial responses resulting in an ORR of 59% and a DCR of 95%. Additionally, in the same cohort, patients who received CARVac showed a prolonged persistence of CAR-T cells.
These results further underline the potential of BioNTech’s BNT211 program. One objective of the ongoing Phase 1/2 trial is to determine the recommended dose for the initiation of a potential pivotal Phase 2 trial in patients with germ cell tumors which is expected to be initiated in 2024.
About BNT211
To harness the power of cell therapies for solid cancers, BioNTech has combined their CAR-T and FixVac platform technologies to develop a tumor-specific CAR-T cell therapy which is enhanced by a CAR-T Cell Amplifying RNA Vaccine (CARVac) that is based on BioNTech’s mRNA-lipoplex technology and encodes for the CAR-T target antigen. The mRNA vaccine is designed to boost CAR-T persistence and functionality. BNT211 is a CAR-T cell therapy directed against the novel oncofetal antigen Claudin-6 (CLDN6), a target expressed on multiple solid tumors such as ovarian cancer, sarcoma, testicular cancer, endometrial cancer and gastric cancer. The program is currently being evaluated in a first-in-human Phase 1/2 trial as a monotherapy and in combination with a CLDN6-encoding CARVac in patients with CLDN6-positive relapsed or refractory advanced solid tumors.
About BioNTech
Biopharmaceutical New Technologies (BioNTech) is a next generation immunotherapy company pioneering novel therapies for cancer and other serious diseases. The Company exploits a wide array of computational discovery and therapeutic drug platforms for the rapid development of novel biopharmaceuticals. Its broad portfolio of oncology product candidates includes individualized and off-the-shelf mRNA-based therapies, innovative chimeric antigen receptor (CAR) T cells, several protein-based therapeutics, including bispecific immune checkpoint modulators, targeted cancer antibodies and antibody-drug conjugate (ADC) therapeutics, as well as small molecules. Based on its deep expertise in mRNA vaccine development and in-house manufacturing capabilities, BioNTech and its collaborators are developing multiple mRNA vaccine candidates for a range of infectious diseases alongside its diverse oncology pipeline. BioNTech has established a broad set of relationships with multiple global pharmaceutical collaborators, including Duality Biologics, Fosun Pharma, Genentech, a member of the Roche Group, Genevant, Genmab, OncoC4, Regeneron, Sanofi and Pfizer.
For more information, please visit www.BioNTech.com.
Forward-Looking Statements
This press release may contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, as amended, including, but not be limited to, statements concerning: the initiation, timing, progress and results of BioNTech’s research and development programs in oncology; BioNTech’s current and future preclinical studies and clinical trials in oncology, including CAR-T cell therapy candidate BNT211, including statements regarding the timing of initiation and completion of studies or trials, such as the expected initiation of a pivotal Phase 2 trial of BNT211 in germ cell tumors, related preparatory work and the availability of results; timing for any data readouts; the registrational potential of any trial we may initiate for our product candidates; the potential safety and efficacy of our product candidates, including qualitative assessments of available data and expectations of potential benefits (including Phase 1/2 data for BNT211 in advanced solid tumors); and BioNTech’s anticipated market opportunity and size for its product candidates. In some cases, forward-looking statements can be identified by terminology such as “will,” “may,” “should,” “expects,” “intends,” “plans,” “aims,” “anticipates,” “believes,” “estimates,” “predicts,” “potential,” “continue,” or the negative of these terms or other comparable terminology, although not all forward-looking statements contain these words. The forward-looking statements in this press release are neither promises nor guarantees, and you should not place undue reliance on these forward-looking statements because they involve known and unknown risks, uncertainties, and other factors, many of which are beyond BioNTech’s control, and which could cause actual results to differ materially from those expressed or implied by these forward-looking statements. These risks and uncertainties include, but are not limited to: the uncertainties inherent in research and development, including the ability to meet anticipated clinical endpoints, commencement and/or completion dates for clinical trials, regulatory submission dates, regulatory approval dates and/or launch dates, as well as risks associated with preclinical and clinical data; the nature of the clinical data, which is subject to ongoing peer review, regulatory review and market interpretation; future commercial demand and medical need; the availability of raw materials; competition from other product candidates, including those with different mechanisms of action and different manufacturing and distribution constraints, on the basis of, among other things, efficacy, cost, convenience of storage and distribution, breadth of approved use, side-effect profile and durability of immune response; BioNTech's ability to identify research opportunities and discover and develop investigational medicines; the ability and willingness of BioNTech's third-party collaborators to continue research and development activities relating to BioNTech's product candidates; the timing of and BioNTech's ability to obtain and maintain regulatory approval for its product candidates; and other factors not known to BioNTech at this time.
You should review the risks and uncertainties described under the heading “Risk Factors” in BioNTech’s Report on Form 6-K for the period ended June 30, 2023, and in subsequent filings made by BioNTech with the U.S. Securities and Exchange Commission (“SEC”), which are available on the SEC’s website at www.sec.gov. Except as required by law, BioNTech disclaims any intention or responsibility for updating or revising any forward-looking statements contained in this press release in the event of new information, future developments or otherwise. These forward-looking statements are based on BioNTech’s current expectations and speak only as of the date hereof.
CONTACTS
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[email protected] | Drug Discoveries |
'I had to breastfeed my HUSBAND': Mother recalls desperate moment her partner had to 'help her out' after she forgot her milk pump on vacation - leaving her swollen boobs 'on fire'
- Janelle McAloon, 32, from Boston, opened up about the ordeal on TikTok
- After one day of not pumping, she said her breasts felt like they 'were on fire'
- She added that 'desperate times called for desperate measures'
A mother-of-four has left the web stunned after she revealed she 'breastfed her husband' to relieve the pain she felt after she forgot her milk pump at home during their vacation.
Janelle McAloon, 32, from Boston, Massachusetts, opened up about the ordeal on TikTok recently, and she explained that 'desperate times called for desperate measures.'
She told her followers that she and her husband, Joshua, were vacationing in Puerto Rico for four days when she accidentally left her breast pump behind.
After one day of not pumping, she said her breasts felt like they 'were on fire,' so she decided to ask her partner to 'help her out.'
'You know the part in your marriage vows, "For better or for worse?" Well, I had to take my husband up on that this last week,' she said in the video, which has now been viewed more than 188,000 times.
A mother-of-four has left the web stunned after she revealed she 'breastfed her husband' to relieve the pain she felt after she forgot her milk pump at home during their vacation
Janelle McAloon, 32, from Boston, Massachusetts, opened up about the ordeal on TikTok recently, and she explained that 'desperate times called for desperate measures'
She told her followers that she and her husband, Joshua, were vacationing in Puerto Rico for four days when she accidentally left her breast pump behind
'We were in Puerto Rico, and as you know, I'm breastfeeding, and I forgot to pack my pump for whatever reason.
'My boobs are on fire. By the first day, I'm like, "Josh, I need you to help me out." And that's what we did. I'm here to tell you, I had to breastfeed my husband.'
'The awkwardness was real,' she captioned the post.
While some were horrified over Janelle's admission, others theorized that Josh likely enjoyed the task - and some even said they were jealous of him.
'Probably the best vacation ever for your husband,' wrote one person.
'I bet that job must have been so tough for him,' another added, while someone else said, 'I wouldn’t say that was a bad thing…. In fact one my conclude that was the for better part of the marriage.'
'It’s hard to see other men living out your dream,' joked a different user.
A fifth comment read, 'Every man's dream.'
After one day of not pumping, she said her breasts felt like they 'were on fire,' so she decided to ask her partner to 'help her out.' The couple is seen with their four kids
'You know the part in your marriage vows, "Or better or for worse?" Well, I had to take my husband up on that this last week,' she said in the video
While some were horrified over Janelle's admission, others theorized that Josh likely enjoyed the task - and some even said they were jealous of him
In a separate video, Janelle went viral after she tricked her husband into drinking some of her breast milk during a blind taste test for him.
She had him drink oat milk, whole milk, almond milk, and breast milk without him seeing which was which, and asked him to try to figure out what each substance was.
When he got to the breast milk, he scrunched his face up with disgust immediately - but he then went for a second sip.
'That's your breast milk,' he said. 'I'm positive.'
Janelle has also gotten attention online in the past for revealing that she often breastfeeds her sister-in-law, Lisa McAloon's baby, after Lisa began struggling with milk supply issues.
During an interview with Truly in November, Janelle said 'it wasn't even a question' for her to 'step in help' her sister-in-law, following the birth of her son, Callum.
In a separate video, Janelle went viral after she tricked her husband into drinking some of her breast milk during a blind taste test for him
She had him drink oat milk, whole milk, almond milk, and breast milk without him seeing which was which, and asked him to try to figure out what each substance was
When he got to the breast milk, he scrunched his face up with disgust immediately - but he then went for a second sip. 'That's your breast milk,' he said. 'I'm positive'
'I love breastfeeding, it's such a great bonding experience with the mom and the baby,' she gushed at the time.
'It's something that always came really easy for me. I enjoy doing it, and I don't think it's weird.'
The idea for Janelle to breastfeed Callum came one afternoon, when the sisters were hanging out and Janelle, who welcomed her daughter Georgia six months before Callum, noticed that Lisa had no milk left, but that Callum was 'crying' because he was 'still hungry.'
'Janelle was like, "Let me try." I was like, "Are you sure?" She was like, "I have plenty of milk, let me just try,"' recalled Lisa.
'So she put him on his breast and he was soothed and happy. She breastfed him and as soon as she was done he was as happy as could be.'
Janelle then decided to post a TikTok video about their situation in an attempt to 'shed some light on breastfeeding' and end the 'different stigmas around it,' however, the sisters soon started to receive a lot of backlash.
Janelle has also gotten attention online in the past for revealing that she often breastfeeds her sister-in-law, Lisa McAloon's baby, after Lisa began struggling with milk supply issues
During an interview with Truly in November, Janelle responded to people who called it 'disgusting,' stating, 'Is it disgusting when you're drinking cow's milk?'
Lisa added: 'This is my sister-in-law, who I 100 per cent trust. Janelle gives him great nutrients, keeps him from going hungry, and keeps him healthy and happy. I was lucky I had Janelle'
Some people called it 'disgusting,' while others said they 'would not be comfortable with their child being fed by someone else.'
'To each their own, obviously not everyone's going to have the same opinion as us,' Janelle told Truly, while discussing the negative comments they have received.
'But why is it disgusting? Is it disgusting when you're drinking cow's milk? You don't know where that cow's been.'
Lisa added: 'It feels like in the hateful comments, people are thinking I'm just walking up the street and finding a random person and saying, "Here, feed my baby." No, this is my sister-in-law, who I 100 per cent trust.
'I let Janelle breastfeed my child to help [him], to give him great nutrients, to keep him from going hungry, and to keep him healthy and happy. I was lucky that I had Janelle.'
Janelle's partner, Josh, added at the time that he thought it was an 'incredibly natural' and 'amazing' thing.
'I love it. I think it's really cool,' he said. 'Online, people get really weird about stuff like that but it's incredibly natural, I think it's an amazing thing.' | Women’s Health |
It's human nature to be judgmental. But why do we place less blame on someone, or give more praise, if we find out that person had a history of suffering in childhood? In a recent study, University of Missouri researchers discovered why someone's childhood adversity influences how others judge their behavior.
The finding contributes to a growing body of evidence that suggests judgments of praise and blame are "asymmetrically sensitive" to certain types of information about someone's life history, said Philip Robbins, associate professor and chair of the Department of Philosophy.
"In the case of negative or anti-social behavior, we see the actions of people with adverse childhood experiences as less of a reflection of their fundamental moral character, and more as a reflection of the environment they were raised in, so we blame them less for those actions," Robbins said. "On the other hand, when someone has experienced adversity in childhood and does something good, we tend to think of that behavior as more reflective or expressive of who the person is deep down, so we praise them more for it."
The research, based on statistical analysis of survey results from 248 participants, suggests that struggling with adversity in early life can be a "deformative experience," reshaping an individual's moral development.
"Experiences deform people's behavior in the sense that adverse experiences can pull people away from who they really are on a deeper level by pushing them onto an 'alternative' track of anti-sociality that they otherwise wouldn't be on," Robbins said.
The research conducted by Robbins and Fernando Alvear, a doctoral candidate in philosophy at MU, builds upon earlier work by Robbins and other colleagues, including Paul Litton, dean of the MU School of Law. Previously, Robbins and his colleagues found that people tend to think of a violent criminal as less culpable and less deserving of punishment when told that the accused had suffered serious harm in childhood. They also found that people tend to give more praise to someone for their good deeds as an adult after discovering that person had to overcome adversity or suffering earlier in life, such as abuse and neglect as a child.
The current study by Robbins and Alvear aimed to address a largely unanswered question from the earlier work about why this kind of information has this effect on people's judgements.
"This has all sorts of implications for people's social interactions," Robbins said. "Moral judgment is tremendously important for how we relate to others as people because they form an essential part of social judgment. The current research is part of a larger project aimed at understanding how moral judgment works. This understanding could potentially reorient people's thinking in ways that could have positive effects on the everyday practice of blaming and praising."
Robbins believes there is a natural "track" for a person's development, and people who haven't experienced challenging life events, including loss, trauma or other social disadvantages, do not typically develop strong anti-social tendencies later in life.
"People generally learn to behave in morally appropriate ways toward other people, such as not hurting, harming or speaking ill of them," Robbins said. "When people don't learn these lessons, they are pulled off-track from the natural path of development. People may not be saints or heroes, but most of us aren't villains either."
In future work, Robbins plans to explore the role that gender stereotyping may play in determining how judgments of blame and praise are affected by information about a person's life history.
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Viruses Hiding Out In Patients Hold Long Covid Answers
Scientists track mutants from one manhole cover to the next; others scan patients’ bodies for signs of hidden infections.
(Bloomberg) -- Tracking microbes through a malodorous network of sewer lines led virologist Marc Johnson to the source of unusual coronavirus mutants.
After months of sampling effluent, the University of Missouri School of Medicine microbiologist found exactly where the mutants originated: from a regular user of restrooms at a specific Wisconsin business. Although unable to identify that individual, Johnson could still see from genetic data that viral particles were being freshly made and expelled for more than a year — many times longer than a typical two-week Covid infection.
And during that time, the mutations showed the virus was “running like hell,” trying to evade the person’s immune system, Johnson said. Laboratory analysis of his sewer samples exposed the battleground inside the patient’s body, where the virus was quickly evolving to maintain a stronghold.
“You can find lots of chronic infections — people that are probably infected for over a year — where the virus hasn’t changed at all,” he said. “And I don’t understand why in some patients it just goes crazy.”
As the Covid-19 scourge enters a fourth year, patients like the one Johnson uncovered by tracing back through miles of waste pipes and drains are nudging researchers closer to answers for key questions: namely, where do worrisome new mutants come from? And what’s their role in long Covid, the mysterious post-infection ailment that afflicts more than 140 million people globally?
Scientists are exploring the possibility that some of the most infectious versions of the coronavirus — omicron and its descendants — came from chronically infected individuals whose immune systems were weakened by disease, drugs or both. Research released in December shows the virus can persist throughout the body and brain for months. That suggests it may be able to hide out in human cells and tissues, not unlike the way HIV and the shingles-causing chickenpox virus do.
Intriguing Autopsies
Traces in the blood and stool of patients experiencing protracted symptoms suggest that SARS-CoV-2 might be holed up in the gut, fat or other tissues that give shelter from the body’s immune defenses. Researchers at the US National Institutes of Health who conducted meticulous autopsies on the bodies of 44 Covid victims found viral genetic material throughout patients’ bodies and brains for as long as 7 1/2 months after symptoms began. In one case, virus particles isolated from the brain were grown in a lab dish, proving they were fully functional and capable of replicating.
“The predominant damage continues to appear to be in the lungs,” said Daniel Chertow, who led the research at the NIH’s emerging pathogens section, “but oh boy, we really need to better understand what type of damage is done in all these other places.”
Most of those autopsied were older and ill even before catching Covid, and all died before vaccines became available. And while none were known to have had long Covid, the findings published in the journal still demand follow-up.
“We absolutely need to, in great detail, try to understand what, if any, role persistence of viral RNA and other viral components might play in long Covid,” Chertow said.
• Read More: Coronavirus Can Persist for Months After Traversing Entire Body
No one knows whether the coronavirus or its remnants remain in everyone who’s had Covid, or if it’s just a group of patients, said Timothy Henrich, an associate professor of medicine at the University of California, San Francisco.
“We’re all making the hypothesis that it is a driver of long Covid, but we really haven’t definitively shown that,” Henrich said. “That is still something that needs to be done.”
Still, Chertow’s research has already encouraged experimental use of antiviral medications such as Pfizer Inc.’s Paxlovid to see if it can root out viral reservoirs and alleviate long-haul symptoms. Even a relatively small number of infected cells could provoke the immune system to produce inflammation, blood clots and other problems associated with long Covid, according to Amy Proal, co-founder of PolyBio Research Foundation, a non-profit in Boston that facilitates research into chronic, infection-associated conditions.
It’s “the most logical explanation because it accounts for pretty much everything else,” she said.
Scanning Hideouts
Henrich, who helped develop sophisticated imaging techniques that can pinpoint HIV within tissues, plans to use the same approach to find Covid’s hideouts. Dozens of patients will undergo a series of whole-body scans that will look for signals of production or persistence of viral protein. Those will be compared with symptoms to see how the lingering presence of the coronavirus correlates to long Covid.
The group has started scanning patients to look for protective T-cells that could indicate an aberrant immune response to SARS-CoV-2. They’re examining biopsies of participants’ digestive tracts for viral vestiges, Henrich said.
A particular focus is lymphoid tissues that produce, store and carry T-cells that fight infection, and antibody-making B cells. The coronavirus may also be hiding out in long-lived nerve cells and heart muscle, where it may drive chest pain, brain fog, fatigue and other long-Covid symptoms, said Diane Griffin, a virologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore who has studied the body’s response to viral infections for more than 50 years.
“We have pretty good information from acute RNA virus infections that RNA does persist and that it does have consequences,” said Griffin, who is vice president of the US National Academy of Sciences. “Basically, it’s hard to get rid of viruses.”
Proving that persistent viral infection causes long Covid will be difficult, Griffin said. Viruses in stealth mode suppress replication to avoid harming their host cells. Despite extensive distribution of coronavirus RNA throughout patients’ bodies, Chertow’s team saw little evidence of inflammation or that the immune system had tried to destroy infected cells outside the respiratory tract.
Viral Evolution
Intriguingly, when they analyzed the genetic makeup of virus specimens collected from six patients, the NIH scientists found versions in the lung that were different from those collected in other tissues. In one patient, viruses found in two brain regions — the thalamus and hypothalamus — were significantly different, suggesting that certain mutations favored the pathogen’s persistence there.
“We know that these RNA viruses have the potential to evolve within a host,” Chertow said. “The more they’re able to replicate and the longer the time that they have to do that, and the higher the level of replication that’s taking place, the more these viruses have the opportunity to evolve.”
That raises an interesting possibility: that as the virus evolves to inhabit different organs and tissues, the process may produce ever-more infectious and immune-evasive variants. No one knows yet if that’s the case, but Johnson’s analysis of wastewater at the University of Missouri is starting to yield clues.
Runaway Pathogens
Since the early days of the Covid pandemic, researchers have known Covid is capable of infecting the digestive tract, resulting in gastric upsets and causing patients to shed traces of the virus in their feces. Johnson routinely scouts across some 100 Midwest sewer networks for unusual SARS-CoV-2 strains, called cryptic lineages because their source is unknown.
“They’re rare, but they’re out there,” he says.
When Johnson began the work in March 2021, he had no idea where it was going. Then, after omicron drove Covid cases in the US to a record more than a year ago, he started actively looking for strains with distinct genetic changes.
He spotted one collected from a Wisconsin drain servicing 100,000 people. Its genetic signature was far more different than early versions of omicron, yet it hadn’t been reported in any patient. Importantly, its mutations began turning up in newer versions of omicron. It was almost as if Johnson had seen where the virus was going — evolutionarily speaking — before it arrived.
“So we started saying, let’s figure out where it’s coming from,” he said.
Black Swan
For four months, he and his colleagues went from one manhole to the next in an undisclosed metropolitan area. Then they found the samples came from one building. Then one side of building. Then, half a dozen restrooms used regularly by about 30 people.
That’s where the investigation has stalled, Johnson said. Even so, he’s been able to deduce that the cryptic lineage is from an individual who was infected almost two years ago, since it evolved from a strain last detected in Wisconsin in April 2021.
In August, the variant’s concentration was 1.5 billion copies per liter of wastewater. By comparison, at the height of an enormous Covid outbreak in a Missouri prison, a liter of wastewater contained only 100 million copies of the coronavirus.
“It’s crazy how much virus this person is shedding,” Johnson said.
In December, the same variant occurred in the Wisconsin restroom plumbing for the 13th straight month.
“Whoever this person is, they are apparently still going to work every day and have been for some time,” Johnson said. “It appears that they don’t know they’re infected. This can’t be good for them.”
The lineage hasn’t turned up anywhere else, which suggests it isn’t spreading, Johnson said. But there’s no question that it can grow, as shown by the long-time high concentrations in the toilet drain.
“The question is why?” he said. “We kind of assume that something like this is what happened with omicron and that there was some kind of black swan event that allowed the virus to get out.”
Johnson says studying cryptic lineages has challenged his thinking about the coronavirus’ ability to hang on in human tissues, especially those outside the respiratory system, and its potential to cause prolonged illness.
“I am now particularly open to the idea that there are secondary infections that we just don’t know about,” he said. “And maybe that helps explain some of these very odd long-Covid symptoms.”
More stories like this are available on bloomberg.com
©2023 Bloomberg L.P. | Disease Research |
A medical research technology company founded by an NHS doctor has raised almost £10m in funding to help tackle a sharp decline in clinical trials in Britain.
Sky News understands that uMed, which stands for United in Medicine, will announce this week that it has secured the new capital from investors including Albion VC and Playfair Capital.
The £9.8m funding round, which also included money from Delin Ventures and Silicon Valley's 11.2 Capital, will be used to expand improved access to clinical trials.
Recent data suggests that patient access to clinical trials in Britain nearly halved between 2017 and 2022, with the number of trials initiated in the UK, including cancer trials, falling by 41% during a similar period.
uMed aims to address this issue by enabling healthcare providers in the UK, US and Canada to take part in clinical research and care improvement activity at no additional cost or bureaucratic burden to staff.
Its platform finds and engages suitable patients, and collects prospective data to answer key clinical questions, in turn allowing GPs to generate additional revenue for their practice.
The company said this was aligned with a review of commercial clinical trials in the UK published in May by Lord O'Shaughnessy, who urged the government to provide financial incentives to GPs to help boost the number of trials.
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One use of the funding will be to extend the reach of uMed's cohort programme in Parkinson's Disease to several thousand patients globally by the end of the year, it said.
The money will also be used to facilitate the expansion of the company's presence in North America, with the objective of increasing its global patient access to more than 10 million people by the end of the year.
Dr Matt Wilson, uMed's founder and chief executive, said: "We developed the uMed platform to help healthcare professionals more easily and efficiently run patient research and targeted care programmes at scale, improving outcomes for patients by mitigating care gaps and accelerating research.
"Our ground-breaking patient cohorts give researchers access to unique data and insights, accelerating development and access to new therapies, while dramatically reducing the cost of finding, engaging and collecting prospective data from patients."
Since a seed funding round in 2020, uMed has signed up more than 450 UK GPs representing five million patients, with the company recruiting more than 6,000 patients to clinical studies.
Rosie Barnett, a principal at Delin Ventures, said the "traditional clinical research model is slow and expensive... [but] uMed provides a unique platform to engage patients at scale in a highly targeted and cost-effective manner".
The valuation at which the capital was raised was unclear. | Disease Research |
Researchers have developed a magnetic gel that can help diabetic wounds heal roughly three times as fast as they would with a conventional wound dressing. The magnetic gel, in combination with an external device to generate a dynamic magnetic field gives the skin cells around the wound a gentle workout.
In a new study, researchers at the National University of Singapore focused on how to encourage chronic wounds, especially wounds in people with diabetes, to heal more quickly. Diabetes often compromises natural healing, and therefore, diabetics often develop chronic wounds that are slow to heal.
For example, diabetic foot ulcers afflict 15 to 25 percent of the roughly 30 million people living with diabetes in the United States. These and other chronic wounds linked to diabetes are the second leading cause worldwide of lower-limb amputations, after amputations necessitated by accidents or injuries. Currently, more than 540 million people globally are living with diabetes, according to the World Health Organization, and this number is expected to rise significantly over time.
“Approximately 10 to 15 percent of diabetic foot ulcers fail to heal,” says study senior author Andy Tay, a biomedical engineer at the National University of Singapore. “Shockingly, about a quarter of these nonhealing cases eventually necessitate amputation.”
Conventional dressings for wounds “fail to fundamentally accelerate the healing of wounds. They mainly serve to prevent wounds from deteriorating, requiring patients to follow a schedule for dressing changes every two to three days over an extended period,” Tay explains. “The fundamental reason behind their limited effectiveness lies in their inability to simultaneously address multiple critical factors associated with diabetic wounds, as well as their incapacity to modify the local microenvironment.”
Andy Tay [center] holds an adhesive bandage loaded with magnetic gel, while Shou Yufeng [right] holds a device that provides magnetic stimulation. Le Zhicheng [left] is holding a sample of the magnetic gel in liquid form.National University of Singapore
In the new study, Tay and his colleagues investigated strategies to more actively treat chronic wounds, rather than wait for the body to take its time. They focused on the way in which the mechanical forces that a person’s skin normally experiences during daily activity can help spur healing. Those mechanical forces can trigger cell proliferation and migration, the secretion of growth factors, and the formation of new blood vessels. However, patients with wounds are usually advised not to walk around or undertake more rigorous activities.
The scientists found another way to create a mechanical force by experimenting with a gel that had been loaded with tiny magnetic particles. When exposed wirelessly to a dynamic magnetic field, the gel exerts a gentle, rhythmic mechanical force.
Aside from the magnetic particles, the researchers loaded the magnetic gel with two kinds of U.S. Food and Drug Administration-approved skin cells—keratinocytes, which are essential for skin repair, and fibroblasts, which help form connective tissue. The mechanical stimulation from the gel can help encourage the skin cells to become more active. The scientists also loaded this gel with insulin, which can influence blood-sugar levels in wounds to help guide the rate of healing.
“One of the most compelling features of this platform is its holistic ‘all-in-one’ approach to wound healing, targeting multiple aspects of the healing process simultaneously,” Tay says.
The scientists placed this gel in a bandage to help treat wounds in diabetic mice. They found the bandages helped wounds heal roughly three times as fast as current approaches, after applying magnetic stimulation for about 1 or 2 hours.
The novel dressings also promoted healing in other ways, the researchers say. For example, the bandages improved fibroblast growth rate by about 240 percent, and more than doubled the production of collagen, a key protein for wound healing. In addition, the researchers found that magnetically directed mechanical stimulation of the gel could help control the rate at which insulin was delivered into wounds.
“Our technology takes a comprehensive approach, effectively targeting several critical factors linked to diabetic wounds,” Tay says. “It not only manages elevated glucose levels within the wound area, but also reactivates dormant skin cells near the wound, restores damaged blood vessels, and repairs the disrupted vascular network within the wound.”
The researchers noted that this new technology may have applications beyond healing diabetic foot ulcers. For instance, it may help treat complex wounds such as burns, Tay says.
Currently, the researchers are conducting additional tests to refine the gel to enhance its effectiveness, Tay says. “In addition, we are collaborating with a clinical partner to assess the gel’s effectiveness using human tissues from diabetic patients,” he adds. “Together, we are working on addressing key challenges related to regulation, industrialization, and clinical implementation.”
The scientists detailed their findings online on 8 September in the journal Advanced Materials. They have also filed a patent for the technology. | Medical Innovations |
Motivation expert warns that you should never, ever hit the snooze button
It actually makes you feel more tired.
Mornings can be a challenge for a lot of folks. Our beds feel incredibly cozy, and after the alarm sounds, the allure of "just five more minutes" seems irresistible. The snooze button promises a brief escape to the warmth of dreams, a little respite before facing the day. It's a small comfort, a momentary delay from the bustle ahead.
But five minutes becomes 10 minutes and then 15 minutes, until we find ourselves racing against the clock to get to work on time. The snooze button can create a terrible cycle that feels like an addiction.
If you’re a snoozeaholic, a one-minute video by Melanie Robbins may break your dependence. Robbins is a podcast host, author, motivational speaker and former lawyer. She is known for her TEDx talk, "How to Stop Screwing Yourself Over," and her books, “The 5 Second Rule” and “The High 5 Habit,” as well as for hosting The Mel Robbins Podcast.
In a TikTok video taken from her podcast, Robbins explains the neuroscience behind why hitting the snooze button is a terrible idea.
@melrobbins
Stop hitting the snooze button on your life and TAKE CONTROL! 🚀 Sign up for my new, FREE 3-part training, Take Control with Mel Robbins. It’s designed specifically to to help you step back into excellence, take ACTION, and create the life you deserve! 🔗 in bio #melrobbins #dailyinspiration #mindsetmotivation #tapintopotential #takecontrol #reinventyourlife #snoozebutton #wakeup #wakeupcall
“Let me hit you with some neuroscience here. Two words: sleep inertia,” Robbins begins the clip. “When you hit the snooze button, you're awake, and as the alarm turns off, your brain then drifts back into sleep."
“Here's the thing that researchers have figured out—when you drift back to sleep after you've woken up, your brain starts a sleep cycle. Sleep cycles take 75 to 90 minutes to complete,” she continued. “So, when that alarm goes off again in nine minutes and you're like ‘oh my God’—have you ever noticed you're in deep sleep when you drift back to sleep?”
Robbins reasons that because you’ve entered a new sleep cycle, you will feel even more exhausted than if you woke up when the alarm first went off, and the feeling can last for a good part of the day.
“That's because you're nine minutes into a 75-minute sleep cycle." That groggy, exhausted feeling that you have, that's not a function of how well you slept. "It takes your brain about four hours to get through that groggy-a** feeling," Robbins says.
If you’re looking for a scientific take on the same issue, Steven Bender, a clinical assistant professor at Texas A&M University, agrees with Robbins. “Delaying getting out of bed for nine minutes by hitting the snooze is simply not going to give us any more restorative sleep. In fact, it may serve to confuse the brain into starting the process of secreting more neurochemicals that cause sleep to occur, according to some hypotheses,” Bender wrote in an article published by Popular Science.
Ultimately, it’s all about feeling our best in the morning to have a productive day. Most people snooze because they want a few extra minutes of sleep to feel even more energized. But, unfortunately, the truth is that it makes you feel worse. So, hopefully, all those snoozers out there will break their habits and get up when the alarm sounds so they can feel their best. | Stress and Wellness |
Dr. Phillip Yang, a cardiologist at Stanford Health Care in California, told Yahoo News that heart problems following COVID vaccination are “theoretically possible but extremely rare.” (Getty Images)There has been no public announcement about what caused Damar Hamlin’s cardiac arrest after a tackle during a “Monday Night Football” game between the Cincinnati Bengals and the Buffalo Bills on Jan. 2 — but that hasn’t stopped people from speculating. One unfounded claim making the rounds on social media is that the 24-year-old’s medical emergency was caused by the COVID-19 vaccine. This assertion about Hamlin isn’t based on facts, and heart problems after vaccination have only been reported in a very small number of cases.What we know about COVID vaccines and heart problemsDr. Phillip Yang, a cardiologist at Stanford Health Care in California, told Yahoo News that heart problems following COVID vaccination are “theoretically possible but extremely rare.”The Centers for Disease Control and Prevention has said it is monitoring reports of myocarditis, an inflammation of the heart muscle, and pericarditis, an inflammation of the outer lining of the heart, after receiving the Pfizer or the Moderna mRNA vaccine. Symptoms of myocarditis or pericarditis may include chest pain, shortness of breath or “feelings of having a fast-beating, fluttering, or pounding heart,” and cases after vaccination have most often been reported in adolescents and young adult males within a week of the second dose of the Pfizer or the Moderna vaccine. While the severity of myocarditis and pericarditis cases can vary, most patients with reported cases who received care “responded well to medicine and rest and felt better quickly.”But experts stress that myocarditis or pericarditis after vaccination is very uncommon. The CDC said in September 2022 that of the more than 123 million people who had received COVID shots, it had verified 131 cases of myocarditis. And data published by the CDC in 2021 found just 12.6 cases per million second doses administered.Myocarditis and pericarditis are usually triggered by a viral infection. In fact, Yang and others say, you’re more likely to experience heart problems after contracting the coronavirus than after getting vaccinated — though Yang emphasized that heart problems related to the coronavirus are also very rare.Researchers have also identified a possible association between COVID vaccines and postural orthostatic tachycardia syndrome, or POTS, a common condition affecting nervous system functions such as heart rate and blood pressure and characterized by symptoms such as light-headedness, brain fog and fatigue. However, instances of POTS after vaccination are also unusual and much less likely to occur as a consequence of COVID vaccination than of the COVID virus itself. A study published in December 2022 by researchers at Cedars-Sinai Medical Center found that the risk of developing POTS is five times higher after COVID-19 infection than after vaccination.“This concern about POTS is something that you don’t see very often after the COVID vaccine. It’s very rare,” Dr. Mitchell Miglis, a clinical associate professor of neurology at Stanford University, told Yahoo News.“I think the really important point is that the risk of all these heart conditions — including myocarditis [and] pericarditis — it’s much, much higher with COVID infection, and vaccination significantly reduces your risk of severe disease from that. So getting vaccinated is the best way to help prevent these cardiac conditions from COVID.”COVID vaccines and misinformationDamar Hamlin of the Buffalo Bills tackles Tee Higgins of the Cincinnati Bengals at Paycor Stadium in Cincinnati on Jan. 2. Hamlin was taken off the field by medical personnel following the play. (Dylan Buell/Getty Images)Dr. Jonathan Kim, chair-elect of the American College of Cardiology Sports and Exercise Cardiology Council, told Yahoo News that claims on social media that the COVID vaccine may have caused Hamlin’s cardiac arrest are “completely irresponsible.”“This is similar to some of these other stories that are circulating on social media, where those with a personal agenda of disinformation are just linking it to the COVID vaccine without any known particulars in each of these cases,” he said.False claims that vaccines are responsible for more heart problems in athletes have been running rampant on social media and advertised by Fox News’ Tucker Carlson, including one oft-cited number from a blog post stating that 1,598 athletes have suffered cardiac arrest since COVID-19 vaccinations began. But as a fact-checking assessment by the Associated Press and others explain, that erroneous number doesn’t come from a rigorous study; it instead clumps together reports of deaths and medical emergencies of people from all over the world from a wide age bracket, including some whose deaths were attributed to conditions other than cardiac arrest, such as cancer.“There’s been no evidence to link a higher incidence of sudden cardiac arrest and death in athletes since the COVID vaccine,” Kim said. “And certainly anecdotally, in my own experience, we have not seen an uptick in terms of sudden cardiac arrest cases different than before the COVID vaccine.”Kim said that most causes of sudden cardiac arrest in young athletes “are typically due to an underlying ... heart problem that was preexisting.” Some medical experts have speculated that commotio cordis — a condition causing an abnormal heart rhythm and cardiac arrest after an object strikes the chest at a critical time during a heartbeat — may have led to Hamlin’s collapse earlier this month.Miglis pointed out that symptoms of heart problems like myocarditis or pericarditis often tend to be “less dramatic” than what fans witnessed with Hamlin on the football field.“Symptoms are going to be persistent for awhile, and someone wouldn’t just suddenly collapse because of it,” Miglis said of myocarditis and pericarditis. “Things like chest pain and shortness of breath, fatigue, that’s going to be more over several days that someone would notice and then present with that — not just a sudden collapse or sudden cardiac arrest.”The takeawayThe CDC recommends that everyone ages 6 months and older get vaccinated for COVID-19, adding that the known risks of COVID illness and its possibly severe complications “far outweigh the potential risks of having a rare adverse reaction to vaccination, including the possible risk of myocarditis or pericarditis.”“The take-home point is that the best way to prevent myocarditis or an inflammatory cardiac condition in the pandemic setting is to get vaccinated,” Miglis said. “Because your risk of getting that from COVID is much, much higher than from a vaccine.” | Vaccine Development |
The freckles that speckle many people's skin are often called "sun kisses" because they tend to appear or darken after exposure to the sun.
But why do freckles come out in the sun?
A freckle develops as a protective mechanism against harmful ultraviolet (UV) radiation, Dr. Jill S. Waibel, a board-certified dermatologist and the medical director of Miami Dermatology and Laser Institute, told Live Science. Sun exposure prompts the skin to produce melanin, the pigment that produces the many hues of human skin and also allows skin to tan.
Melanin scatters UV rays, meaning it sends the rays bouncing in different directions; this prevents them from penetrating the skin and damaging its DNA. However, some patches of skin produce more of this pigment than others, and these melanin-rich spots are referred to as freckles, Waibel said.
As a result, freckles tend to become more visible during the summer and disappear or lighten during months when the UV radiation is not as strong.
That said, not all freckles respond to the seasonal sun exposure in the same way, Dr. Rebecca Kazin, a board-certified dermatologist and the director of clinical research at Icon Dermatology and Aesthetics, a dermatology practice in North Bethesda, Maryland, told Live Science by email.
There are two main types of freckles: ephelides, which are what people typically think of as freckles, and solar lentigines, also known as liver spots or age spots. Both types are more common in people with fair skin and in those with a genetic predisposition to develop them. However, solar lentigines do not fade in the winter like ephelides do, Kazin said.
Ephelides, the most common freckle type, are usually small and light brown, and they appear on skin that's commonly exposed to the sun: on the face, arms and shoulders, she said. These freckles tend to darken and fade in response to short-term sun exposure, while solar lentigines are associated with accumulated sun damage to the skin and do not fade.
Solar lentigines tend to be larger and darker than ephelides, and they are more common in older people, Kazin said. Also called sun spots, solar lentigines appear when UV radiation damages the DNA in skin and thus changes the behavior of melanin-making cells, according to a 2014 review in the journal Pigment Cell & Melanoma Research. These changes in gene activity boost both the number and production levels of these melanin makers, resulting in patches of skin where melanin pigment accumulates and clumps up.
Solar lentigines are not cancerous and don't require any treatment, but they can look similar to some skin cancers. If you're concerned about a spot or notice that one is undergoing rapid changes, contact a health care provider to get checked out, Kaiser Permanente advises.
This article is for informational purposes only and is not meant to offer medical advice.
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Anna Gora is a health writer at Live Science, having previously worked across Coach, Fit&Well, T3, TechRadar and Tom's Guide. She is a certified personal trainer, nutritionist and health coach with nearly 10 years of professional experience. Anna holds a Bachelor's degree in Nutrition from the Warsaw University of Life Sciences, a Master’s degree in Nutrition, Physical Activity & Public Health from the University of Bristol, as well as various health coaching certificates. She is passionate about empowering people to live a healthy lifestyle and promoting the benefits of a plant-based diet. | Disease Research |
Junior doctors are claiming up to £10,000 tax-free in “life admin” expenses on the NHS, including redirecting their post and nursery fees, as they strike over pay demands.
Trainee doctors are eligible for the fund if they’re relocating 30 miles, or at least one hour’s travel time in “normal traffic”, from their home.
In the last five years, more than £40 million has been claimed by junior doctors in moving expenses, according to figures obtained under freedom of information laws.
The relocation expenses are exempt from income tax.
The new figures come as junior doctors began a 96-hour strike in a dispute over pay.
The British Medical Association (BMA) is calling for a 35 per cent pay rise to restore wages to 2008 levels, amid concerns doctors are being “overworked and underpaid”.
The union has also launched “misleading” campaign adverts claiming junior doctors earn less than Pret-a-Manger baristas.
The advert, which claimed baristas would be paid £14.10 per hour while junior doctors make £14.09, was dismissed as “misleading” by the Department of Health and Social Care (DHSC) because it didn’t take into account the additional earning capacity and pay progression available to junior doctors.
MPs have questioned why additional benefits, such as the trainee relocation and travel funds, have seemingly been left out of the BMA’s campaigning.
Paul Bristow, Conservative MP for Peterborough and member of the health select committee, said: “I think it is absolutely right that junior doctors can access this budget during training. We need more junior doctors and this should act as an incentive.
“But I find it interesting that this money is never mentioned during this dispute on pay. It’s the overall package that counts and this is an extremely generous element that the BMA remains silent about.”
The Telegraph understands discussions between the BMA and ministers did not cover benefits and working conditions, as the union has refused to move beyond its 35 per cent pay demand.
The £10,000 fund is in place to provide support to junior doctors who are required to relocate or commute due to the rotational nature of their training.
Trainees can claim relocation and travel expenses through their NHS trust, which then charges Health Education England (HEE) - the non-departmental public body which educates and trains the NHS workforce - which is responsible for the costs.
John O’Connell, chief executive of the TaxPayers’ Alliance said: “Patients are tired of complaints about funding from a health service that already receives record levels of cash.
“With doctors able to bill taxpayers for life admin and other perks, households will rightly recognise that a doctor’s salary is just one part of the package.
“Ministers must ensure that when discussing pay, they view negotiations in the round.”
‘Misleading’
Under the scheme, trainees can claim solicitors’ and estate agents’ fees, stamp duty, land registry fees, survey fees, any incidental legal expenses, and temporary accommodation expenses.
The storage of furniture for up to a year where necessary can be claimed for, as well as a removal firm to pack and unpack furniture and effects from the old home to the new one.
If a trainee’s family remains in the old home temporarily until suitable accommodation is found in the new area, they may claim weekly travel costs for visiting the family home for up to a year.
Other incidental expenses, such as redirecting their post for up to six months, and any non-refundable nursery registration fees (for up to £150 per child) can also be claimed.
Dr Vivek Trivedi, co-chair of the BMA junior doctors committee, said: “It is misleading to suggest that junior doctors derive any financial gain from this policy. Due to the national recruitment process for medical training, junior doctors typically move across the country between trusts or GP practices many times over the course of their training.
“This policy is designed to reimburse some of the reasonable costs incurred by moving for work, ensuring that all parts of the country, including under doctored and remote areas, are well supplied with doctors in training who provide essential care to patients.”
He added that the policy was “completely separate” from the real terms pay cut junior doctors have incurred over the last 15 years.
“Rather than conflating the issues of pay and reasonable relocation expenses, MPs would do better to hold the Government to account for its failure to bring a swift end to this dispute and get around the negotiating table,” he said.
The national arrangements for the scheme were updated in 2020 to allow junior doctors to claim up to £10,000 for relocation and excess mileage costs over the duration of their postgraduate training.
The allowance was increased from £8,000 after a consultation with the BMA and other stakeholders, “to provide a consistent approach to support all trainees across the country who face the financial costs of moving house to take up training, and/or may be financially disadvantaged as a result of their training programme covering a large geographical area”.
Figures obtained by The Telegraph show the amount claimed in 2021/22, the first full year under the new framework, increased by more than a quarter compared to the previous year - £9.98m compared to £7.86m.
In 2022/23, more than £7.98 million has been claimed so far up to February. | Health Policy |
Matt Hancock feared being labelled 'racist' over raising concerns that Covid was spreading faster among certain communities, new leaked messages reveal.
WhatsApp exchanges from August 2020 show Nadine Dorries, a key figure at the Department of Health at the time, warn her boss Mr Hancock not to lockdown 'our voters' because of the 'behaviour of non compliant communities'.
She later suggested there could be 'race riots' if he chose to lockdown the 'white working-class' area of Colne in Lancashire while the virus was quickly spreading in the neighbouring town of Nelson.
The messages, the latest to be published by The Daily Telegraph, also reveal another Conservative MP told then prime minister, Boris Johnson, that local lockdown restrictions were fuelling 'race relation issues' in his constituency.
Texts unearthed today reveal Mr Hancock, then health secretary, told Ms Dorries on August 20, 2020: 'I don't want to be called a racist but we've got to name it.'
Ms Dorries, who at the time served as minister for patient safety, suicide prevention and mental health, responded: 'We can't put whole towns and villages with extremely low R rates in lockdown (our voters) and deprive those people of work and family bcse of the behaviour of non compliant communities.'
MailOnline has not seen or independently verified the WhatsApp messages, leaked to The Daily Telegraph by Isabel Oakeshott, the journalist who helped Mr Hancock write his book Pandemic Diaries.
The R rate - which epidemiologists use measure a disease's ability to spread - is, in essence, the number of people that one infected person will pass on a virus to, on average.
At the time the R rate across England was believed to be between 0.9 and 1.0 according to data from the Scientific Advisory Group for Emergencies (Sage).
On August 19, test and trace data showed a 27 per cent jump in the number of positive Covid cases, despite the number of people tested reducing slightly.
Local lockdowns and measures were in place across a number of towns to target areas with a higher R rate, after the national lockdown ended on July 4.
On August 20, ministers were considering fresh interventions in Oldham, Pendle and Blackburn in Lancashire as the epidemiological data showed that cases were getting out of control in certain areas.
Later that day, in a message to Ms Dorries, Mr Hancock said he had spoken to Philip Davies, the Conservative MP for Shipley, West Yorkshire regarding local lockdowns.
'I told him that given he's got a veto, it's actually very good for him,' Mr Hancock told Ms Dorries.
'I'm speaking to Andrew Stephenson (Tory MP for Pendle) tonight regarding Pendle', she responded.
She added: 'Remember the Burnley race riots? I was working as Oliver Letwin's Spad [special advisor] at the time. Andrew very concerned at his LA [local authority] CEOs stance that any restrictions should be one size fits all, across the constituency.
'The town ward of Colne, 18 pubs, white working class would be like a tinder box if it's pubs closed bcse of non compliance and infection rates in Nelson, 2 pubs, Pakistani community next door.'
On August 21, the Government then unveiled new Covid guidance to come into force on August 22, tightening restrictions on households meeting and attendances at weddings and funerals, in some parts of east Lancashire.
Those in Oldham, Pendle and Blackburn were told not to socialise with anyone outside their household and not to use public transport unless it was essential.
Colne was not included in these new measures.
Announcing the restrictions, Mr Hancock said at the time: 'Working with local leaders we agreed further action in Oldham, Pendle and Blackburn. It is vital that everyone in these areas follow the advice of their councils, and abide by their local rules carefully.'
The action was 'as targeted as possible, with the maximum possible local consensus', he added.
It came as Mr Davies had reached out to then Prime Minister, Boris Johnson, earlier in August to prevent lockdown restrictions from including Pendle, leaked WhatsApp messages show.
In a message shared with Mr Hancock by Mr Johnson, the MP for Shipley wrote: 'I am desperate to speak to you about the decision of the govt to include my constituency in the local lockdown on Bradford - even though there are barely any cases in my constituency.
'This is causing a massive issue and is fuelling huge race relations issues. This needs to be resolved ASAP.
'I would be very grateful if you could find the time to discuss with me. This is toxic locally.'
Pendle had been placed under restrictions alongside swathes of the north of England including Bradford and Greater Manchester on July 30, the evening before Eid.
But further texts leaked to The Daily Telegraph also show Dido Harding, who led the Government's test and trace programme, warn Mr Hancock of a rise in infections among the 'same communities' who would be celebrating Eid, ten days earlier.
She wrote: 'I am really worried about Eid. The geographic spread is all in the same communities.' | Epidemics & Outbreaks |
Patients have been sharing their negative and positive experiences of the health service with Sky News during a day of special programmes about the NHS crisis, including a live phone-in and an audience debate.We have been looking at whether the service can survive as it currently endures its most difficult winter on record.
You can see how your health service is performing using the tool below. It comes as new data shows that GP waiting times fell in December for the second consecutive month, with the share of people managing to secure an urgent appointment on the same day rising from 69% to 74%.And separate figures found ambulance handover delays outside hospitals in England have dropped to their lowest level this winter, though one in five patients are still waiting at least half an hour to be transferred to A&E teams.
NHS latest: Rock star unexpectedly joins our NHS phone-in and offers to pay for life-saving scans Please use Chrome browser for a more accessible video player NHS Crisis: 'He got very frail' Sarah's mother ended up staying for an extended time in hospital and 'dying for no reason' More on Nhs NHS crisis: Politicians are not offering a comprehensive solution on how to fix the health service NHS needs are long-term, complicated and challenging Sir Rod Stewart calls in to Sky News to donate for medical scans after hearing NHS crisis stories and says 'change the bloody government' Sarah Templeton said her mother had been admitted for treatment for a punctured lung, six fractured ribs and a damaged spleen following a fall.Her mother was in there for four weeks before Ms Templeton was told her loved one could be moved to a discharge and assessment centre. But she was not released and she ended up getting a chest infection, flu and pneumonia, and then "we sat holding her hand while she died on 30 December". Image: Sarah Templeton Ms Templeton said: "She didn't need to die. She was perfectly well for three weeks. She was bored. She wanted to come out of that hospital."She said she could not fault the "amazing" medics but added that two doctors on separate occasions told her: "I'm really sorry Sarah, but this is what happens when you come into hospital now."If you come in and you're elderly, or you've got a lower immune system, you will get a chest infection, you will get the flu, you will get pneumonia, and you will die. I said to them: 'Why didn't you tell us that because would have broken her out of here'."We would not have left her there. We thought she was in the best place for seven weeks. She died gasping for breath. There was nowhere to take her."Ms Templeton said the hospital would not let her take her home as she had to be under the responsibility of the local authority. "But the local authority didn't look after her. She ended up staying and dying for no reason."Janet had a 37-hour wait in A&E - 'I was bleeding all over my nightdress'A former practice manager in primary care, Janet said she had two spinal surgeries within 14 days last year and had only just been discharged after the second procedure when she suffered complications and was taken back to hospital in an ambulance.She said that after about six hours she had a "lot of tests" and had a cannula (thin tube) inserted in her arm, before being moved to another part of A&E which was "overflowing with patients".Janet, from Lancashire, added that she felt "so sorry" for the nurses and the doctors. "Honestly, it was dreadful. There weren't enough staff," she said.She went on to say that during the night in hospital she felt like she needed to use the toilet but realised her catheter bag was "full and overflowing"."I got urine on my nightdress, on the sheets. Also I tried to take my dressing gown off because it was wet with urine and I pulled a cannula out of my arm."I was bleeding all over my nightdress. I was shouting desperately for a nurse to come and help me and got to the stage where I got myself up and sat on the edge of the trolley and started to cry."Read more:Sir Rod Stewart calls in to Sky News to donate for medical scansProposals to make some patients pay for care spark backlash Please use Chrome browser for a more accessible video player 'Very difficult December' for ambulance service Amy was moved to a different hospital during labourAmy, from Essex, says she had originally planned to go to a midwifery-led unit but during her pregnancy it shut down due to staffing issues.She ended up having to go to her nearest hospital, which is an hour away, but due to her not going there for appointments she was sent to a day assessment unit rather than the maternity ward to give birth to her daughter."I actually ended up nearly having her in the corridor because there wasn't anywhere for me to go," she said.Describing her maternity care, she added: "After I had her, I was due to be stitched up but I was actually left for about three hours after having her due to a shift change."But the lady who did end up coming in to do my stitches apologised profusely. It was no fault of her own. She was honest, which I appreciated. She just said, 'I'm really sorry'." Please use Chrome browser for a more accessible video player NHS is 'failing every day', says paramedic Anastasia left on waiting list for three years - 'I feel like I'm losing the will to live'Anastasia, from Leeds, has been waiting for an appointment for three years.She has cerebral palsy and is now suffering with a urology issue."I feel like I'm losing the will to live. I have a urological condition and I just want it fixed. I'm not receiving any social care, I'm not receiving any support."Unfortunately, I come from a care background from no fault of my own because my mother put me in an institution when I was two weeks old - the support isn't there."She explained that she was once called up for an appointment to have the procedure, but they did not realise she had cerebral palsy."It all often depends on who you speak to, and I don't feel listened to," she added."I don't know what to do, and what worries me is that the situation for me and others could get worse." Please use Chrome browser for a more accessible video player The crises facing ambulances Ezra 'can't praise NHS staff enough'Cancer patient Ezra, from Lincoln, said he "can't praise enough" those who looked after him and the fast turnaround between when he was first diagnosed and then had surgery.Ezra said he had a PSA blood test which can help detect prostate cancer.He had a raised level and was asked to come into his GP surgery the day after the result came in, and had an examination.Ezra said he was then put on to a two-week cancer care wait and within a fortnight he had an MRI scan at his local hospital. He also had a biopsy and a bone scan, and a urologist talked him through the whole procedure for his cancer.He asked if the surgery could be after Christmas and he went into his local hospital early this month.Recalling his time there, Ezra said: "One night about 3am, a nurse came up to me. I think it was a 10-bed ward and all the men were sleeping. Very quietly with a little light on, so not to disturb me, she did my blood pressure, my oxygen levels. These people, they're not heroes, they're professionals. And I really can't praise them enough." Please use Chrome browser for a more accessible video player NHS crisis: 27 hours for a bed Shirley says NHS staff 'saved my life so many times'Shirley from Devon has been in hospital for the last 10 days in the midst of nurses going on strikes.She said she "supports the staff 100%" and added they were "not getting what they deserve".Speaking about the treatment she has received from NHS workers over the years, she said: "They saved my life so many times these last 10 years."Last month, I was in with heart problems and they saved my life there. It was serious. I can't fault them."She said she even asked her local MP to do a shift with staff in hospitals "so he could see how they work".Carole says 'all the nurses were fabulous' after her 90-year-old father was picked up by ambulance and treated within five and a half hoursCarole, from Sheffield, said her dad fell on the ice last Friday and broke his leg.She says the ambulance was called at around 9.45am and by 2.30pm that afternoon she had already received a call to say her father was comfortable and being treated for his pain."All of his treatment has been absolutely brilliant, it has all gone really swimmingly and the nurses have been fabulous."In the olden days, five and a half hours might have seemed like a long time, but let's be straight and let's give some credit where it is due for people still managing to do a fabulous job.""They must get very demoralised when they hear negative stories the whole time," she said. | Health Policy |
The cost of the NHS strike action is “eye-watering” and could run into billions of pounds, a health boss has said as he urged ministers to resolve the row over pay.
Matthew Taylor, the chief executive of the NHS Confederation, which represents the healthcare system in England, Wales and Northern Ireland, said some NHS trusts were losing £500,000 for every day of industrial action.
Consultants in England began striking for the first time in a decade on Thursday after eight months of industrial action by other staff across the health service. Their strike will continue until 7am on Saturday, and they will strike again for 48 hours in August.
Hospitals are having to spend vast sums on agency workers to cover shifts during the strikes and administration costs to cancel and reschedule hundreds of thousands of appointments, procedures and operations. Taylor said the strikes were also derailing efforts to tackle the backlog of 7 million patients waiting for care.
“Many health leaders have told us they are deeply concerned by the long-term impact prolonged industrial action is having on the NHS’s ability to reduce waiting lists, improve staff morale and patient satisfaction,” Taylor said. “They feel like the government has buried its head in the sand by refusing to acknowledge this.
“Several members have estimated that each previous round of industrial action from junior doctors has cost them around half a million pounds, so there is an increasing financial toll to this which could run into many billions the longer the walkouts continue.”
He added: “The longer these strikes continue, the more money the NHS will have to spend on their eye-watering costs as waiting lists rise further and vital shifts need to be covered at higher rates. The direct costs of April’s industrial action involving junior doctors has been estimated to be around £100m. However, this does not include the wider loss of earnings from elective or other activity not being carried out. The true cost is likely to be much higher.
“Some leaders have told us their trusts have seen losses of around £500k each day from the strikes, so if junior doctors alone were to strike each month, it’s possible this bill could run into billions.”
Taylor urged ministers to “get back to the table to find a solution that gets the NHS moving again”.
At a rally by senior doctors at the central London headquarters of the British Medical Association (BMA) on Thursday, the union said the consultants’ strike was a last-ditch attempt to save the profession in the face of years of pay erosion and undermined patient care.
The BMA consultants committee chair, Dr Vishal Sharma, said: “When we say strike action is a last resort, we really mean it is a last resort. We have tried everything to get them to listen. We have demonstrated that our pay has fallen not only against inflation but against all our comparator groups. For 15 years, we have pleaded for the government to listen but they have ignored us and inflicted pay cut after pay cut after pay cut.”
Steve Barclay, the health secretary, has told consultants they will receive a 6% pay rise but the BMA has called this derisory and said doctors’ take-home pay has fallen in real terms by more than a third over the past 14 years.
Sharma said pay had fallen by 35% since 2008, “a staggering figure which means effectively we are working for four months of the year for free”.
According to the BMA, consultants on a 2003 contract have a starting salary of £88,364 in basic pay, rising to £119,133 after about 19 years.
The Department of Health says extra payments such as clinical excellence awards and cash for being on call would take the average NHS pay for consultants in 2023-24 to about £134,000.
Patients expressed mixed views about the latest strike action. Sarah Goodchild, 57, said she “doesn’t have a lot of sympathy” for the consultants after her hospital appointment in relation to an endocrine condition, organised nine months ago for Thursday, was cancelled.
“I’m quite angry actually because I’ve been waiting a long time for the appointment,” said Goodchild, a silversmith from Norfolk. “This is going to cause delays in detection, delays in treatment, and I think people are going to die.”
Another patient, whose life was saved by the NHS, said she supported the strike action but only if it ended quickly. Manou Dhama’levy, a patient at University College London hospital for nine years, said: “I’m unhappy about the strikes, especially senior doctors, but they do such an amazing job. I am behind them, as long as it doesn’t last too long.” | Health Policy |
Thousands of people are dying needlessly from cancer because the UK lags behind comparable countries when it comes to survival rates, a damning report says.
Big strides forward have been made in treating the disease over the past 50 years, according to the study by Cancer Research UK, but slow and late diagnosis coupled with treatment delays mean the progress is “at risk of stalling”.
League tables drawn up by international researchers and cited by the charity show the UK has the worst survival rates in five out of seven forms of cancer compared with Australia, Canada, Norway, Denmark, Ireland and New Zealand.
About 20,000 deaths could be avoided every year in the UK by 2040 if ministers adopted a bold new plan for the condition, Cancer Research UK said. A national cancer council accountable to the prime minster should also be created, it added.
The charity’s report called for more action to speed up diagnosis, get people treated quickly and recruit a further 16,000 full-time cancer staff by 2029.
The NHS has already set a target to diagnose 75% of cancers at the earliest stages of 1 or 2 by 2028 but the charity warned this would be missed.
The report said cancer was a “fixable problem”. Three decades ago the UK and Denmark were improving cancer outcomes at broadly the same rate but Denmark has “raced ahead, with consistent funding and long-term cancer strategies”.
It said: “Across the UK, cancer waiting times are being consistently missed, and some have not been met for over a decade. While they wait for diagnosis and treatment, patients and their families face an anxious and worrying time.
“Investment in prevention, NHS staff, equipment and facilities is needed to turn the tide.”
The report said the “inequalities in who gets and dies from cancer are stark, with more than 33,000 cases each year across the UK attributable to deprivation”.
Prof Sir Mike Richards, a former national cancer director at the Department of Health who now advises NHS England, told a briefing there was much work to do to improve survival rates.
“The late stage problem is a big one,” he said. “Nearly half of all patients with cancer are diagnosed at stage 3 and 4. They have poor prognosis compared to those in stage 1 and 2.
“We are not currently on target for the government’s target of 75% being diagnosed (at early stages) by 2028. There’s a lot we can do: we can improve our screening programmes, we can improve our diagnosis of symptomatic patients and we can reduce inequalities in treatment.”
On lung cancer, Richards said the NHS needed “more CT scanners, more radiographers, more radiologists, more thoracic surgeons”. While the Covid pandemic hit cancer targets overall, they were slipping even before then, he added.
In its report, Cancer Research UK said funding was needed to plug a £1bn gap in research over the next decade. It said the proportion of cancer research funded by the government was the lowest of any major condition, “while having among the highest cost of disease burden”.
The report also said four in 10 cancers in the UK were preventable, with thousands of cases caused by unhealthy lifestyles and smoking.
Cancer Research UK said that within a year of the next general election, ministers should have raised the age of sale of tobacco products and implemented the 2022 legislation on TV and online advertising restrictions on foods high in fat, salt and sugar.
Cancer Research UK’s chief executive, Michelle Mitchell, said: “Cancer is the defining health issue of our time. Avoiding thousands of cancer deaths is possible but it will take leadership, political will, investment and reform.
“The impact of cancer is immense. We estimate that half a million people – friends, colleagues and loved ones – will be diagnosed with the disease every year by 2040. Their lives are at stake if we don’t act now.” | Disease Research |
Health bosses warned Brits to be wary of heat exhaustion as the country could see its hottest ever June day, with temperatures set to soar to a record 96F (35.6C) later this week.UK heat peaks are expected to beat Jamaica and Costa Rica by Friday and power past 86F (30C), with some forecasters predicting parts of southern and the east of England will break records for the time of year.There are suggestions that the UK's June record of 96F (35.6C), which is jointly held by June 28, 1976, and June 29, 1957, could be under threat. A plume of hot air is being drawn up from Spain, where decades-old temperature records have already been broken on the Iberian peninsula, up towards the UK. Loobie Bailey, 19, enjoys the warm weather today at Bournemouth beach in Dorset. The coming days are set to feature more glorious sunshine and pleasant temperatures Summer arrives in Bournemouth as people flock to the beach to make the most of the glorious sunshine on Tuesday, June 14 The UK's June record of 35.6C is expected to be smashed by temperatures later on this week, defeating 1957 and 1976 highs A reveller runs into the sea at Bournemouth beach, Dorset earlier today as glorious sunshine enticed thousands to the shoresThe 'unusual' temperatures in the first-half of June come after Spain experienced its hottest May in at least 100 years, according to Spanish met office Aemet. South Spain set to hit 113F (45C) within days A cloud of hot air from North Africa has sent temperatures soaring and the suffocating heat could last in most of Spain until June 16 or 17, a few days before summer officially starts on June 21, the earliest heatwave in 40 years.The searing heat has spread to Portugal and Spain and will move north later this week to Germany, the UK and northern Europe.The high June temperatures are being caused by a 'heat dome', which means the warmth extends high into the atmosphere and impacts pressure and wind patterns.A mountain of hot air is trapped by high-pressure conditions, compressing it like a lid and wedging it between areas of low pressure, pushing cooler air away.The current heatwave is the earliest one in Spain registered since 1981, according to state meteorological agency AEMET.Temperatures are forecast to climb as high as 113F in the southern Andalusia region, especially in the cities of Cordoba or Seville, according to Aemet. It seems almost certain that the coming days will be the warmest of the year so far, with a reading of 81.5F (27.5C) recorded at Heathrow Airport on May 17 set to be cast aside.The Met Office has issued a heat alert for parts of England, while animal charities are desperately urging pet owners to be mindful of the impact of the heat as temperatures begin to soar.The Met Office and the UK Health Security Agency (UKHSA) have issued a heat-health alert warning ahead of rising temperatures predicted for later this week.The forecaster said a level 2 heat-health alert has been issued for a large part of southern and central England, with a level 1 alert in place for northern England. UKHSA's head of extreme events and health protection, Agostinho Sousa, said: 'We want everyone to enjoy the hot weather safely when it arrives and be aware of good health advice for coping with warmer conditions.'During periods of hot weather it is especially important to keep checking on those who are most vulnerable, such as older people and those with heart or lung conditions.'Make sure to look out for signs of heat exhaustion and follow our simple health advice to beat the heat.'Forecasters say they are keeping a keen eye on the situation, with Friday looking like the most likely day to see the record broken.This is set to bring dry, sunny weather, along with soaring temperatures not far short of the all-time temperature record for the UK.The previous June record of 96F (35.6C) has been recorded twice in the UK - the first time in London on June 29, 1957, and the second time in Southampton during a famous summer heatwave on June 28, 1976.The all-time temperature record for the UK is 101.7F (38.7C), which was set on July 25, 2019, in Cambridge University Botanical Gardens. People soak up the sunshine in Portsmouth today by laying down their towels and resting next to the walls in the town's harbour Forecasts suggest that temperatures in southern and eastern England could reach new highs, as the June record of 96F (35.6C) comes under threatAnd while Friday may fall short of this, some forecasts are predicting temperatures in the UK to be higher than in Barbados, Jamaica and Greece.Netweather said: 'Some forecast maps runs show 36C, which would be the June record.'The Weather Outlook forecaster Brian Gaze said: 'Computer models have 35-36C maximum temperatures.'Coral spokesman Harry Aitkenhead said: 'The June record is firmly under threat. It's around a 50/50 call as to whether history record books are rewritten.' Being away from the beach is no barrier, as this woman enjoys the warm weather by sunbathing in St James' Park in London today The warm weather is likely to draw more people to the coast in the coming days. Pictured here are father and son Alex (left) and Ashton Fraude (right) playing beach tennis in Bournemouth today People watch the Changing of the Guard in Horse Guards Parade, London, today. The glorious sunshine provided a fitting backdrop to the ceremony Prince Charles, Prince of Wales and Camilla, Duchess of Cornwall, wave as they attend a sun soaked Royal Ascot at the Ascot Racecourse today Royal Ascot, which is one of the biggest horse racing events on the calendar, was bathed in sunshine and warm weather today Forecasters predict the glorious weather is set to continue towards the weekend, with temperatures set to peak on Friday, June 17However, the Met Office urged slightly more caution, with one forecaster saying: 'Friday is likely to reach the low to mid-30s across large parts of central and southern England.'Met Office forecaster Marco Petagna said: 'Friday is all about temperature watch.'His colleague and fellow forecaster Dan Rudman said; 'Many parts of the southern half of the UK are likely to exceed 30C, and may reach 34C in places.'A Government heatwave alert from tomorrow night will put hospitals on alert for an increase in admissions and ordered health and social workers to prepare to make daily contact with the ill, vulnerable and elderly.Agostinho Sousa, head of extreme events and health protection at the UKHSA, said: 'Temperatures are forecast to reach 30C in some parts of the south on Friday and we want everyone to enjoy the hot weather safely when it arrives and be aware of good health advice for coping with warmer conditions.'During periods of hot weather it is especially important to keep checking on those who are most vulnerable, such as older people and those with heart or lung conditions.'Make sure to look out for signs of heat exhaustion and follow our simple health advice to beat the heat.'Met Office deputy chief meteorologist Dan Rudman said the temperature predictions are unusual for this time of year. Sunbathers relax on a busy beach in Weymouth today. The beaches are only set to get busier in the coming days as temperatures continue to rise People relax on Bournemouth Beach in Dorset on Tuesday afternoon, June 14. Forecasters are predicting temperatures on Friday could reach 96F (35.6C) on Friday'Many areas will also see some warm nights with minimum temperatures expected to be in the high teens or even low 20Cs for some overnight,' he said.'The heat is a result of a mix of home-grown warming in the day due to high pressure, as well as a southerly airflow introducing some of the warm air from the continent to UK shores.'An Environment Agency spokesperson said there is a low-risk of drought but warned further hot, dry weather could put pressure on some areas.The British Red Cross, meanwhile, has encouraged people to protect themselves and to check in with vulnerable friends, family and neighbours during the soaring temperatures.It has given advice to help keep people healthy, including urging them to drink plenty of fluids but avoid excessive alcohol consumption, wear sun cream and keep workplaces and homes cool. The RSPCA is urging dog owners to be aware of the dangers of walking their pets - especially ones with thick coats and underlying health conditions - during the warmer seasons.Esme Wheeler, RSPCA dog welfare specialist, said: 'The truth is walking dogs in hot weather can be a silent killer. Families set up camp on Weymouth Beach in Dorset earlier today. Forecasters are urging people to be mindful of the rising temperatures in the coming days Loobie Bailey, 19, from Southampton, makes the most of beautiful weather by going for a run along the beach in Bournemouth today Racegoers bask in the glorious sunshine at Royal Ascot today, with the event at Ascot Racecourse being held in perfect conditions today'While the majority would never leave our dogs in a car on a hot day, or even take our dogs for a really long walk in the heat, many people may still be putting their dogs at risk even on a short walk, or taking them to places such as fields and beaches with little or no shade.'We have long-campaigned that dogs die in hot cars, but this year we're highlighting that dogs die on hot walks, too. The message remains very simple - never leave a dog in a hot car because 'not long' is too long, and when it comes to walks, 'if in doubt, don't go out.'The Blue Cross meanwhile urged cat owners to be careful when leaving windows open after one kitten fell from a third storey window and fractured her leg. The Blue Cross said Dory, a 16-week old kitten, was found by her owner after she fell from a window in Pimlico, central London, during a spate of hot weather on May 18.The kitten was so badly injured she had to have her leg amputated.Dory's owner placed her in the care of the charity following the incident and the Blue Cross is now hoping to rehome her.Some advice by the charity to cool pets down includes keeping cats indoors during the hottest points in the day, with windows open that have wire mesh or netting to prevent any injuries, and instead letting them out during the cooler parts of the day.Forecasters are predicting that July and August will be hotter still, as the British summer truly kicks into gear. The Weather Outlook forecaster Brian Gaze said: 'It looks like sun cream conditions ahead, with a hotter-than-average July expected, with more hot spells in August.' | Epidemics & Outbreaks |
- Most eligible dentists and doctors will receive at least a 6% pay rise
- Pay for junior doctors will be increased by an average of around 8.8%. Pay will be uplifted by between 8.1% and 10.3% depending on where they are in their training
- Government accepts the independent pay review bodies’ pay recommendations in full, recognising the vital contribution that NHS staff make to our country
- This pay rise recognises the need to recognise, recruit and retain NHS staff while protecting the taxpayer and bringing down inflation
- Announcement follows nurses, paramedics and midwives also receiving a pay rise and one off payments
Pay scales for most doctors and dentists to increase by at least a 6% this year after the government accepted the recommendations from the independent pay review bodies in full.
Around 130,000 full-time equivalent doctors and dentists, including junior doctors and consultants will see their pay rise in line with the Review Body on Doctors’ and Dentists’ Remuneration’s (DDRB) recommendations. Pay for junior doctors will be increased by 8.8% on average. The agreement means pay for a first year junior doctor will increase by 10.3%. Pay for the most experienced junior doctors will increase by 8.1%. For consultants, this means a rise of 6%.
Health and Social Care Secretary Steve Barclay said:
We hugely value the work of all NHS staff.
That’s why we’re giving junior doctors, consultants and senior NHS staff a fair and reasonable pay rise as recommended by the independent pay review bodies.
But it also balances the need to keep inflation in check while giving some staff significant pay increases.
We’ve made it clear this pay award is not up for negotiation and urge those unions still in dispute with the government to end their strikes immediately.
As recommended by the DDRB, most dentists and doctors will receive at least a 6% pay rise. Junior doctor pay will be increased by 6% plus £1,250.
Average basic pay for a first year junior doctor will increase from £29,300 to £32,300 and for a junior doctor in core training with 3 years’ experience it will increase from £40,200 to £43,900. For consultants and SAS doctors on pre-2021 contracts, this is on top of the 4.5% pay rise they received last year. Some staff will also benefit from performance pay, overtime, pay progression and pay rises from promotion, alongside the pay uplift.
The government has been clear about the need for pay awards to recognise the hard work of the public sector whilst meeting the Prime Minister’s priority to halve inflation and managing public spending effectively.
More borrowing would add pressures on inflation at exactly the wrong time, risking higher interest rates and higher mortgage rates. The government plans to increase the main rate of the Immigration Health Surcharge – to ensure it covers the full healthcare costs of those who pay it, having been frozen for the last three years despite high inflation and wider pressures – to at least £1,035, and the discounted rate for students, their dependents, those on Youth Mobility Schemes and under-18s to £776. The government will fund this pay award through prioritisation within existing departmental budgets, with front line services being protected.
Last month one million NHS staff, including nurses and paramedics, received a 5% pay rise worth at least £1,065 to full-time staff as well as two one off payments worth at least £1,655.
Today’s announcement comes weeks after the NHS published its first ever NHS Long Term Workforce Plan, backed by over £2.4 billion government funding, will deliver the biggest training expansion in NHS history and recruit and retain hundreds of thousands more staff over the next 15 years.
Background
- The pay review bodies considered a range of evidence from various organisations.
- All pay awards will be backdated to 1 April 2023. This pay award is only applicable to NHS staff in England. The 2023-24 pay uplift for NHS staff directly employed by NHS providers will be funded by NHSE through system allocations.
- The government asked the DDRB and SSRB for recommendations for NHS staff not already in multi-year deals – this includes junior doctors, dentists in training, consultants, SAS doctors on old contracts, dentists, and salaried GPs.
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The full Pay Review Body reports can be found on gov.uk and says:
- The Review Body for Doctors’ and Dentists’ Remuneration (covering doctors and dentists not in multi-year deals) recommended a 6% increase for the majority of its remit group.
- Pay for junior doctors will increase by around 8.8% on average. This is because the DDRB recommended 6% plus £1250 on a consolidated basis.
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The Senior Salaries Review Body (covering Very Senior Managers in the NHS and Executive Senior Managers in DHSC’s arm’s length bodies) recommended a 5% increase, with a further 0.5% in each employing organisation is used to address specific pay anomalies.
- Following acceptance of the Agenda for Change offer by the NHS Staff Council, the government confirmed it would no longer be seeking recommendations on the 2023-24 pay award from the NHS Pay Review Body (NHSPRB) for non-medical staff on the AfC contract.
- The government has since received the report from the NHSPRB with their observations on the pay deal in England which we welcome and we have published at the same time as the DDRB and SSRB reports.
- Those already in multi-year deals were not in scope of the pay review body’s recommendations this year. The DDRB were not asked to make a pay recommendation for GP partners as they are subject to a five-year investment agreement to 2023/24, which was agreed with NHSE and the BMA in 2019. For Salaried GPs, the 6% award will raise the minimum salary by around £3,900 and the maximum by around £5,900.
- The GP contract will be uplifted to provide funding for salaried general practice staff. This funding will be backdated to April 2023 and it is our expectation this funding is passed on promptly to all salaried general practice staff. As self-employed contractors to the NHS, it is for GP practices to determine uplifts in pay for their employees.
- The government is absolutely committed to ensuring the NHS has the funding it needs to deliver for patients.
- The government is committed to living within its means and delivering value for the taxpayer, and therefore it’s prioritising within existing Departmental funding to fund these uplifts.
- The government is working in collaboration with the NHS Staff Council to implement the NHS pay deal: https://www.gov.uk/government/news/government-and-unions-collaborate-to-implement-nhs-pay-deal | Health Policy |
AUSTIN, Texas — A new, bio-inspired drug restores the effectiveness of immune cells in fighting cancer, a team led by researchers at The University of Texas at Austin has found. In mouse models of melanoma, bladder cancer, leukemia and colon cancer, the drug slows the growth of tumors, extends lifespan and boosts the efficacy of immunotherapy. The research is published in the journal Cancer Cell and could be a game changer for many cancer patients.
Many cancers delete a stretch of DNA called 9p21, which is the most common deletion across all cancers, occurring in 25%-50% of certain cancers such as melanoma, bladder cancer, mesothelioma and some brain cancers. Scientists have long known that cancers with the 9p21 deletion mean worse outcomes for patients and resistance to immunotherapies — the treatment strategies designed to supercharge a patient’s natural immune response to cancer.
The deletion helps cancer cells avoid getting detected and wiped out by the immune system, in part by prompting the cancer to pump out a toxic compound called MTA that impairs normal functioning of immune cells and also blocks the effectiveness of immunotherapies.
“In animal models, our drug lowers MTA back down to normal, and the immune system comes back on,” said Everett Stone, a research associate professor in the Department of Molecular Biosciences and associate professor of oncology at Dell Medical School, who led the work. “We see a lot more T cells around the tumor, and they’re in attack mode. T cells are an important immune cell type, like a SWAT team that can recognize tumor cells and pump them full of enzymes that chew up the tumor from the inside out.”
Stone envisions the drug being used in combination with immunotherapies to boost their effectiveness.
The study’s co-first authors are Donjeta Gjuka, a former UT postdoctoral researcher and currently a scientist at Takeda Oncology, and Elio Adib, formerly a postdoctoral researcher at Brigham and Women’s Hospital and the Dana-Farber Cancer Institute, and currently a resident physician at Mass General Brigham.
The 9p21 deletion leads to the loss of some key genes in cancer cells. Gone are a pair of genes that produce cell cycle regulators — proteins that keep healthy cells growing and dividing at a slow, steady rate. When those genes are lost, cells can grow unchecked. That’s what makes them cancerous. Also deleted is a housekeeping gene that produces an enzyme that breaks down the toxin MTA. It’s this loss, according to Stone, that lets cancer cells acquire a new superpower: the ability to deactivate the immune system.
“Cancer gets a two-for-one when it loses both of these genes,” Stone said. “It loses the brakes that normally keep it from growing in an uncontrolled manner. And then at the same time, it disarms the body’s police force. So, it becomes a much more aggressive and malignant kind of cancer.”
To create their drug candidate, Stone and his colleagues started with the helpful enzyme that’s naturally produced by the body to break down MTA and then added flexible polymers.
“It’s already a really good enzyme, but we needed to optimize it to last longer in the body,” Stone said. “If we injected just the natural enzyme, it would be eliminated within a few hours. In mice, our modified version stays in circulation for days; in humans it will last even longer.”
The researchers plan to do more safety tests on their drug, called PEG-MTAP, and are seeking funding to take it into human clinical trials.
The study’s other co-authors from UT are Kendra Garrison, Candice Lamb, Yuri Tanno and George Georgiou. The study’s co-corresponding authors are Stone and David Kwiatkowski, a senior physician at Brigham and Women’s Hospital and a professor of medicine at Harvard Medical School.
This work was supported by funding from the National Cancer Institute, the Doris Duke Foundation, The University of Texas MD Anderson Cancer Center, the Joan and Herb Kelleher Charitable Foundation, the Kidney Cancer Association, the V Foundation and the U.S. Department of Defense.
The University of Texas at Austin is committed to transparency and disclosure of all potential conflicts of interest. University investigators involved in this research have submitted required financial disclosure forms with the University. Stone and Gjuka are inventors of two patents related to this work owned by The University of Texas at Austin. | Drug Discoveries |
Several college swim teams learned a stomach-churning lesson the hard way during a recent series of meets: regardless of skill or speed, the real winner of the meet will always be the gastrointestinal pathogen that enters the pool.In an outbreak investigation that is destined to become a nauseating cautionary tale, health officials traced the spread of the water-based intestinal parasite Cryptosporidium (aka crypto) through several pools of competitive swimmers with the squirts. The case involved a lucky break: Health officials fished out the crypto rather quickly. But, it wasn't fast enough to keep the parasite from butterflying its way to members of another college's team, showing how quickly and easily it could have spread without intervention
It also highlighted "an ongoing need to promote healthy swimming, including recommendations for persons not to swim if they have diarrhea and to avoid swallowing swimming pool water to prevent waterborne disease," the authors of a case report on the investigation wrote. The report, led by health officials in Massachusetts, was published Thursday in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.
It all began earlier this year when competitive swimmers from a Massachusetts-based college went to Puerto Rico for a weeklong training session. While there, the swimmers plunged into a training pool, a waterfall, and the ocean. It's unclear where they picked up the gruesome gut crasher exactly, but three days after their return, the swimmers' health started dipping. By the end, 19 of 50 swim team members of the men's and women's teams would fall ill.
Amid the intestinal eruptions, the swim teams continued on with their training and meet schedule—including with the members experiencing tummy troubles. Within a week of their return, the swimmers had two separate meets: one against a New York-based team five days after their return and a subsequent meet with a Rhode Island-based team a day later.
Natural swimmers
With swimmers sprinting to bathrooms, officials at the Massachusetts college contacted the state's health department—nine days after they returned from the trip to Puerto Rico. By then, one of the swimmers had already tested positive for crypto. The health department didn't waste any time, contacting officials in Puerto Rico, New York, and Rhode Island the same day.
But, it was too late to halt all of the spread. Two swimmers on the team from Rhode Island team fell ill with crypto seven days after the meet with the Massachusetts team. Testing indicated that the subtypes of crypto in the Rhode Island swimmers matched some of those found in the Massachusetts team.
Crytpo is exceptionally infectious, particularly in pools. The parasite is shed in feces, and an infected person can spew 10 million to 100 million parasites in a single blowout, according to the CDC. Swallowing just 10 parasites is enough to ignite a new explosive infection. The symptoms of which include watery diarrhea, nausea, stomach pain and cramps, vomiting, fever, and dehydration. For otherwise healthy people, the infection and infectious period can last a few weeks. For those with compromised immune systems, the infection can be serious, longer-lasting, and potentially fatal.
While crypto can spread via anything with fecal contamination—dirty hands, contaminated food, etc.—recreational water is particularly problematic. The parasite has a tough outer shell, making it highly tolerant to chlorine. It can survive in a properly chlorinated pool for over seven days, the CDC says. It also is not effectively killed by hand sanitizers.
As the Massachusetts health department investigated the outbreak, the college closed its swimming pool and hired a contractor to sanitize it with a hyperchlorinated treatment.
In all, the health officials overseeing the investigation dodged a bullet. They caught the Rhode Island team fast enough before transmission continued. They noted that "because of the regular intercollegiate competition and subsequent championship schedule, the potential exists for sustained Cryptosporidium transmission among competitive swimmers," they wrote. And if they hadn't had an early detection of crypto in one of the swimmers, the Massachusetts college may not have shut down the pool, preventing further transmission on campus. | Epidemics & Outbreaks |
Boris Johnson asked to be injected with COVID on live TV and said he would rather "let the bodies pile high" than impose another lockdown in September 2020, according to one of his most veteran aides.
Edward Udny-Lister made the revelations to the COVID inquiry today - telling Lady Hallett the former prime minister's offer to appear on live TV was to "demonstrate to the public that it did not pose a threat", but "was an unfortunate comment when Covid was not seen as being the serious disease it subsequently became".
The bodies comment backs up reports in The Daily Mail and allegations made by Dominic Cummings in 2021.
Mr Johnson denied making the bodies remark on numerous occasions - both on television and in the House of Commons.
Politics latest: Johnson wanted to be injected with COVID on TV
Lord Udny-Lister worked with Mr Johnson when he was mayor of London, as well as when he was the foreign secretary.
He was one of the most senior aides to Mr Johnson in Downing Street - alongside Mr Cummings - and ultimately replaced Mr Cummings as chief of staff.
Lord Udny-Lister's statement to the inquiry said: "In September 2020, the R number was rising. A circuit breaker was proposed in response to this increase and the health secretary was pushing hard for this to take place.
"However, the opposition to any form of lockdown was intense.
"I recall the PM saying in September 2020 that he would rather 'let the bodies pile high' than impose another lockdown.
"Whilst this was an unfortunate turn of phrase, it should be born [sic] in mind that by this point the government was trying to avoid a further lockdown given the already severe impact on the economy and education."
A spokesman for Mr Johnson said the former prime minister would be giving evidence to the inquiry in due course.
His evidence was given on another illuminating day at the official COVID inquiry.
As well as the above claims, Lord Udny-Lister laid out the dysfunctionality of Downing Street - especially in the early days of the pandemic.
The adviser - who had a desk opposite Mr Cummings - said: "Some of the personalities made it very, very toxic... Dominic Cummings's relationship with other people had become very strained."
And messages released to the inquiry revealed that Mark Sedwill - then the head of the civil service - said in July 2020 that "it's hard to ask people to [march] to the sound of gunfire if they're shot in the back".
Simon Case - who is now the head of the civil service - responded by saying: "I've never seen a bunch of people less well-equipped to run a country."
Read more:
Final message between Johnson and Cummings revealed
The moments you may have missed at the inquiry last week
He added that "top-drawer" potential recruits had refused to work in Downing Street because of the "toxic reputation" of the setup.
Lord Udny-Lister also spoke of a distrust or dislike within Downing Street for including devolved administrations within decision-making, as it was felt that that decisions would be briefing or introduced early by Scotland for "political" reasons.
Before the political appointee gave evidence, Simon Ridley - who was head of the COVID-19 taskforce within Number 10 - was before the lawyers.
At one point, he confirmed that the taskforce - which coordinated COVID policy - was "blindsided" by Rishi Sunak's Eat Out to Help Out announcement. He said the decision was instead made by the then chancellor and Mr Johnson.
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Another point to come out of Mr Ridley's evidence was an email sent by Alexandra Burns, a Number 10 official, in April 2020. This asked if there was an "overall strategy" for care homes - adding that looking at Europe made it seem like one was necessary as "once someone gets [COVID] in one of these places many die".
A diary extract from Sir Patrick Vallance, the former chief scientific adviser, wrote in his diary in October 2020 that he had a "very bad meeting" in Downing Street, in which Mr Johnson called for a "whisky and a revolver" and Mr Sunak was "using increasingly specific and spurious arguments against closing hospitality". | Epidemics & Outbreaks |
In June 2021, 32-year-old Alyssa Maness was diagnosed with POTS, a nervous system disorder that her doctors believe was triggered by Covid.
POTS, or postural orthostatic tachycardia syndrome, caused numbness throughout her arms and legs, a pins-and-needles sensation and sudden drops in her heart rate.
Because her heart problems didn't go away, in early 2022 her doctors began conducting a series of lab tests in an attempt to better understand her long Covid symptoms.
When Maness submitted the testing to her insurance — Anthem Blue Cross — the provider deemed the testing medically unnecessary and declined to cover the cost. She’s now on the hook for the medical bills, which have already cost her more than $10,000 out of pocket.
“I’m kind of at the point sadly where I’ve just given up,” said Maness, a Ph.D. student in Sacramento, California. Many of her insurance appeals have been denied. “I don’t have the mental bandwidth to even battle this anymore, because it’s become clear that it is most likely going to be unsuccessful.”
Maness is among several long Covid patients in the United States interviewed by NBC News who say their insurance providers are declining to provide coverage related to their illness.
But there are likely many more. Up to 4 million full-time workers are out of the labor force due to long Covid, according to research from the Brookings Institution, a Washington-based think tank.
NBC News has asked insurance providers for comment.
For some, the care they need to manage their chronic illness has left them in medical debt, which can easily balloon into the thousands or even tens of thousands of dollars, experts say. It's unclear how many are being denied coverage, but a paper published in May in JAMA Health Forum estimated that the individual medical costs of long Covid could come to roughly $9,000 a year.
Part of the problem, experts say, is the ambiguity of long Covid symptoms, which can range from extreme fatigue to loss of taste and smell to debilitating heart palpitations. There's no official test to diagnose the condition, nor is there any specific recommended treatment. That makes it more difficult for doctors to come up with a proper treatment.
Before they pay, insurance companies often want to know if the treatment is proven to work.
Long Covid patients can fight the denied claims through appeals or going to court — a time-consuming and draining approach for any patient, let alone those who may suffer from fatigue and brain fog, said Michele Johnson, the executive director of the Tennessee Justice Center, a legal aid group that has helped long Covid patients get health coverage.
“They’re trying to keep their job or keep caring for their family," she said, "and there’s so much bureaucracy and red tape that they’re just drowning in it."
'Medical necessity'
Experts say insurance companies will often deny claims for care related to long Covid because they don't see it as a “medical necessity.”
The term is what insurance companies use to assess whether they should approve or deny a claim, said Linda Bergthold, a former health policy researcher at Stanford University’s Center for Health Policy.
The term has been thrown around by insurance companies for decades, but it wasn’t given a formal framework until the late 1990s, which Bergthold helped develop.
In order for the care a patient receives to be deemed medically necessary by an insurance provider, there has to be substantial research or evidence that shows that it works, she said.
That's "a key issue for long Covid," she said, because the illness is so new and still poorly understood.
"Research, just like everything with Covid, is all new," she said. "Nobody really quite knows what works and nobody really understands why some people have it longer than others."
To be sure, as of 2021, there are diagnostic codes for long Covid — key tools used by doctors to characterize medical diagnoses for insurance coverage, said Dr. Alan Kwan, a cardiologist at Cedars-Sinai Medical Center in Los Angeles. Those codes, however, don't always cover the myriad health problems linked to long Covid, he said.
POTS, for example, does not have a standardized diagnostic code and has only recently been linked to Covid.
Doctors may work hard to get a patient a formal diagnosis for long Covid to help with insurance, though there isn't an official test for long Covid and the testing that is done may not be covered by insurance.
Some patients may eventually get coverage after submitting an appeal to their insurance, but usually not before shelling out hundreds of dollars, Kwan said.
Others may not be so lucky and may be forced to pay for most of their care out of pocket.
That's what happened to Amy Cook, 51, of Orange County, California.
In May, she got Covid, which caused her multiple long-term health problems including chest congestion, erratic heart rate, headaches and visual impairment.
Cook, who works a full-time job as a chief operating officer for a consulting agency, said she was bedbound for four months because of her long Covid symptoms.
Around October, her doctor recommended that she try naltrexone, a drug used for opioid addiction that has shown promise in lifting long Covid symptoms, as well as hyperbaric oxygen. Both therapies are being tested in clinical trials as potential treatments for the condition, though neither is approved by the Food and Drug Administration for the illness.
Aetna, her insurance provider, declined to cover most of the cost of the treatments.
“I’m at $28,000 to date and I have more treatments coming up,” Cook said of her out-of-pocket expenses.
Cook said she’s currently in a financial position to be able to self-fund the treatments, although she still hasn’t recovered from her illness and the expenses could easily grow.
“I don’t know when I’ll be able to stop,” she said.
In a statement, Alex Kepnes, a spokesperson for Aetna, said there is no single definition for long Covid and that coverage decisions "are based on medical necessity and evidence-based guidelines."
"We are focused and committed to providing our members with access to care and treatments for medically necessary services to help them address their conditions and improve their health," he said.
What can be done?
Johnson, of the Tennessee Justice Center, said a patient can improve their chances of insurance approving their claim by making sure they have a plan before they even enter the doctor's office.
Her guidance:
- Ask how much the care will cost.
- Ask the doctor to explain clearly on insurance paperwork exactly why the care was needed.
Working with a doctor can be "very effective," Johnson said, as they are usually trained to know what meets insurance providers' standards for coverage.
If that doesn't work, and insurance denies the patient's claim, the patient can appeal the decision, she said. Under the Affordable Care Act, all health insurance must have an external appeal process that allows a patient to challenge the provider's verdict.
“The idea that you could deny services without an opportunity for appeal is no longer true,” she said.
If still unsuccessful at this point, patients may begin to panic, Johnson said, because the outstanding bill can be taken to collections and patients can take a hit on their credit score. Providers often provide a very short time window for payment, and appeals often take months.
Maness, of California, said she's panicked at least once when her insurance provider took too long to get back to her on an appeal and ended up shelling out hundreds of dollars toward her bill.
What a patient does after that will depend on their health insurance, Johnson said.
People with Medicaid, for example, can take the claim to court if they feel the denial was unjustified. For people on private insurance, it's less clear what they can do, but one option is to contact the state's Department of Commerce and Insurance, which regulates insurance companies.
Johnson suggested patients frame their complaint saying, "You've licensed this insurance to do this in our state and they're denying essential benefits consistently." | Epidemics & Outbreaks |
Though people often want to share good news as soon as they learn it, a study published by the American Psychological Association has found that keeping good news a secret before telling someone else could make people feel more energized and alive.
"Decades of research on secrecy suggest it is bad for our well-being, but this work has only examined keeping secrets that have negative implications for our lives. Is secrecy inherently bad for our well-being or do the negative effects of secrecy tend to stem from keeping negative secrets?" asked lead author Michael Slepian, PhD, an associate professor of business at Columbia University. "While negative secrets are far more common than positive secrets, some of life's most joyful occasions begin as secrets, including secret marriage proposals, pregnancies, surprise gifts and exciting news."
The research was published in the Journal of Personality and Social Psychology.
A pre-study survey of 500 people found that 76% said the first thing they would do upon learning good news is share it with someone. But there are many positive life events that people may choose to keep secret, such as a marriage proposal, a desired pregnancy or splurging on a luxury purchase.
Researchers conducted five experiments with more than 2,500 participants to understand what motivates people to keep positive secrets, and how keeping a positive secret may affect someone compared with a secret they keep because they consider it to be unpleasant or embarrassing.
In one experiment, participants were shown a list of nearly 40 common types of good news, which included items such as saving up money, buying a gift for oneself or reducing a debt. The participants then indicated which pieces of good news they currently had and which they had kept secret. Some participants were asked to reflect on the good news they kept secret, while others reflected on good news that was not secret, and then rated how energized the news made them feel and whether they intended to share the news with someone else.
The researchers found that people held on average 14 to 15 pieces of good news, with an average of five to six that were kept secret. The participants who reflected on their positive secrets reported feeling more energized than the participants who thought about their good news that was not secret. People who reported that they intended to share their news with others also reported feeling more energized, whether the news was secret or not.
"Positive secrets that people choose to keep should make them feel good, and positive emotion is a known predictor of feeling energized," said Slepian. But the researchers found across four follow-up studies that positive secrets make people feel energized for another reason too.
One of those experiments showed participants the list of common types of good news and asked them to select the piece of news that was most likely to happen to them in the near future. One group of participants then imagined that they kept the good news secret until they told their partner later that day while another group imagined that they were currently unable to reach their partner and so were not able to tell them until later in the day. When participants imagined wanting to hold the information back to make the revelation surprising, they were more energized than when they were unable to reveal the information.
Another experiment asked participants to recall a current positive secret (a secret they felt good about), a current negative secret (a secret they felt bad about) or simply a current secret. The researchers found that people keep positive secrets in particular for internal or personal reasons, rather than because they felt forced by outside pressures to keep the information secret.
In contrast to negative or embarrassing secrets, which are often governed by external pressures or fears, positive secrets made people feel enlivened when they could choose to keep the information secret, according to Slepian.
"People will often keep positive secrets for their own enjoyment, or to make a surprise more exciting. Rather than based in external pressures, positive secrets are more often chosen due to personal desires and internal motives," he said. "When we feel that our actions arise from our own desires rather than external pressures, we also feel ready to take on whatever lies ahead."
The researchers also found that keeping good news a secret can make people feel energized and alive, regardless of whether they intend to share that information later with someone or not.
"People sometimes go to great lengths to orchestrate revealing a positive secret to make it all the more exciting. This kind of surprise can be intensely enjoyable, but surprise is the most fleeting of our emotions," Slepian said. "Having extra time -- days, weeks or even longer -- to imagine the joyful surprise on another person's face allows us more time with this exciting moment, even if only in our own minds."
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Nurses have been shown to improve patient outcomes in terms of health, recovery and satisfaction in numerous studies — but in some cases, they also make a personal impact on people that can’t be measured in numbers.
Four years ago, Ashley Gibson, then 28, had earned a degree in theater and was working as an actor in Medina, Ohio, where she lived with her husband and dogs. But when she was diagnosed with leukemia in 2019, everything changed.
By the time Gibson’s treatment was over and she entered remission in 2020, she had decided to switch careers completely — and become a nurse herself.
"The passion and care I received from my nurses propelled me to follow in their footsteps," she told Fox News Digital in an interview.
After a surprise diagnosis, quick action
In the weeks before her diagnosis, Gibson started noticing large purple and black bruises showing up all over her body with no explanation. Then came nosebleeds and a constant, bone-weary fatigue.
"I was so tired and weak that in the middle of a workout, I would just lay down on the floor," she told Fox News Digital in an interview.
Suspecting she might be anemic, Gibson saw her nurse practitioner for blood tests.
Hours later, she got a call that she should go straight to the ER at Cleveland Clinic Hospital.
By the next day, she’d been diagnosed with acute lymphocytic leukemia (ALL), a type of blood cancer.
The expected number of total leukemia cases for 2023 is nearly 60,000, but only 6,540 people are expected to be diagnosed with the type of leukemia Gibson had.
For people older than 20 years of age, the five-year survival rate for ALL is 40%, according to the National Cancer Institute.
Cleveland Clinic immediately began forming Gibson’s care team to help ensure she would be included in that group of survivors.
‘They were like my family’
Initially Gibson spent a month in the hospital, where she started blood infusions and chemotherapy treatments right away.
Dr. Hetty Carraway, director of the Leukemia Program at Cleveland Clinic, was Gibson’s primary oncologist who delivered her diagnosis.
"I didn’t want to stop receiving the comfort, care and security they gave me."
Gibson also had a team of oncology nurses who cared for her throughout nearly a year of treatments, approximately five days per week.
"An acute cancer diagnosis can be devastating," Carraway said. "Our leukemia nurses are some of the best care providers in all of oncology. Along with the rest of the multidisciplinary team, they provided empathetic, compassionate and holistic care, along with deep medical knowledge."
When Gibson was at her sickest — dealing with bad migraines, bone pain and exhaustion — she credits the nurses for helping her through it.
"I was at a very dangerous point where I could have taken a turn for the worst at any point," she said. "They were very positive and helped to lift my spirits."
Over time, the nurses became her friends, she said.
"We got to know each other so well — we joked around and had nicknames for each other and even shared life stories."
One of the nurses she became closest with was Sue Singleton. Gibson nicknamed her "Sunshine Sue." A nurse for 40 years, Singleton said the impact was mutual.
"I felt an immediate connection with Ashley — she was adorable and the sweetest thing," she told Fox News Digital in an interview. "Over time, we got to know each other so well, it was almost like we were family."
"I was already registered for the nursing program before I even finished chemo."
Gibson’s treatment was successful. Just one month after finishing her therapy, she was in remission.
Carraway credits Gibson’s diligence and dedication as a factor in her triumph over the disease.
"It’s not easy to have your whole life turned upside down at such a young age, but Ashley was committed to her therapy," she said.
"Patients who immediately embark on therapy have a higher likelihood of being cured."
Singleton agreed. "Ashley had a great outlook and never complained — she took it all in stride."
Gibson was relieved to be cancer-free, but also surprised to feel a bit of sadness.
"I remember at the end, when the doctor said I was done with my chemo, I was crying because I didn't want to stop seeing my nurses every day, and didn’t want to stop receiving the comfort, care and security they gave me," she said.
Gibson did, however, receive plenty of support and care from her husband, parents, siblings and other family members during her treatment.
"I have an amazing support system of family and friends," she said. "And we also have our two rescue dogs at home, who we treat like our little babies."
A life saved leads to a life-changing decision
With the end of Gibson’s cancer treatment came a new beginning.
Earlier, she had toyed with the idea of going to nursing school, but she didn’t think it would ever actually happen.
"I didn’t have a science background and I was daunted by all the prerequisites I would need to get into the program," she said.
But once Gibson began her own cancer treatment, and as she witnessed firsthand the impact the nurses made every day, she felt compelled to make her dream a reality.
"I decided it was my turn to be the support system for other people," she told Fox News Digital. "I was already registered for the nursing program before I even finished chemo."
On May 13, some four years after beating cancer, Gibson will graduate from nursing school. She attended Cleveland State University, completing the accelerated BSN (Bachelor of Science in Nursing) program.
Carraway, her oncologist, believes that Gibson’s experience of being on the receiving end of care will help her become an even more effective and empathetic nurse.
"Having shouldered this burden and come through on other side in such a positive manner is so empowering," Carraway said.
"My hat is off to Ashley — I’m excited to see her graduate and enter this space, where we truly need people like her." | Disease Research |
Five million disposable vapes are thrown away each week, a fourfold increase over the past year, according to research from recycling campaign group Material Focus.
Only 17% of vapers recycle their vapes the correct recycling bins, the research found.
Vapes can cause fires in bin lorries and waste treatment facilities if not disposed of correctly.
The vaping industry says it is working to improve recycling rates.
Disposable vapes, cheap plastic devices designed to give a few hundred puffs of nicotine vapour before being thrown away, are often discarded in bins and on roadsides.
Material Focus, a non-profit organisation which campaigns to increase recycling rates, calculated that UK adults buy around 30 million vapes a month, a huge increase that reflects the rapid growth in popularity of these products.
Disposable vapes contain copper wires and lithium batteries, which are both valuable materials. Material Focus estimates that all the disposable vapes thrown away in a year contain enough lithium to provide batteries for 5000 electric cars.
They should be disposed of in decided bins, in shops or recycling centres, containing a mineral called vermiculite to reduce the risk of fires. From there, they can be taken to dedicated recycling facilities where they can be dismantled by hand.
By law, everywhere that sells vapes is meant to take them back, but it's a facility that costs money to provide, and many do not.
The potential yearly cost of recycling all those vapes would be £200m, a cost which is not being met by producers, importers or retailers, they say.
"There's far more vapes thrown on the floor, and in public bins and kitchen bins than are being recycled," says Scott Butler, Executive Director of Material Focus. Current recycling facilities are "a long way from what we need. It needs to be as easy to recycle as it is to buy them."
Vapes that get mixed up with other household waste can cause fires in bin lorries and waste facilities. The waste company Veolia, which collects around a tenth of the UK's waste, says lithium batteries, including vapes, cause around one fire a day in its facilities.
It is illegal for under-18s to buy vapes - and the research found that young vapers are much more likely than adults to throw their vapes away or even flush them down toilets, to prevent parents finding out that they are vaping.
A spokesperson for Elfbar, the UK's most popular disposable vape brand, said it is "fully committed to increasing rates of recycling" and working to put thousands of recycling points in place in retail outlets, and increasing the recyclability of its products.
John Dunne, Director General of the UK Vaping Industry Association, said that the growth of the industry had been so rapid that it had been hard to keep up with, but many independent vape shops now had recycling facilities in place.
A UK government spokesperson said: "The government is very concerned about the environmental impacts of disposable vapes and will shortly publish a response to its call for evidence on vaping which closed in June."
The Scottish Government is considering a ban on disposable vapes. In July, councils in England and Wales called for a ban, partly because of the problems they can cause in waste disposal.
Material Focus's research was based on a survey by the pollsters Yougov of 5,156 people, of whom 167 were 16 or 17 years old. | Global Health |
Taking control of your health can be complicated, especially when you don’t know where to start or are presented with millions of options.
Enter Heali, a new startup launching out of stealth with a personalized platform to eliminate the guesswork for people who want to treat and manage their health conditions using evidence-based nutrition protocols.
Heali's recipe search. Image Credits: Heali
Company co-founder and CEO Kyle Dardashti knows firsthand how difficult it is to start the nutrition journey. He is the “one” in the one in two Americans that suffer from a chronic condition that Dardashti says can be improved through nutritional coaching. He just didn’t know about it at the time.
“I’ve had Crohn’s disease since I was 15 years old,” Dardashti told TechCrunch. “It's a battle, and I tried all different types of solutions in the pharmaceutical area. I finally thought there’s got to be some alternative ways to do this.”
After discussing alternative options with his gastrointestinal doctor, Dardashti started on a dietary protocol that had evidence of similar efficacy to some of the drugs he was already taking. Dardashti tried it, and after about four months, “felt healthier than I’ve ever felt.”
Medical nutrition model
He then began learning as much as he could about the concept of medical nutrition therapy, which he described as a way to treat and manage disease through different nutrition protocols. However, Dardashti found those protocols difficult, meaning, he basically had to become a food scientist to decipher which ingredients worked and which didn’t.
“It stripped the enjoyment out of the eating,” Dardashti said. “What was clear to me is that we can use technology to do all of the analysis so you don’t have to go through that struggle. There are so many fad diets out there that aren’t research-backed, yet so many clinically-backed diets that patients don’t know about. We think it shouldn’t take patients decades, like me, to find out that food is an option.”
You’ll see similar features on Heali, like meal planning and tracking, an in-app scanner for the grocery store, recipes and recommendations. However, Dardashti said what sets Heali apart is its proprietary dietitian-led, scientific literature-backed comprehensive nutritional guidance and personalized meal planning. The app’s scanning option also leverages artificial intelligence so a user can scan a restaurant menu and get recommendations on which meal options are safe.
In addition, among the library of recipes, Heali purposefully included a way to search based on a certain medical condition, health/wellness goals and dietary preferences. That has resulted in more than 30 different cuisine options with the ability to sort by cultural needs. It also received recognition from the U.S. Centers for Disease Control following in-market testing and clinical trials.
Heali's personalized nutrition app. Image Credits: Heali
Future growth
When Heali was first developing its platform, it was focused on 30 chronic conditions, including autoimmune diseases, allergies, neurological conditions and variations of cancer. Today that has grown to more than 200 conditions, many with their own specific nutrition protocols. Due to its dietary engine, Heali is considered the “first clinical grade hyper-personalized nutrition platform that can support medical nutrition therapy at scale,” Dardashti said.
In its beta period, patients with irritable bowel syndrome who participated in a clinical trial of Heali saw 2.6 times the improvement in their quality of life and their symptoms improved 2x over those in the trial who did not use Heali.
Heali provides its app via healthcare partnerships, like the one it has with Boston Heart Diagnostics. It is also offered as a standalone software-as-a-service option, called Heali Intel, for food businesses looking to provide food-as-medicine offerings. The startup is still in the very early stages, though Dardashti disclosed Heali has more than 10,000 users today.
Today, the company announced $3 million in seed funding led by Astanor Ventures. Dardashti intends to use the capital to accelerate product development and partnership acquisition and grow its commercialization model of medically tailored meal suggestions. There are also plans to offer a one-on-one health coach offering and to expand its Instacart grocery delivery relationship to include custom meal kit delivery options.
“I’ve met so many people who don't know diet is an option, and I hope that we can use Heali to make a world where food isn't the last option, it is the first option,” Dardashti said.
Got a news tip or inside information about a topic we covered? We’d love to hear from you. You can reach Christine Hall at [email protected] or via Signal at 832-862-1051. | Nutrition Research |
Alcohol vs. cannabis vs. tobacco: Doctors answer which is worst for you
(NEXSTAR) – In nearly half of the United States, all three are legal for those over 21: alcohol, tobacco and marijuana. However, the three substances come with different rules, taxes and — of course — health effects.
We posed the question to three doctors around the country: How do alcohol, weed and cigarettes rank when it comes to your health?
All three doctors agreed on which is best.
First off, they had a few conditions. “It is difficult to conclusively rank them in the order of their risks, since there have been no major randomized controlled head-to-head trials among the substances,” said Dr. Michael L. Glickman, a Washington, D.C. family medicine doctor and weight loss expert. He added that the amount you consume of each substance also greatly impacts your risk of bad effects.
Dr. Anand Akhil, a behavioral health doctor with Cleveland Clinic, also pointed out that each individual has their own risk factors based on family history, pre-existing conditions and more.
But when it comes to generalizing for the average person, Akhil said alcohol was the worst, followed by tobacco.
“Alcohol use is linked to over 200 health conditions and diseases, damaging every organ system in the body,” said Akhil. “Depression, anxiety, dementia, cancers, heart and liver disease, and bone disease can all result from alcohol consumption. Similarly, tobacco use is largely connected to serious cancers, chronic obstructive pulmonary disease, and cardiovascular diseases.”
Dr. Kevin Most, chief medical officer at Northwestern Central DuPage Hospital, agreed.
“I would certainly rank alcohol No. 1,” Most said in a recent interview with WGN Radio. “I’m going to say that alcohol in moderation is OK, but too much alcohol is going to have impact on many illnesses.”
The harms of consuming tobacco, Most said, could be largely reversed when people stop smoking earlier in life. “If people understand the the risk of lung cancer, based on how many years you’ve been smoking and how much you’ve been smoking, if you stop that smoking at an early age … your lungs can reinvigorate and get back almost to normal.”
But Glickman disagreed, and ranked tobacco as worst due to the fact it has no proven health benefits.
“Tobacco I would argue is the worse substance of the three, given it has no conceivable benefit even in light amounts, and considerable risks. Tobacco has been linked to increases in heart disease, cancers, and premature mortality, among others,” Glickman expalined. “Alcohol on the other hand, could have benefits at light or moderate amounts, but then risks with large amounts.”
He said red wine in particular contains antioxidants, and pointed to studies showing up to one glass per day can reduce inflammation in blood vessels.
But all three doctors agreed on which ranked least harmful to the average person’s health.
“I would put marijuana third, mainly because we know that there’s a lot of medicinal uses for marijuana and used in the right format and in the controlled environment is fine,” Most said. He said chemotherapy patients often credit cannabis as the only thing keeping their appetite up, allowing them to get nutrition they need.
Glickman said evaluating cannabis’ healthfulness and harmfulness is more complicated than the other two.
“The available evidence suggests that cannabis could be of benefit when medically supervised as part of a treatment plan for certain conditions such as chronic pain, anxiety, trauma, insomnia, and muscular disorders, among others,” he said. But Glickman went on to say cannabis use could make certain mental health issues worse, as well as impair memory and concentration.
He said the data suggests there is an extra risk to young adults whose brains aren’t fully developed.
Plus, Akhil noted, while the U.S. Department of Agriculture and Health and Human Services have guidelines on how much alcohol adults can consume in moderation (up to two drinks a day for men, one drink for women), there are no such guidelines for safe cannabis or tobacco use.
“I think negative health consequences could be possible for all of the three substances, even in moderate amounts, depending on the person and situation,” Glickman said. “There is no foolproof vice.”
All three experts emphasized each person is unique, and you should always talk to your doctor about your specific situation.
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. | Disease Research |
The number of doctors seeking help for mental health issues has risen by more than three quarters within two years, according to figures from a specialist treatment service for NHS staff. For one GP, the relentless stress of the job led to him taking three months off work with burnout.
David Triska is no stranger to high-pressure situations. As an army medic, he served two tours of Afghanistan.
But mounting workloads at his village GP surgery left him feeling "hollowed out and spent". Simple tasks, like unlocking his car or making a meal, became a challenge - an experience he describes as leaving him feeling "like a husk of a human".
"At that extreme point, I couldn't see why I needed to be here anymore," Dr Triska said.
He is not alone. Since the year ending March 2021, there has been a 77% rise in the number of doctors seeking help for mental health issues, according to figures shared with the BBC by a confidential support service for NHS staff.
More than 5,600 doctors used the NHS Practitioner Health programme in England in 2022/23, with about a third having thought about taking their own lives.
Most cases stemmed from difficult working conditions, said the service's medical director, Zaid Al-Najjar.
The figures "reflect distress in the workforce", with demand expected to increase further during winter as the NHS faces its busiest period, he said.
For Dr Triska, it took a colleague's intervention before he realised he was suffering burnout - described by the World Health Organization as a syndrome resulting from chronic workplace stress that can lead to feelings of exhaustion.
He was supported by NHS Practitioner Health, but still needed to take three months away from work at his surgery in Witley, Surrey.
"That was the only way to recuperate, which is extraordinary in a time when we are the people supposed to be providing care and it's impossible in our own workplace and work system to provide that care for ourselves," he said.
Dr Al-Najjar said factors like the "extraordinary" working conditions of the pandemic and "chronic underfunding of the NHS" contributed to the mental health issues they treated.
He said he feared the increase in people using the service was "just the tip of the iceberg", adding: "They'll be a lot of people still worried about obtaining help, because they are worried about the effect it might have on their career."
"A service like ours, offering confidential care, has never been more important," he said.
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The NHS Practitioner Health service was founded in 2008 in London to provide confidential support for doctors. It expanded to cover all doctors in England in 2019 and by 2021 was available to eligible staff across the NHS.
Figures obtained by BBC South East show that 3,194 doctors used the service in England in 2020/21, rising to 4,814 in 2021/22 and 5,667 in 2022/23.
About 90% of people using the service are doctors, with GPs over-represented at about 40% of the total.
The British Medical Association (BMA) said the figures were a "stark and painful reminder of the immense pressures" that GPs face.
Dr Samira Anane, deputy chair of the BMA's GP committee, said there is not enough staff to meet soaring patient demand, adding: "All of this puts an enormous amount of pressure on GPs."
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More than 40% of doctors felt unable to cope with their workload each week in 2022, up from 30% in 2021, according to a survey by the General Medical Council.
The government says the NHS England workforce plan aims to train more doctors and nurses, and thousands of new roles will be created to work alongside them.
The Department of Health and Social Care said: "The wellbeing of all those working in the NHS is vital and extensive coaching and support and practitioner mental health services are available for all staff.
"There are more than 2,000 additional doctors and 31,000 additional staff working in general practice compared to June 2019 as well as a record number of trainees."
If you have been affected by any of the issues raised in this article you can visit the BBC Action Line for help. | Mental Health Treatments |
Police forces across Great Britain have seen a significant rise in the number of mental health incidents they have dealt with in the past five years.
Some 21 forces out of 48 in England, Scotland and Wales responded to a BBC freedom of information request - and every force reported a rise since 2017.
In Merseyside, mental health-related incidents increased from 7,629 in 2017 to 28,039 last year - a 313% rise.
The government says such pressures are stopping officers fighting crime.
The Home Office said a new approach involving police and health partners is being developed to free up police time and better care for people in a mental health crisis.
BBC Two's Newsnight asked forces how many incidents had been tagged as involving mental health each year.
Of those that responded, police in North Wales saw the largest proportional increase, responding to more than five times as many incidents in 2022 (3,910) as in 2017 (781).
Gloucestershire Police saw the lowest rise, an increase of 16% over the same five-year period - from 6,737 incidents to 7,369.
It is not clear how the data was collected by individual forces and whether the definition of mental health incidents differed between forces, or changed over the five years.
Newsnight has been given exclusive access to Merseyside Police's mental health triage team.
As part of the team, a mental health nurse and a police officer work together in Liverpool visiting those who are thought to be struggling with their mental health.
A triage car was first commissioned in 2019 as part of a six-month pilot and it was then recommissioned in April 2020. There are now three cars in the area. Experts believe the model reduces the amount of time police spend on such cases.
"It can help prevent hospital admission, get [patients] more access to more appropriate support and in a more timely fashion," says Owen Winsland, a mental health nurse on the team. "And for the police, it reduces the amount of officer time that is spent dealing with health and social care issues."
"Certainly in my time, 17 years, we've never had any standardised formal mental health training," Sgt Paul Shelley told Newsnight. "We do have inputs from health around - in particular - diagnosis and how to deal with people in a particular way."
'Not police work'
The College of Policing defines a mental health incident as "any police incident thought to relate to someone's mental health where their vulnerability is at the centre of the incident". And police officers are estimated to spend 20-40% of their time dealing with such incidents.
Some police chiefs believe the rise is down to police increasingly being seen as the first resort for people in a crisis, as well as a lack of capacity in the community to deal with growing mental health demands.
In November last year, the commissioner of London's Metropolitan Police said for every mental health patient his officers deal with, they spent an average of 14 hours in A&E. Sir Mark Rowley said officers were doing health and social care work that was "not police work".
The Home Office said the new approach it is developing "will make it easier for staff in police control rooms to identify the right agency to deploy at the outset when responding to 999 calls concerning individuals experiencing a mental health crisis".
The government says £150m capital investment announced last month will improve the places and spaces across the NHS for people experiencing - or at risk of experiencing - mental health crises to receive care and support in more appropriate settings outside of A&E.
It says the funding will allow for the procurement of up to 90 new mental health ambulances, which will take specialist staff directly to patients to deliver support on scene or transfer them to the most appropriate place for care. | Mental Health Treatments |
Oct. 31, 2023 â Hot flashes have been a hot topic lately.Â
Vasomotor symptoms, the sudden rises in body temperature that affect about 75% of menopausal women, have drawn interest after the approval of a new oral drug and research linking hot flashes to Alzheimerâs, heart disease, and stroke.Â
Now entering the discussion are researchers from the University of Massachusetts Amherst and Embr Labs (a Massachusetts Institute of Technology spinoff) who say theyâve developed a machine learning algorithm that can predict a hot flash.Â
Their idea is to combine this algorithm with a product called Embr Wave, a watch-like wearable that can emit coolness (or warmth) to the sensitive skin on the inside of the wrist, providing whole-body relief. The device, which sells for for $299, is already touted as a way to manage menopausal hot flashes.Â
But once the algorithm is added, the device will be able to âcontinuously monitor physiological signals â skin temperature, body temperature, sweating, activity level, or heart rate â and identify early indicators that a hot flash is building,â says Michael Busa, PhD, director of the Center for Human Health and Performance at UMass Amherst, who led the team that developed the algorithm.
That data would be sent to a computing platform in the cloud, where the algorithm can flag signs of an impending hot flash, Busa said. The device would automatically prompt cooling in less than a second, which could effectively stop the hot flash in its tracks or at least help to take the edge off.Â
Exploring Cooling Therapy for Hot Flashes
âThere is always tremendous interest in anything that is nonhormonal and effective in treatment of hot flashes,â said Karen Adams, MD, an OB/GYN and director of the Menopause and Healthy Aging Program at Stanford University. (Adams was not involved in developing this technology.)Â
Hormone therapy is the primary treatment, easing hot flashes in 3 to 4 weeks, Adams said. âBut some women do not want to take estrogen, or should not due to medical contraindications.âÂ
Hormone therapy is generally not recommended for people with a history of breast cancer, blood clots, or diseases of their heart or blood vessels. Recent research presented at the annual meeting of the Menopause Society found that hormone therapy may not work as well in women with obesity.Â
For nonhormonal treatments, the FDA cleared the oral med fezolinetant (Veozah) in May. Antidepressant medications can also be used as a first-line treatment in those who canât take estrogen. Another oral drug, elinzanetant, is in late-stage clinical trials.Â
But there has been little clinical investigation â only two small studies, Adams said â examining cooling therapy as a treatment for hot flashes. Thatâs something the makers of this device hope to change.Â
âDespite the fact that seeking cooling relief is a womanâs immediate natural response to the onset of a hot flash, there is limited work done to understand the benefits of this natural therapy,â said Matthew Smith, PhD, chief technology officer at Embr Labs. âThis is in part because the technology didnât exist to deliver cooling in an immediate, reproducible manner.â
The algorithmâs performance has been benchmarked using data from women having hot flashes, Smith said. Results have been submitted for publication. Â
The Embr Wave has been shown to help menopausal women with hot flashes sleep better. It has also been tested as a therapy for hot flashes related to cancer treatment.Â
But to truly evaluate the device as a treatment for hot flashes, it should be tested in randomized trials including a âsham treatment armâ â where some people get the real treatment while others get the sham treatment, Adams said.Â
âDevice studies tend to have high placebo response rates that can only be truly evaluated when there is a sham treatment in the study,â she said. âIf such a device were shown to be safe and effective, we would absolutely recommend it. But weâre a long way from that.â | Medical Innovations |
The order aims to expand access to gender affirming care and advance LGBTQ-inclusive learning environments at American schools.President Joe Biden has been pressing Congress to pass comprehensive LGBTQ rights legislation in the form of the Equality Act.Patrick Semansky / APJune 15, 2022, 4:49 PM UTCPresident Joe Biden is set to sign an executive order Wednesday aimed at combating a historic number of anti-LGBTQ bills introduced in state legislatures across the country.The order will direct federal health and education agencies to expand access to gender affirming care and advance LGBTQ-inclusive learning environments at American schools.It will also curb federal funding for the debunked practice of “conversion therapy,” which nearly every leading U.S. medical association has condemned, and ask the Federal Trade Commission to consider whether the practice constitutes an unfair or deceptive act.The president's order comes during LBGTQ Pride month and as advocates fight against a record number of anti-LGBTQ bills introduced in states across the country this year — more than 320, according to the Human Rights Campaign (HRC), the nation's largest LGBTQ advocacy group. "President Biden always stands up to bullies and that’s what these extreme MAGA laws and policies do — they bully kids," a senior administration official told reporters in a briefing on Wednesday. "Hateful, discriminatory laws that target children are out of line with where the American people are, and President Biden is going to use his executive authority to protect kids and families.”A bulk of the bills signed into law in recent months — 24 in 13 states, according to the HRC — aim to limit access to gender affirming care for transgender youth, prohibit trans girls and women from competing on girls' sports teams in school, and bar the instruction of LGBTQ issues in school.Under the executive order, a coordinating committee will also be established to lead efforts across federal agencies to strengthen the collection of data on sexual orientation and gender identity. It will also direct the Department of Health and Human Services to expand resources to address LGBTQ youth suicide and homelessness and study barriers same-sex married couples face in accessing government benefits.The new measures coincide with a recent surge in charged rhetoric surrounding how and whether children should learn about LGBTQ issues.In recent months, conservative lawmakers, television pundits and other public figures have accused opponents of a newly enacted Florida education law, which critics have dubbed the “Don’t Say Gay” law, of trying to “groom” or “indoctrinate” children. The word “grooming” has long been used to mischaracterize LGBTQ people, particularly gay men and transgender women, as child sex abusers.Advocates have been urging public officials against using the charged rhetoric, warning that it could cause violence directed at LGBTQ Americans. At least three LGBTQ events were targeted by white nationalist groups last weekend, with police arresting 31 people at an annual Pride in the Park event in Coeur d’Alene, Idaho, on charges of suspicion of conspiracy to riot. Those arrested came to the event with gas masks and shields.The president has been urging Congress to pass comprehensive LGBTQ rights legislation in the form of the Equality Act. But after passing in the House last year, the bill stalled in the Senate. Biden again called on Congress to take action in a White House fact sheet.Follow NBC Out on Twitter, Facebook & Instagram | Health Policy |
In the early days of the pandemic, ministers believed and told the public the UK was at the forefront of Covid testing. The government’s scientific advisers appeared to share the view and were perhaps even a factor in its widespread belief. At the first Sage meeting in January 2020, the assembled experts said a Covid test would be ready within days and that it could be “scalable across the UK in weeks”.
That assessment was way off the mark. The UK was indeed one of the first countries to develop a Covid test, but it squandered the advantage by failing to deliver them. The inability to ramp up testing capacity had serious knock-on effects. Scientists had no clear picture of the size of the outbreak, while prioritisation of what tests existed left many vulnerable people, including those in care homes, dangerously exposed.
The extent of the problem was clear from the figures. In late January 2020, Public Health England, now the UK Health Security Agency, was able to administer only 400 to 500 Covid tests a day. In the six weeks to 11 March 2020, less than two weeks before the first lockdown, the UK performed fewer than 30,000 Covid tests. That equates to less than one a day for each parliamentary constituency. At about the same time, in mid-March 2020, Germany was testing 50,000 people a day.
A month before the former health secretary, Matt Hancock, asked Prof Chris Whitty, England’s chief medical officer, for advice on testing for care home admissions, the UK abandoned all testing in the community. The decision, on 12 March 2020, ran counter to advice from the World Health Organization and marked a shift in England’s management of the pandemic from “containment” to “delay”, amounting to an acceptance that the virus was out of control.
Dr Jenny Harries, then deputy chief medical officer for England, defended the decision to halt community testing, saying it was “not an appropriate intervention” given the prevalence of the virus. But two months later, she admitted to the Commons health select committee that the decision was partly due to a lack of testing capacity. Another factor was that the government’s strategy was modelled on a flu pandemic, which mandated an end to testing once community transmission was established.
Without the capacity to track the pandemic in the public, tests were prioritised for the NHS where staff and patients were at greater risk. But ministers knew that care home residents were extremely vulnerable to outbreaks too. According to Hancock’s messages, he received advice from Whitty on 14 April that anyone being admitted to a care home – whether from hospital or the community – should be tested for Covid and isolated if necessary. A spokesperson for Hancock said he accepted this, but was told at an operational meeting later that day it was not possible to test everyone going into a care home.
The main concern at the time was that patients could be discharged from hospitals, where Covid was often rife, directly into care homes without being tested. Hancock sought to assure critics that “right from the start” government had thrown a “protective ring around our care homes”, but there were no requirements around admissions from the community, and government advice on 2 April 2020 stated that negative tests were “not required” before patients were transferred from hospitals to care homes.
It was not until mid-April that Covid tests were made a requirement for hospital patients being discharged into care homes. But even then, the guidance assumed patients could be safely isolated on arrival. In reality, many care homes lacked the facilities to do that.
There was even less protection for care home residents from people admitted from the community and from care workers themselves. The lack of testing of staff in particular meant social care workers spread the virus unwittingly, at times between several different homes where they were employed. The failure to prevent outbreaks in care homes led to more than 40,000 Covid deaths among residents between March 2020 and April 2021, more than a quarter of the Covid deaths in England over the same period of the pandemic. | Epidemics & Outbreaks |
Media caption, Victoria Andrews, from Cardiff, says it was a "stomach-churning" experience as she feared for her daughter's wellbeing.A 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 practising 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 it was 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 |
England's former deputy chief medical officer has said his family were threatened with "having their throats cut" during the pandemic, as he gave evidence to the UK Covid inquiry.
Prof Sir Jonathan Van-Tam said that at one point he was asked by police to leave his house over safety concerns.
He said receiving hate mail made him consider stepping down from his role.
Prof Van-Tam warned that officials advising on future crises may be put off due to the "implications".
He told the public inquiry, which is looking into the UK's response to Covid, that he was working 16-hour days, seven days a week, which he said was "very, very intense".
Prof Van-Tam became a household name due to his regular television appearances during the pandemic and was affectionately known by his initials JVT.
He told the inquiry that, while his job involved huge workloads and stress, he "did not expect my family to be threatened with having their throats cut".
"I did not expect the police to have to say 'will you move out in the middle of the night... while we look at this and potentially make some arrests?'," he explained.
He told the inquiry he was describing the "extremely hateful messages" because he was worried his experience would deter experts from taking on similar roles in future.
Inquiry chairwoman Baroness Heather Hallett described the threats as "awful" and told Prof Van-Tam "the vast majority of the population abhor such conduct, and we are enormously grateful to you and your colleagues".
Earlier this year, England's chief medical officer Prof Sir Chris Whitty told the inquiry he had similar concerns after he was attacked in a London park in 2021.
Covid restrictions
In his testimony, Prof Van-Tam told the inquiry he became concerned about reports of a new virus spreading in China as early as 15 January 2020 - two months before a full UK lockdown was ordered.
"My instincts were telling me that this was going to cause us real trouble and be a pandemic," he said.
By the start of March, he said it was clear that the virus was spreading quickly.
With the benefit of hindsight, it would have been better to have brought in the first major restrictions "certainly seven days earlier, possibly a little longer than that", he added.
Asked whether there would have been any other option than ordering a full lockdown on 23 March 2020, he said there was "almost certainly no alternative".
"We would have first run out of intensive care beds," he said, with the possibility that hospitals would have had to stop admitting Covid patients "within a couple of weeks".
"[There were] some pretty awful potential considerations at that point," he added.
Eat Out to Help Out
Asked about the Eat Out to Help Out scheme, launched in August 2020 by then chancellor Rishi Sunak, Prof Van-Tam said he first heard about it "on TV".
He suggested the scheme, which was aimed at boosting the hospitality sector after the first UK lockdown, "did not seem sensible", as it encouraged indoor socialising between different households.
Giving evidence earlier, Prof Whitty also said that neither he nor Sir Patrick Vallance, the government's former chief scientific adviser, were told about it in advance.
"I think we should have been," he added.
Earlier in the week, Sir Patrick said the scheme was "highly likely" to have increased infections and deaths.
Mr Sunak told the Commons on Wednesday that the government "took advice from scientific advisers".
In his witness statement to the inquiry, then Prime Minister Boris Johnson said "it was properly discussed with Chris and Patrick".
Asked to respond, Prof Whitty said: "On this one, neither Patrick nor I can recall it and I think we would have done."
"It would have been prudent, let's put it that way, for them to have thought about discussing it before it was launched."
Herd immunity 'inconceivable'
Earlier, Prof Whitty said discussions about "herd immunity" in government at the start of the pandemic had become "extremely confused" and were "not based on proper understanding".
Giving evidence for a second day, he said the idea - of allowing the virus to spread until a large proportion of people were immune, thus protecting the population as a whole - was never a serious policy goal.
He told the inquiry the concept was widely misunderstood and the approach during Covid would have been "inconceivable" as it "would have led to extraordinarily high loss of life".
"There was a large amount of chatter about this by people who did not fully understand the issue," he said, adding that it "upset and confused a lot of people".
He continued that, in his view, "the only rational policy response" in which herd immunity could be achieved was by vaccination.
Later in his testimony, he said he believed the second England-wide lockdown, introduced on 5 November 2020, could potentially have been avoided "had previous decisions been different".
However, he said that by the time it was imposed, the amount of virus circulating meant it had become "inevitable". | Epidemics & Outbreaks |
Millions of people over the age of 65 likely have mild cognitive impairment, or MCI—minor problems with memory or decisionmaking that can, over time, turn into dementia. But a pair of recent studies both concluded that 92 percent of people experiencing MCI in the United States are not getting diagnosed at an early stage, preventing them from accessing new Alzheimer’s treatments that may be able to slow cognitive decline if it’s caught soon enough.“We knew it was bad. But we didn’t know it was that bad,” says Ying Liu, a statistician at the University of Southern California’s Center for Economic and Social Research and a researcher on both studies.In the first, published this summer in Alzheimer’s Research & Therapy, Liu’s team aimed to figure out how often MCI is being diagnosed—and how often it’s overlooked. Using data from the Health and Retirement Study, a longitudinal survey of some 20,000 people in the US about a wide range of age-related factors, Liu built a model predicting the number of expected MCI diagnoses for the over-65 population overall: about 8 million. Then, Liu’s team pulled data from all Medicare beneficiaries aged 65 and up who were enrolled from 2015 to 2019, to see how many were actually diagnosed with the condition. They found that only 8 percent of the people whom their model predicted would be candidates for MCI, based on their health demographics, actually received a diagnosis. This number was even lower for Black and Hispanic beneficiaries and among lower-income people. (The team used eligibility for Medicaid, health coverage that supplements Medicare, as a marker of income status.)A second study, published in October by Liu’s team, looked at Medicare claims submitted by 226,756 primary care physicians and compared their MCI detection rates with those predicted by their model. Again, they found that only about 8 percent of predicted cases were actually diagnosed, and only 0.1 percent of clinicians diagnosed the condition as often as the team calculated that they should.Autopsies reveal that most people who die in old age have some kind of brain pathology that impairs cognition, from traces of stroke to the amyloid plaques that characterize Alzheimer’s. Not everyone who has these anatomical markers of neurodegeneration experiences memory problems, but “the more of these things you have in your brain, the more likely you are to manifest dementia,” says Bryan James, an epidemiologist at the Rush Alzheimer’s Disease Center, who was not involved in this research. If someone does experience problems like forgetting who family members are, or getting lost while walking familiar paths, a combination of cognitive tests, brain scans, blood work, or a spinal tap can pinpoint the cause of their dementia.Diagnosing mild cognitive impairment is much trickier. People might notice that something is off, but they’re still able to function independently. Most are seen by primary care physicians, not researchers in specialized memory care clinics. Because these doctors don’t see many dementia patients, their confidence in giving someone a potentially life-shattering diagnosis can be low. “They don’t want to make a mistake,” says Sarah Kremen, a neurologist at the Jona Goldrich Center for Alzheimer’s and Memory Disorders, who was not involved in this research.“We are still struggling, as a healthcare profession, with how to best identify mild cognitive impairment,” adds primary care physician Barak Gaster, who is also a professor of medicine at the University of Washington. Many doctors in Gaster’s field know they lack the training to handle cognitive concerns, and they are eager to learn. However, annual Medicare wellness visits are time-constrained—often just 15 minutes—and cover a lot of ground. Cognitive assessments are too cursory to detect the subtleties of MCI. “It’s really challenging to ask a community health provider to do another thing, because they’re already doing everything,” says Nancy Berlinger, a senior research scholar at the Hastings Center, an independent bioethics research institute in New York. Plus, people generally don’t want to be told they have memory problems. “Because of the stigma surrounding dementia, primary care providers may just avoid the topic,” says Berlinger.“We’re failing a lot of people,” says Sarah Banks, a neuropsychologist at the University of California, San Diego, and director of their Memory Disorders Clinic. “I’m not surprised that it’s being underdiagnosed, but I was surprised by how much.”Even if both the doctor and the patient notice something is off, Gaster adds, “the elephant in the room is that, if a cognitive concern comes up, most primary care providers still aren’t sure what to do.” Until very recently, an MCI diagnosis didn’t come with any actionable treatment options—just the knowledge that a patient may develop dementia someday. The same question has plagued efforts to develop blood tests for Alzheimer’s risk: Will they unnecessarily stress a person who can do little to change their outcome?But this summer, the US Food and Drug Administration approved the new Alzheimer’s medication lecanemab-irmb, or Leqembi, which clears amyloid plaques from the brain and slows the progression of cognitive decline. Liu calls it “a big game changer.” Donanemab, another potential treatment developed by pharmaceutical company Eli Lilly, also reduced amyloid levels and slowed cognitive decline in Phase 3 clinical trials of people with early-stage Alzheimer’s disease.While these new medications are a big deal, “they’re not a panacea,” Kremen cautions. In Phase 3 clinical trials, lecanemab slowed cognitive decline by 27 percent over the 18-month study, a relatively modest improvement. And it’s not an easy treatment—patients need infusions at a clinic every two weeks. The drug can have potentially life-threatening side effects like brain swelling and seizures. As a consequence, “I think a lot of us in the field are a little skeptical about how helpful they’ll be,” Banks says. James adds, “There’s a risk-benefit balance that I don’t think we’ve worked out yet.”Drug treatment also depends on early detection. Amyloid plaques kill brain cells, which can’t grow back. If you don’t try to get rid of the plaques until they’ve already killed a bunch of cells, James says, “You’re trying to put out a fire after the house burned down.”More clinical testing will be necessary to determine exactly how effective these drugs will be for people who start taking them as early as possible. “Dementia is not a problem that we can quickly solve through a pill,” Berlinger says, but “we may be in an era of promising interventions in early stages, which rely on the ability to detect early symptoms.”Still, James predicts that in five years, as these treatments become more effective and accessible, the diagnostic rate for MCI will skyrocket. “Diagnostic practices are driven by the availability of treatment,” he says. “People don’t just diagnose in a vacuum. They diagnose for a purpose.”Even if these treatments work, the US healthcare system is not currently equipped to handle the demand for them. Lecanemab currently costs $26,500 per year, and Medicare covers 80 percent of the cost. If all of the people whom Liu’s studies estimate are experiencing mild cognitive impairment are diagnosed and seek treatment, James says, “it would bankrupt Medicare.” Memory clinics will also struggle to handle the onslaught of referrals. (Rush Memory Clinic, where James works, already has a yearlong waitlist.)These studies were limited to demographic basics like age, sex, race, and Medicaid eligibility. Age is one of the greatest risk factors for developing MCI—the older you are, the more likely you are to have it. Autopsy studies also show that women seem to develop neuropathology linked to dementia more than men, but in Liu’s studies, detection rates were not dramatically different across sexes or age groups.Race, however, was one of the strongest predictors of whether or not MCI is accurately diagnosed, with Black people getting diagnosed at half the rate of white people. It’s unclear whether the stark racial divide in detection rates Liu’s team observed is due to differences in MCI prevalence itself, or to differences in healthcare access. Cognitive screening measures were largely developed by white people, for white people, Banks says, likely reducing their sensitivity in other populations. Factors like lower-quality childhood education, the chronic stress of systemic racism, and lack of access to healthy food can all contribute to dementia risk, James adds. Liu’s team is currently building predictive models that account for more of these factors.Even if a person’s MCI never escalates into full-blown dementia, doctors say there is value in screening for it, because it can let them help alleviate symptoms or weed out other possible confounding causes. For example, doctors can review medications with patients to make sure nothing they are taking lists brain fog as a side effect. Hearing loss is a major contributor to dementia risk, and doctors can help people access hearing aids. Basic lifestyle changes like eating well, exercising, getting good sleep, and nurturing social connections address both brain health and overall well-being.Doctors need to normalize talking about brain health with patients of all ages, says Elizabeth Head, a program manager at the Georgia Department of Public Health, who led their campaign for early detection of dementia. “We don’t have to ‘break the ice’ to talk about heart disease, cancer, or other chronic conditions,” she says. “It should be talked about like any other type of disease.” | Disease Research |
Subsets and Splits