With evermore unhoused people on the streets of our biggest cities, and publicized subway crimes in New York, mental health treatment is again in the news. Politicians speak about “caring” for the mentally ill in a new way, which turns out to be the old way—putting them away. The mention of involuntary confinement, predictably, sparks anxiety and controversy, giving rise to the question of whom this policy is meant to help: the people taken away or the rest of population, those shopping, jogging, carrying groceries home, who, presumably, will no longer be bothered by the inconvenient reality of a person speaking to God, while blocking the sidewalk. Nonetheless, whether or not present laws limiting involuntary commitments should be altered, as proposed by New York Mayor Eric Adams and California Governor Gavin Newsom, the real question is where would the mentally ill be taken and how would they be treated? As it is, there is no adequate system in place. There are not enough psychiatric beds available for even the short holds now stipulated by law. The closest state mental health hospital still open near to where I live is fifty miles away in Norwalk, California. Metropolitan, as the hospital is ironically named, includes, as several of the old asylums still standing do, a museum of itself, put together by people who once worked there, memorializing what the hospital had once been: a vast complex that housed and treated, cared for, and in some cases even cured, up to four thousand patients at a time. Metropolitan opened in 1916, when the area was rural, populated primarily with dairy farms and sugarbeet fields. Norwalk was chosen, over Long Beach and Beverly Hills, because the Anaheim Branch railroad ran there, making it was easy to bring patients by buckboard. I spoke many times with three retired staff members, who still volunteer at Metropolitan one day a month. Emily Wong and Shirley Olmstead are both retired nurses, Erma Aalund is a retired psychiatric technician. They were all ward charges for decades. They helped put together the museum, on the grounds in the fire chief’s old house, and they’ve taken on enormous task of organizing the hospital’s archives, in a room which had been the vegetable peeling room in the once-enormous institutional kitchen that’s now repurposed as the hospital library. One of them came to work at the hospital just out of high school. “I worked admissions. They came in busloads from the County. They were screaming, shouting, nothing made sense. You had to bathe them. Their hair would be all matted and dirty. We did body checks for lice, bruises, tumors, bulges and wounds. It gave me an open mind. You learn to accept people for what they are.” Later, the hospital paid for her to school, to become an RN. “The state started a program where we worked part time. Metropolitan was the biggest nursing hospital west of the Mississippi.” Her mother and father had also worked at Metropolitan and she met her husband there. That was very common, she said. “I grew up knowing this place. We used to come and see movies and magic shows over in James Hall.” Some of the staff members lived on the grounds. In exchange for low rent ($19 a month, which would be around $120 today) they were on call if anything happened. The executive director lived in a large house on the hospital grounds, too. Some of the hospital’s labor was done by patients. “They maintained everything,” one of women said (they preferred their quoted comments to be attributed collectively, as they relied on each other to check their memories). “Cows, chickens, pigs, gardens all over. Orchards. Everybody wanted to work on the farm. They had a little house in the field where they ate their lunch. “In the old days, everyone had a job,” another continued, “No matter how sick the patient was, they had to have a job. A nurse would ask a patient, ‘can you help me fold the laundry?’ And the patient blossomed. They felt needed. If they pushed someone from geri (the geriatric unit) in a wheelchair to the dining room for me, I paid them in tokens, to be used in the little store on the grounds to buy treats. Now they have to get minimum wage. The State took the smoking away too. They no longer provided cigarettes. Smoking had been very calming.” Many of the older buildings, the three recall, had marble floors in the foyers, and oak staircases, fireplaces, screened in porches and wicker antiques. But they were expensive to keep up, when the patient population dwindled and asbestos was an issue. Some buildings were torn down, others remain abandoned on the grounds, which still feel vast, although they represent only about a third of the hospital’s former holdings. “Patients were safe and cared for and not sleeping in the streets,” one said. “They used to come back to the hospital and beg me for shock therapy. It was very very effective for the very depressed people After they were out into the community, they would come back for therapy. It didn’t matter who they talked to. They came back to touch the walls.” Oliver Sacks wrote, in a 2009 piece published by the New York Review of Books, “There were, at Bronx State as at all such hospitals, great variations in the quality of patient care: there were good, sometimes exemplary, wards, with decent, thoughtful physicians and attendants, and bad, even hideous ones, marked by negligence and cruelty. I saw both of these in my twenty-five years at Bronx State. But I also have memories of how some patients, no longer violently psychotic or on locked wards, might wander tranquilly around the grounds, or play baseball, or go to concerts or films. … and at any time, patients could be found reading quietly in the hospital library or looking at newspapers or magazines in the dayrooms.” Over the past sixty years, since Kennedy signed the Community Mental Health Act, three weeks before his assassinations in 1963, the mental health state hospital system across the U.S., that Sacks remembered, has been largely dismantled. Kennedy’s idea was spurred not only by widespread movements for reform after exposés of overcrowding, abuses and staff shortages and the hopeful introduction of new antipsychotic medications but also by the life of his own sister, who was given a lobotomy and lived in an institution for most of the rest of her life. He intended the large hospitals, like Bronx State and Metropolitan, to empty out and care of the mentally ill to fall to community health centers. But the incentives to create community based care, during the Reagan years, came in the form of federal block grants to the states. “States could pick,” the nurses said, “highways or mental health. They picked highways.” As it’s always easier to dismantle than to build only half the community centers envisioned were ever opened, while the large hospitals emptied out. No one organization claims responsibility for the basic needs of the mentally ill in the world outside. Funding falls to Supplemental Security Income, Social Security Disability Insurance and food stamps. Many people don’t qualify for Medicaid and Medicare. Those who were lucky were cared for by the families; those without a home, ended up on the streets or in jails, prisons or forensic institutions. “So many of our patients went to jail and jail has no means of treating this,” the women said. “Many of our patients would go to a restaurant to eat, because they were hungry and then not pay the bill, and then they would be thrown in jail.” This has been the state of things for decades. We’ve all witnessed the failures. “This could be u,” the artist Mark Hammons stenciled over his installation of tents outside his gallery, just blocks from LA’s real skid row, yet no feasible alternative is on any ballot. Millions of mentally ill people remain the most excluded people in American society even as it is clear, from books like Ely Saks The Center Cannot Hold: A Tale of Mental Illness from the Inside that even people with severe diagnoses can be helped to live productive, meaningful lives. I grew up as the child of a person who experienced delusions, both delirious and painful, who heard voices and suffered debilitating depressions. She managed to raise a child and even, in her work as a speech therapist, use a unique talent to teach stroke victims to talk again, all in the larger world, with only the exception of one period in jail, about which she never told me about. Nonetheless, as the child who grew up with her, it was impossible not to wonder, whether there could have been another life possible, an alternative world like the one Dr. Sacks describes and the retired staff members remember, where her struggles could have been eased by good medical care. By now, it seems clear that the correction, like so many corrections, was an overcorrection. The miracle drugs, introduced in the fifties, proved less miraculous than first hoped. Less than half of the community centers Kennedy envisioned were ever built, though 90% of patient beds in large state mental health hospitals were eliminated. State hospitals should have been improved, better staffed and financed, rather than closed wholesale. Though they have fond memories of work at the hospital the retired staff members are not sentimental about mental health. They remember patients assaulting each other, half a supervisor’s ear was bitten off, once a nose. “Before tranquilizers, some patients would have put their eyes out,” one said. Rapes were not infrequent. Another remembered a patient who cut the fetus out of another patient. The building where the lobotomies had once been done had been taken down, they told me. “To erase the stigma, the memory.” But they object to legislation (the Lanterman-Petris Short Act, in California) sometimes called the Magna Carta for the mentally ill. “We couldn’t force them to take their medicine anymore. If you have TB and you won’t take their medicines, the state has the right to put you in isolation. I had a patient who heard voices to kill her children and she killed all three of them. She later got a ground pass. Her name was Donna. She was the sweetest young thing. Once she was out, she jumped off an overpass onto the freeway.” They had a patient who threatened to burn her house. “She was released and she went right home and set fire to it. Freedom to be sick, helpless and isolated is not freedom,” one said. “It is a return to the Middle Ages, when the mentally ill roamed the streets and little boys threw rocks at them. Now they can die with their rights on. A psychiatrist said that once and it became a refrain.” Just about everyone who worked there thinks the new laws were a mistake, they said. They were too restrictive. Under the LPS act, in order to hold somebody for 72 hours, they must be able to find food, clothing and shelter. They made a kind of rueful joke. “Garbage, rags ad tents fit the bill.” Most patients at Metropolitan now no longer have grounds privileges. After a lady stabbed a boy with a ball point pen on the corner near the hospital, the city of Norwalk was outraged, and in response, the hospital locked the ward doors and required passes. But the three women have happy memories, too, “A psych tech named invited the patients to tea, with china teacups and saucers. They’d talk about daily events on the news. People strived to show her they would behave. They wanted to be invited to the tea.” A doctor had a rocket club. They’d shoot off rockets, watch them parachute down on the big lawns. They had a shoe shop, barber, a hair salon. “Our own laundry,” one remembers. Movies shown in James Hall. Fashion shows. Program wide bar-b-ques. “One unit would invite another unit to come over on a Saturday night for a dance. Staff would do live music.” Despite the dances, dating wasn’t allowed. Patients got around the restrictions, though and they remembers opening doors to find patients having sex in an empty room or outside. (“We called it bush therapy,” one said. They all did say this, but Shirley feels queasy about including it.) “Geriatrics had wine and cheese parties. I taught a cooking class. There were lots of activities if people wanted to get involved.” “It was a world,” another said. from https://ift.tt/Apj4mac Check out https://takiaisfobia.blogspot.com/
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Moderate drinking isn’t likely to extend your life, according to a new meta-analysis that adds to the mounting scientific consensus that alcohol consumption offers few health benefits and comes with serious risks. That conclusion may be surprising to anyone who’s heard that moderate drinking—usually defined as no more than two alcoholic beverages per day for men, or one for women--is good for the heart, potentially helping prevent heart disease, strokes, and heart attacks. Numerous studies have also linked the Mediterranean diet, red wine and all, with long, healthy lives. “The idea that alcohol is good for your health is so ingrained in many cultures,” says Tim Stockwell, who co-authored the new meta-analysis and is a professor of psychology at Canada’s University of Victoria and former director of the Canadian Institute for Substance Use Research. While there’s still some back and forth in the research world, Stockwell says that concept is built on decades of flawed science. Many studies on alcohol and health compared light or moderate drinkers to people who abstain from alcohol, without adequately accounting for the fact that many people quit drinking because they have health problems or previously drank heavily. Many studies also focused on older adults, in whom this trend may be particularly apparent. “People who are still healthy in their 70s and 80s can continue to drink,” Stockwell says. “Those who become frail, are on medication, or socialize less [tend to] stop or cut down on their drinking.” Moderate drinkers may indeed be healthier than abstainers, but alcohol isn’t necessarily the reason. Stockwell and his colleagues, who published their meta-analysis in JAMA Network Open on Mar. 31, set out to correct some of those issues. They reviewed more than 100 previously published studies on alcohol consumption and mortality, involving nearly 5 million research participants in all, and accounted for how “sick quitters,” older study groups, and other factors may have skewed earlier results. When compared to lifetime non-drinkers, people who had roughly two drinks per day or less did not have a significantly lower risk of premature death, the researchers found. People who drank heavily—defined as about three drinks per day or more—had higher mortality risks than non- or occasional drinkers. “At higher levels, per drink, women seem to be at greater risk of mortality than men,” Stockwell adds. That may be because women, on average, are smaller than men and become impaired by less alcohol, he says. Nonetheless, excessive alcohol use is linked to health issues that affect people of any gender, including a range of cancers, liver disease, dementia, and—despite the narrative that alcohol is heart-healthy--cardiovascular disease. Earlier this year, both the Canadian Centre on Substance Use and Addiction and the World Health Organization (WHO) published guidance saying the safest amount of drinking is none. “When it comes to alcohol consumption,” the WHO’s statement reads, “there is no safe amount that does not affect health.” (Stockwell was on the advisory panel behind Canada’s guidelines.) U.S. regulators have not been as explicit in their guidance. The U.S. government’s Dietary Guidelines for Americans say that “drinking less is better for health than drinking more” and recommend men have no more than two drinks per day, and women no more than one. Science aside, Stockwell says deciding whether and how much to drink is a personal choice. Based on his research, Stockwell estimates that someone who drinks one alcoholic beverage per day shaves about five minutes off their lifespan with each drink, and the losses compound at higher levels of consumption. Whether that’s an acceptable tradeoff, Stockwell says, is up to the drinker. from https://ift.tt/XGDdFSz Check out https://takiaisfobia.blogspot.com/ A federal judge in Texas who previously ruled to dismantle the Affordable Care Act struck down a narrower but key part of the nation’s health law Thursday that requires most insurers to cover preventive services that include screenings for cancer, diabetes and mental health. Other no-cost services, including HIV screenings, are also impacted under the ruling by U.S. District Judge Reed O’Connor that opponents say will jeopardize preventive care for millions of Americans. Experts cautioned that insurers are unlikely to stop any coverage immediately. The Biden administration was expected to appeal and seek a stay of the ruling. [time-brightcove not-tgx=”true”] “This is not the potential fatal blow to the ACA like previous court cases, but it would limit a very popular benefit that tens of millions of people use,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. The decision comes more than four years after O’Connor, a nominee of former President George W. Bush, ruled that the entire health care law also known as “Obamacare” was unconstitutional. The U.S. Supreme Court overturned that ruling. This time O’Conner blocked only the requirement that most insurers cover a range of preventive care — including screenings for multiple types of cancer — siding with plaintiffs who include a conservative activist in Texas and a Christian dentist who opposed mandatory coverage for contraception and an HIV prevention treatment on religious grounds. The requirements for coverage are driven by recommendations by the U.S. Preventive Services Task Force, which is made up of volunteers. O’Connor ruled that enforcing the recommendations was “unlawful” and a violation of the Constitution’s Appointment Clause, which lays out how government officials can be appointed. Dr. Michael Barry, chairman of the federal task force, said in a statement following the ruling that people with low incomes have been able to get services they need as care has expanded over the past decade because of the law. “Fundamentally, people across the country deserve the opportunity to receive these important preventive services that have been proven to help them live longer and healthier lives,” Barry said. White House Press Secretary Karine Jean-Pierre said the Department of Justice and the Department of Health and Human Services were reviewing the ruling, but called the case “yet another attack” on the health care law that has been in place for 13 years and survived multiple legal challenges. The Biden administration previously told the court that the outcome of the case “could create extraordinary upheaval in the United States’ public health system.” More than 20 states, mostly controlled by Democrats, had urged O’Connor against a sweeping ruling that would do away with the preventive care coverage requirement entirely. The ruling applies to recommendations made by the task force after March 2010, when the Affordable Care Act was enacted. Some of the nation’s largest medical groups came out against the lawsuit, warning that insurers in the future could impose cost-sharing on patients for screenings that are now fully covered. Levitt said if O’Connor’s ruling is allowed to stand, insurers are likely to look at changes in coverage beginning in the next calendar year, since existing contracts are already in effect. Although the ruling impacts a broad spectrum of preventive care, it does not wipe out coverage for all preventive screenings. For instance, experts said the decision would not overturn coverage for preventive women’s health services that were approved outside the task force. Some cancer screenings approved before 2010 would also not be affected, including screenings for cervical and colorectal cancer, said Alina Salganicoff, senior vice president and director for women’s health policy at the Kaiser foundation. But she said screenings for lung and skin cancer, which were more recently approved, could be affected. In September, O’Connor ruled that required coverage of the HIV prevention treatment known as PrEP, which is a pill taken daily to prevent infection, violated the plaintiffs’ religious beliefs. That decision also undercut the broader system that determines which preventive drugs are covered in the U.S., ruling that a federal task force that recommends coverage of preventive treatments is unconstitutional. Employers’ religious objections have been a sticking point in past challenges to former President Barack Obama’s health care law, including over contraception. The lawsuit is among the attempts by conservatives to chip away at the Affordable Care Act — or wipe it out entirely — since it was signed into law in 2010. The attorney who filed the suit was an architect of the Texas abortion law that was the nation’s strictest before the Supreme Court overturned Roe v. Wade in June and allowed states to ban the procedure. ___ Associated Press reporters Amanda Seitz and Seung Min Kim in Washington contributed to this report. from https://ift.tt/RTVNi3S Check out https://takiaisfobia.blogspot.com/ On a recent shift, I arrived to find our emergency department full and our waiting room overflowing with suffering patients. Half of our ER beds were occupied by “boarders”—patients who were ill enough to require hospital admission, but with no inpatient bed available for them in our hospital, or at any other in the state. These boarding patients included a seriously ill infant with respiratory distress from RSV, a moribund elderly woman on a ventilator, and a teenaged boy who had been held under security watch in the ER for three straight days, waiting for transfer to a psychiatric bed. In the hour after I arrived, I attended to four new critically ill patients who joined the ranks of our ER boarders, having no ICU able to receive them. The minute-to-minute bedside care they would require from us indefinitely meant even less attention for the other sick patients. A seasoned nurse whispered to me in a moment of overwhelm, “I can’t do this anymore. This isn’t worth my license.” And I thought grimly, and not for the first time: this is a dangerous situation. For our patients, and for us. As a physician who coaches other doctors through the stress of malpractice litigation, I am keenly aware of a truth that has gone unspoken in public discussions about why healthcare workers are quitting. What has been published so far is very true: We are burned out and overwhelmed. Violence against healthcare workers is a regular occurrence. We are worn down by the daily roadblocks set up by intransigent health insurers, error-promoting electronic health records, and C-suite executives with little understanding of the boots-on-the-ground perspective. We have been working through COVID-19 and staffing shortages, in systems that are crumbling around us. And when there is an outcome that causes suffering and grief for patients and their families, we are not only crushed by these failures, but also become the faces of them. Read more: Caring for the Caregivers Post-Pandemic Malpractice litigation is a thorny topic to discuss openly. Even among doctors, though litigation is exceedingly common, it carries an air of shame and secrecy. Personal experiences in litigation are rarely discussed. Many physicians have no understanding of how litigation actually works. But malpractice litigation happens to many good doctors. For example, one survey showed that over 80% of currently practicing OB-GYN physicians and general surgeons have been sued at least once. For many, the initiation of a lawsuit or disciplinary investigation is nearly as significant as the outcome. The formal accusation of malpractice, whether or not any occurred, marks the beginning of a long cycle of shame and psychological distress for the clinician who has dedicated their life to their profession and genuinely cares about the outcomes of their patients. The opportunity to talk to the patient or their family—to heal, to explain, to listen, to soften—is lost; lawyers now attack or defend in our stead. Adding to the distress of a serious adverse outcome for their patient is now the fear of personal assets at risk, the potential loss of licensure or livelihood, and the stigma of the lasting public record of the lawsuit; worry runs rampant, as does the shame of being judged incompetent by patients and peers alike. This fear is generally left unspoken by clinicians who are admonished by their lawyers and insurers not to talk about it, but is highly leveraged during the legal process by opposing counsel, who are well versed in the psychological distress that litigation creates in the defendant. They know that a highly stressed physician is more likely to make a mistake in deposition, to push for a settlement just to end their ordeal, or appear poorly on the stand as a witness at trial. Serious medical mistakes do occur, of course, and the risk increases as our healthcare system frays. In no way should the discussion of the impact of litigation on healthcare workers diminish the suffering of patients or their families when error occurs. Historically, however, many filed malpractice lawsuits have not involved true error. The majority of filed lawsuits end in non-payment, and when cases proceed to trial, physicians prevail over 85% of the time. Yet it is important to recognize that whether or not an error occurred, and regardless of the ultimate outcome of a case, malpractice litigation stress is a chief driver of burnout, substance use, divorce, and mental health crises among clinicians. Physicians as a group have a remarkably higher rate of suicide than the general population, and one 2011 study of over 7,000 U.S. surgeons found that recent malpractice suits were “strongly related to burnout, depression, and recent thoughts of suicide.” Another 2020 JAMA study demonstrated that “civil legal problems were a significant risk factor for suicide among health care professionals.” For a physician whose identity has revolved around being ‘the good doctor’ but now is a defendant, an inner crisis brews which often goes unaddressed. Medical providers are often minimally supported by their institutions during litigation; the result is a general sense of mistrust between hospital administration and staff. Physicians and nurses are keenly aware of the recent RaDonda Vaught case, in which a nurse was convicted of criminally negligent homicide for a medication error, though flawed hospital-based medication dispensing systems were also contributory. Clinicians often expect to be “thrown under the bus” once the wheels of litigation begin to turn. Independent of litigation, medical errors themselves are linked to increased suicidality in physicians. We measure our intrinsic worth not by the thousands of times we were right, but the few times we were wrong. And today, our dangerously understaffed conditions are leading to more adverse events—and in a vicious cycle, the impact of those events will drive even more of us away. All of this has always been part of our jobs, but the more we are tasked with the impossible, and blamed when unable to achieve it, the more keenly aware we are that every malpractice lawsuit needs a face, and that face will soon be ours. What we state openly about the healthcare exodus is true: we are overwhelmed, we are burned out, we cannot help everyone who needs our help. People are dying that would not be dying, if we only had the time and resources to do our jobs as we were trained to. from https://ift.tt/ipg9kut Check out https://takiaisfobia.blogspot.com/ The opioid overdose epidemic, which caused 80,000 deaths in 2021, can often seem like an unrelenting tragedy, but on Wednesday, there was cause to celebrate. The U.S. Food and Drug Administration announced that it has approved Narcan, a nasal-spray form of the opioid-overdose-reversing drug naloxone, without a prescription over-the-counter. This is a major win, because Narcan works as first aid, and must typically be administered by someone else to an overdosing person. Over-the-counter Narcan could mean that more people have the medicine on hand during the crucial minutes of an overdose. At the same time, public health experts say that efforts to improve naloxone access cannot stop with over-the-counter access when it becomes available—which manufacturer Emergent BioSolutions projects will be in late summer. Going forward, they warn, two obstacles which have prevented people from buying Narcan in the past could remain barriers going forward: high cost and stigma against drug users. While Emergent BioSolutions has not yet commented on the price of over-the-counter Narcan, there’s reason to be wary that the drug could be costly: prescription Narcan can cost over $100 for two doses at some pharmacies, according to GoodRx. Chelsea Shover, an epidemiologist and assistant professor at the University of California-Los Angeles notes that many of the people she’s provided Narcan to for free—including teenagers and people living in street encampments—wouldn’t be able to afford it on their own. Also uncertain is whether insurance companies, which have historically covered most of the cost of Narcan, will cover an over-the-counter drug. “Narcan was covered by many kinds of insurance at no or very low cost to the consumer. Now that it’s available over the counter, I worry about losing that coverage,” says Shover. The other challenge, says Lucas Hill, a clinical associate professor at the University of Texas at Austin College of Pharmacy, is that there’s persistent stigma about needing Narcan. This stigma, he says, can impact every step of buying the medicine, including making opioid prescribers or pharmacists hesitant to recommend that a patient buy Narcan, in the worry that they might offend patients by the suggestion. In particular, he says, he fears that high cost of Narcan and prejudice against drug users will converge and lead many grocery stores and pharmacies to lock it up or keep it behind the counter, which would require customers to request it. “Even though the [over-the-counter] transition could theoretically allow Narcan nasal spray to be sold at a gas station, I think it’s unlikely that we’re going to see it next to the Pringles chips anytime soon,” he says. But overall, Hill says that he’s optimistic that over-the-counter Narcan will greatly improve access. Even if the drug remains costly, it is still expected to be less expensive for people without insurance than the prescription version. Indeed, in Hill’s view, the FDA should make all forms of naloxone, including the injectable dose, available over the counter, because that could potentially lower the cost of the drug overall as manufacturers are forced to compete on price. Until that day, the other formulations of naloxone will still be prescription only—which means that people with insurance will still be able to obtain those other formulations through their coverage. Meanwhile, people without insurance and who cannot afford the over-the-counter drug will still likely be available to obtain it through other avenues. Naloxone is often available through non-profits and community organizations for free, in part because they can purchase Narcan at a discounted rate, or by distributing less-costly injectable forms of the medicine. Emergent BioSolutions told TIME that it plans to continue the program to discount Narcan for public interest customers. Going forward, experts say that health care workers will play a vital role in reducing stigma about naloxone and opioid use disorder. Dr. Michael W. Champeau, president of the American Society of Anesthesiologists, says that doctors should routinely spread the word about naloxone, especially if a patient has a prescription for opioids. “I think that incorporating questions about the presence and availability of narcotics in the home, stressing the importance of having naloxone available, are going to be increasingly perceived as part of being a good physician, no matter what specialty you practice,” says Champeau. Hill hopes the recognition that some people overdose when they don’t even know they’re using an opioid will help to reduce stigma about carrying Narcan, especially as people realize they could help save someone else. “Decreasing the stigma associated with illegal drug use and drug poisonings is the long haul. And we’ve got quite a ways to go,” says Hill. from https://ift.tt/SoFgfd7 Check out https://takiaisfobia.blogspot.com/ Following the Nashville, Tenn., school shooting this week—the third such tragedy in as many months in 2023—one of the many urgent questions confronting the nation revolves around the growing generation of survivors, many of whom are children too young to properly process a traumatic event. When survivors are elementary school students, as the dozens of students at Nashville’s Covenant School are, they won’t necessarily have the language and emotional maturity to express themselves, much less process such trauma. “Young kids are just beginning to learn how to identify and communicate emotions through language, and to find those words,” says Rachel Masi, a clinical psychologist and director of research at Sandy Hook Promise, a non-profit organization formed to prevent violence against youth. Yet, even at young ages, “kids are definitely able to experience trauma and grief,” says Melissa Brymer, director of terrorism and disaster programs at the UCLA-Duke National Center for Child Traumatic Stress, a government-funded network of experts who educate and provide treatment recommendations for managing traumatic stress among children. Reading the different ways that children express those emotions falls to their families and teachers, who might be the first to notice the changes in behavior that are often the most common way younger kids signal that they are struggling. “When kids don’t have the language to express themselves, they often have physical symptoms such as stomach aches or headaches,” says Masi. “Depression also looks different in children; some might refuse to go to school, or get up in the morning, or even develop increased attachment to their parents or caregiver.” The question, in such cases, is how can mental health professionals provide the support that these young survivors need? Masi, who was part of the team that worked with the young survivors and families affected by the shooting at Sandy Hook Elementary School in 2012, says standard strategies for addressing trauma in adults, such as cognitive behavior therapy, can also be helpful with children, with some modifications. Rather than focusing as heavily on conversations and discussions, for example, she will turn to outlets such as drawing to allow children to express their feelings. Play is another way to help children to express themselves, as is focusing on their physical symptoms. “I often start with asking what is going on in the child’s body…[like] how they know they are hungry.” says Masi. “They will say their stomach rumbles, or makes sounds. Then I ask how their stomach feels when they are worried or anxious, and they will tell me it feels like they have butterflies in their stomach, or that their feet won’t stay still. I help them understand what their emotional experiences look like in the physical realm, and from there work with them to develop language for what they are feeling so they can start to process their trauma.” And because children aren’t always able to understand or articulate what they are feeling, the adults in their lives bear a greater responsibility in understanding and looking for signs of struggle. Brymer, who also worked with families from Sandy Hook, says it’s important to provide services not just for the children but also for the adults closest to them, to ensure those adults feel comfortable and equipped to provide the support that the children need. Feeling strong support from their adult caregivers can help children affected by trauma to learn how to trust and feel safe again. For younger kids that means adults also need to be aware that as their children develop mentally, their understanding and processing of their trauma may also need to evolve. Parents may be able to shield the students at Covenant, for example, from the barrage of news reports and the bodycam footage of law enforcement officers storming their school, but as these children get older and gain more independence and access to social media and the internet, that will change. And seeing their trauma play out again may be challenging for them to manage. That’s also true of any depiction of violence, and especially gun violence, in our culture, says Brymer. Books, movies, and other entertainment aimed at younger children don’t generally contain many references to violence, but as children mature, they are exposed to increasingly intense violence, not only in almost every form of popular culture they consume, but also through the bloody battles that are part of our history. “There is a sensational aspect to violence and trauma [depicted in our culture] that kids who have experienced real trauma and violence don’t appreciate,” says Brymer. “For them, they’ve seen loved ones killed. So it’s not entertaining. Teachers and parents should be proactive with reading and social content to appreciate what the children can handle at a given moment.” But there is no playbook for that yet, largely because each child’s experience, and ability to process and cope with a traumatic event, is different. And the understanding of how these interventions are helping children who survive a school shooting, both in the short run, but equally importantly over the long term, still isn’t clear. “We really don’t know yet what effect exposure to such trauma will have on children as they grow up,” says Masi. “I think it does impact whether they see their world as safe or not, but we don’t quite know yet. We are living in it and can only give our best guesses and try to prepare them and help them heal as much as possible.” Part of that processing and recovery goes beyond what individual children and families can do, and that relies on broader societal and political leadership to enact changes to make places like schools safer. “This generation is frustrated because they feel these things keep happening to them, and nothing happens,” says Masi of the young school shooting survivors who are now grown and have become activists for reform in gun control laws. A critical part of helping young trauma survivors rebuild their trust and sense of safety in society is to see positive actions to prevent violent events such as school shootings from happening again. “As adults, we can do more to create that change, to say that ‘Okay, we hear you and your experience is valid and real; you shouldn’t have to be scared to go to school, and we’re going to change it.’ We can give kids tools to empower themselves, but our communities also need to create change to make things better. The more we can do to create real change, the better for these survivors.” from https://ift.tt/t4bRAoe Check out https://takiaisfobia.blogspot.com/ Nobody wants to get sick, but knowing you’ll soon be battling a virus could, at the very least, help you prepare for what’s coming. Such knowledge could be particularly useful when it comes to COVID-19. Granted, the symptoms of the latest Omicron variants don’t tend to be severe, but testing positive means isolating for several days so you don’t pass the virus on to others. Knowing you’re infected could help more people take this step and potentially slow the spread of disease. In a study published on March 29 in Digital Biomarkers, researchers at Oura—which makes a smart ring that tracks basic physiological metrics like body temperature and heart and breathing rates—report the most detailed data yet on body changes that might be related to COVID-19 infections. Among 838 Oura ring wearers who reported that they tested positive for COVID-19, about 100 indicated that they had been vaccinated, while the remainder did not. Among those who tested positive, the ring detected changes in body temperature, heart rate, breathing rate, variability in heart rate, and sleep efficiency up to 2.5 days before the wearers reported their positive tests. The greatest changes were in body temperature, with the other metrics following in decreasing magnitude. Changes in these measurements continued for about 10 days after participants reported testing positive for COVID-19. The study also included analysis of 20,000 people who reported that they had been vaccinated, and documented changes in their physiological responses to the first and second shots. Responses to the vaccines began the night of the immunization, and built for about four days, with people under age 35 showing more pronounced responses than people over 50. The study builds on earlier work Oura conducted to figure out how useful a wearable device can be in passively monitoring physiological metrics and picking up changes associated with infections. In a previous trial in 2020, researchers led by a group at University of California, San Francisco documented that the Oura ring could detect changes in body temperature that predicted COVID-19 infections even if the wearer didn’t experience any symptoms. A follow-up study in 2022 found that changes in body temperature and heart rate the night after people received a COVID-19 vaccine could be linked to the amount of antibodies the immune system was revving up against SARS-CoV-2. Other wearable makers have also documented the potential data-collecting devices have in screening for diseases, as well as tracking the body’s responses to them. Early data from an ongoing study involving Fitbit, a wrist-based wearable that tracks body metrics such as breathing rate and heart rate variation, shows that in about half of COVID-19 cases, the device can detect infections about a day before people start noticing symptoms. “These data build on the case for wearables not only as a tool for early detection, but as an important signal for helping to manage spread of infectious disease in the future,” says Shyamal Patel, head of science at Oura. Wearables such as Oura can be distributed widely to a population, which means the device could collect the massive amounts of data required to identify meaningful patterns—helpful intel for public health experts tracking infectious disease outbreaks. The individual-level data provided to wearers is also useful, since people can track changes from their own baseline and have a better understanding of when they might be getting sick. That information could provide a new strategy for combatting the spread of infectious diseases, as people become more aware of when they’re contagious and take appropriate steps to isolate themselves and avoid public situations where they could spread their illness to others. Patel says Oura and other wearables could also play an increasingly larger role in the development of vaccines against infectious diseases such as coronavirus infections—particularly once promising shots reach the point of testing in human volunteers. Often, these trials require thousands or tens of thousands of participants, since only a fraction will get infected with the disease in question. Wearables like Oura can detect these positive infections more quickly since they could pick up positive cases well before symptoms appear, which is the measure on which researchers currently rely. “You could recruit fewer participants and significantly accelerate the timeline for development of these vaccines,” Patel says, if the participants were using wearables. In addition, once the vaccines are approved, wearables could be used to track their effectiveness by noting changes in body metrics that correlate with an enhanced immune response, which is what the current study showed. Patel declined to share whether Oura plans to apply for U.S. Food and Drug Administration approval to use its device to detect disease or track things like immune responses. But as more data accumulates, that could be an option the company considers—especially for specific indications and diseases. For now, the current study and data from other wearable devices are building a strong case for the role that these data-collectors might play in improving public health in coming years. “At a high level, I feel wearables will be marketed in the future for specific use cases,” such as early detection of infection Patel says. “I think there is enough evidence built up over the last two to three years supporting such use cases.” from https://ift.tt/Z5J2Q8T Check out https://takiaisfobia.blogspot.com/ About 8% of children in the U.S. have a food allergy, roughly double the percentage who did in 2007. It’s not entirely clear why more kids are being diagnosed with food allergies, both in the U.S. and across the world—but as these potentially life-threatening conditions grow more common, lots of researchers are studying how to treat or prevent them. A study published in PLOS ONE on Mar. 29 offers one potential strategy: get a pet. Among thousands of babies in Japan, exposure to cats or dogs during pregnancy or early infancy was associated with a lower risk of developing food allergies, the researchers found. That finding is based on data from the Japan Environment and Children’s Study, an ongoing trial that includes about 100,000 women in Japan who became pregnant from January 2011 to March 2014 and their children. Kids in the study are tracked until they turn 13 so researchers can learn more about how their living conditions and environmental exposures affect their health. The new study looked at about 66,000 children whose mothers provided information about their pet exposure and food allergies. Compared to children without pets, kids who were exposed to a cat or dog during pregnancy or early infancy were roughly 15% less likely to develop allergies to common triggers including eggs, milk, wheat, soybeans, and nuts by age three, according to their mothers’ survey responses. Read More: How Smart Is a Dog, Really? The Secrets of a Canine Mind Other pets—including hamsters, turtles, and birds—didn’t seem to provide the same benefits. Dogs kept indoors were also associated with a larger risk reduction than dogs kept outdoors. Scientists don’t fully understand the link between animal exposure and food allergies, the researchers write. One theory is that living with pets alters babies’ microbiomes in a way that protects them from food sensitivities, but more research is needed to say for sure. The new study should be taken with a grain of salt, since it relies on parents’ survey answers rather than objective allergy diagnostics. This sort of data also can’t prove cause and effect—so, while the researchers considered factors like parental health, the family’s socioeconomic status, and where they lived, it’s possible there’s another explanation for the link between pets and lower rates of food allergy. Not all previous studies on pets and food allergies have come to the same conclusion, the authors note. However, other researchers have found that kids who live with pets during infancy are less likely to develop environmental allergies, asthma, and other respiratory illnesses. Pets are also associated with better mental and physical health among adults—so adopting a cat or dog may be beneficial for an entire household’s health. from https://ift.tt/7BeFdO0 Check out https://takiaisfobia.blogspot.com/ The U.S. Food and Drug Administration on Wednesday approved selling naloxone without a prescription, setting the overdose-reversing drug on course to become the first opioid treatment drug to be sold over the counter. It’s a move that some advocates have long sought as a way to improve access to a life-saving drug, though the exact impact will not be clear immediately. Here’s a look at the issues involved. What is Narcan?The approved branded nasal spray from Gaithersburg, Maryland-based Emergent BioSolutions is the best-known form of naloxone. It can reverse overdoses of opioids, including street drugs such as heroin and fentanyl and prescription versions including oxycodone. Making naloxone available more widely is seen as a key strategy to control the nationwide overdose crisis, which has been linked to more than 100,000 U.S. deaths a year. The majority of those deaths are tied to opioids, primarily potent synthetic versions such as fentanyl that can take multiple doses of naloxone to reverse. Advocates believe it’s important to get naloxone to the people who are most likely to be around overdoses, including people who use drugs and their relatives. Police and other first responders also often carry it. What does the FDA approval mean?Narcan will become available over-the-counter by late summer, the company said. Other brands of naloxone and injectable forms will not yet be available over the counter, but they could be soon. The nonprofit Harm Reduction Therapeutics Inc., which has funding from OxyContin maker Purdue Pharma, has an application before the FDA to distribute its version of spray naloxone without a prescription. How is naloxone distributed now?Even before the FDA’s action, pharmacies could sell naloxone without a prescription because officials in every state have allowed it. But not every pharmacy carries it. And buyers have to pay for the medication — either with an insurance co-pay or for the full retail price. The cost varies, but two doses of Narcan often go for around $50. The drug is also distributed by community organizations that serve people who use drugs, though it’s not easily accessible to everyone who needs it. Emergent has not announced its price and it’s not clear yet whether insurers will continue to cover it as a prescription drug if it’s available over the counter. Does making naloxone over-the-counter improve access?It clears the way for Narcan to be made available in places without pharmacies — convenience stores, supermarkets and online retailers, for instance. Jose Benitez, the lead executive officer at Prevention Point Philadelphia, an organization that tries to reduce risk for people who use drugs with services including handing out free naloxone, said it could help a lot for people who don’t seek services — or who live in places where they’re not available. Now, he said, some people are concerned about getting naloxone at pharmacies because their insurers will know they’re getting it. “Putting it out of the shelves is going to allows people just to pick it up, not have stigma attached to it and readily access this life-saving drug,” he said. But it remains to be seen how many stores will carry it and what the prices will be. The U.S. Centers for Medicaid and Medicare Services, which now cover prescription naloxone for people on the government insurance programs, says that coverage of over-the-counter naloxone would depend on the insurance program. The centers have not given any official guidance. Maya Doe-Simkins, a co-director of Remedy Alliance/For The People, which launched last year to provide low-cost — and sometimes free — naloxone to community organizations, said her group will continue to distribute injectable naloxone. Are there drawbacks to over-the-counter sales?One concern is whether people who buy Narcan over-the-counter will know how to use it properly, said Keith Humphreys, a Stanford University addiction expert, though the manufacturer is responsible for clear directions and online videos on that. One benefit of having pharmacists involved, he said, is that they can show buyers how to use it. One key thing people need to be reminded of: Call an ambulance for the person receiving naloxone after it’s been administered. He also said there are fears that if the drug isn’t profitable as an over-the-counter option, the drugmaker could stop producing it. The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content. from https://ift.tt/7TLCIz4 Check out https://takiaisfobia.blogspot.com/ Researchers from Johns Hopkins University recently published an article in JAMA that highlights rising concern around the effects of direct-to-consumer advertising (DTC) on health care. Their work shows that DTC advertising might have direct harm on patients. They studied drug characteristics and total advertising expenditures for the 150 top-selling branded prescription drugs in the United States, finding that total promotional spending by the manufacturer was associated with a significantly lower added clinical benefit for the drug. In fact, companies spent nearly 15% more on DTC advertising for drugs that had demonstrated lower added benefit. Even more troubling, each 1.5% increase in spending was associated with a 10% increase in sales. Simply put, pharmaceutical companies spent more money on DTC advertising when medical research found that the drug was less effective, and this spending directly led to more sales for those inferior drugs. As the U.S. is one of only two countries in the world that still allows direct-to-consumer (DTC) advertising, it is important to understand the implications of DTC on patients and society at large. Aside from the fact that millions of dollars are annually spent on DTC prescription drug advertising, numerous previous studies have demonstrated that this practice has tangible impacts on prescription rates and patient requests for particular drugs. Pharmaceutical companies appear to be allocating a larger portion of their marketing budget towards those drugs which have demonstrated lower clinical benefit, hoping that patients will request prescriptions for these drugs, since providers who know the evidence are less likely to prescribe them. Conversely, companies do not need to spend marketing dollars on proven, effective drugs that providers will prescribe anyway. Aside from increased pressure on providers to prescribe particular drugs which may not be the best option, there are other downsides to DTC. The data show that DTC advertising leads to increased drug costs overall, adding to the already skyrocketing costs of medical care in America. Additionally, DTC advertising tends to reduce use of generic medications, which are often equally effective but significantly cheaper for patients. Certainly, there are proponents of DTC advertising. Pharmaceutical companies and their supporters argue that DTC messaging allows a more informed consumer and patient, one who can better engage in discussions with their doctor. However, the state of affairs today allows for deception and misleading messaging by pharmaceutical companies. The JAMA study appears to support this notion, as DTC advertising is causing inferior drugs to be prescribed at disproportionately higher rates. This brings us to the key question: how should prescribing decisions be made? We argue that this important decision should be based on shared decision-making, considering goals that are agreed upon between the provider and the patient. The provider should use their medical knowledge and training to recommend an option that aligns with the patient’s values. DTC advertising only seems to bias these important conversations, erode the patient-provider relationship, and ultimately, harm patient outcomes. The tried and true approach of having your provider be the person who informs decisions to begin medications—if and when indicated—is a safer and more judicious approach to patient care. Such decisions should not be informed or promoted by DTC advertising. Case in point: the explosive demand for weight loss medications such as Ozempic and Wegovy have their origins in DTC advertising, which laid the foundation for patients to request—and ultimately influence—provider prescriptions for off-label use of such medications. The resulting black market for acquiring these weight loss medications subsequently developed as a result of this supply-demand imbalance. In recent decades, there have been significant changes to limit how the pharmaceutical industry interacts with providers. There have been significant limitations to how pharmaceutical companies can bias doctors to prescribe certain products. Similar changes are needed in the DTC setting so companies do not bias patients. Future reforms should focus on the lack of regulations of DTC advertising and need for guardrails which prevent misleading messages or bias. Moreover, the U.S. lacks robust analysis of relative clinical benefit for drugs in their post-marketing phase, although this is intended to change in 2026 with recent reforms requiring Medicare to evaluate comparative effectiveness. Hopefully, with this coming reform, consumers and providers will have more access to data regarding the benefits and risks of different treatment options. Ultimately, although an informed consumer is vital to effective health care, we need to ensure that the information that is publicly spread is unbiased, accurate, and supported by the advanced training that providers receive. It is vital that patients remain aware about the larger factors in play in the pharmaceutical industry until systemic reforms can be achieved in the U.S. Patients who are informed about the pitfalls of DTC advertising can more critically evaluate drug advertisements to arrive at the best decisions for their own health, in partnership with their provider’s advice to take into account evidence based practice. from https://ift.tt/OZ54cpl Check out https://takiaisfobia.blogspot.com/ |
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