There were moments in the past few years when Police Sgt. Brian Vaughan would have tried almost anything to break the cycle of sleeplessness that wore him down—to wash away the images, sounds, and smells of violence that stuck to his memory, and ease the constant pain that was shooting through his back. At one point, he found himself tempted to try CBD, a widely available cannabis derivative that can offer relief from many ailments. “It would have been great to be able to take it and see if it helps,” says Vaughan, a 14-year law enforcement veteran and training coordinator for the police department in Dallas, Georgia, a small city northwest of Atlanta. But he didn’t. “It’s just not worth the risk.” That risk is testing positive for trace amounts of tetrahydrocannabinol (THC), the mind-altering compound in cannabis--a career-ender in most law enforcement agencies in the U.S. Vaughan’s dilemma is echoed by cops across the country. Other professions are affected as well, like firefighters, heavy machinery workers, and airline pilots. CBD is sold in supermarkets, pharmacies, and health food stores, and it’s offered in gyms, bars, and restaurants. It comes in many forms--oils, lotions, tinctures, capsules, or chewable gummies. Menus feature CBD-enhanced tacos and CBD-infused cocktails. Many people see it as a physically safe and non-addictive way to deal with job-associated stress and pain. Still, the legal, regulatory, medical, and cultural landscape of cannabis, including CBD, remains complicated and confusing to navigate, with plenty of muddy spots. Cannabis is now legal for medical use in many states and recreational use in some. Yet it is considered a controlled Schedule 1 substance--and therefore illegal--on the federal level. Because of this status, federally funded research into medical cannabis is largely blocked. CBD--short for cannabidiol--is extracted from the hemp or the marijuana plant. Both belong to the cannabis family, but hemp-based CBD typically contains lower levels of THC, and it doesn’t create a “high.” The 2018 Farm Bill made hemp-derived CBD legal if it contains less than 0.3% THC. It’s those trace levels of THC that make the risk real for people like Vaughan, the police officer from Georgia. Most of the approximately 18,000 law enforcement agencies in the U.S.--federal, state, and local--have policies that strictly prohibit the use of controlled substances such as opioids, methamphetamines, cocaine, and cannabis. Police departments contacted in a handful of states, including Arizona, California, Colorado, Florida, Georgia, New York, Texas, and Vermont, do not have guidelines explicitly addressing CBD. But several said the issue keeps coming up more frequently now, especially among younger officers, and command staff would advise their employees against taking CBD. Any substance that causes an impairment--or creates the perception of impairment--“is a strict liability issue for us,” says Chief Brian Peete of the police department in Montpelier, Vermont, a state where recreational and medical cannabis are legal. “Because CBD is still such a gray area, we tell the men and women we represent to err on the side of caution,” seconds Larry Cosme, president of the Federal Law Enforcement Officers Association. The group represents members from agencies like the FBI, the Secret Service, and U.S. Border Patrol. “And, at the moment, that means to refrain from using any CBD product.” The concern is valid, says Dr. Kevin P. Hill, a professor of addiction psychiatry at Harvard Medical School. The ambiguity and uncertainty of the legal landscape surrounding CBD create a conundrum for law enforcement. “The key issues with CBD are purity and potency,” says Hill, who has written several books about medical cannabis. Typically, using hemp-derived CBD products does not lead to a positive drug screen, he further explains. Yet sometimes, it happens. Depending on the plant variety as well as harvesting and refinement techniques, the THC level can be higher than the federally legal limit—which makes CBD a legal product with a potentially illegal ingredient. Also, Hill says that most CBD marketed in the United States is “essentially unregulated or very loosely regulated.” In fact, only 30 % of commercially available CBD products are accurately labeled, according to a research letter published in JAMA. And only one specific CBD formula is currently approved by the U.S. Food and Drug Administration as a medication to treat certain seizure disorders, especially in children. Purified CBD, with zero or untraceable amounts of THC, exists, Hill emphasizes—but finding credible manufacturers requires a lot of research by consumers. Testing doesn’t always provide a clear picture, either. Standard urine screens cannot identify the source of THC, Hill explains. They can’t distinguish, for example, whether the THC comes from rubbing CBD oil on a sore elbow or lighting up a joint. Timing is another issue, as it’s difficult to determine when THC was ingested. Police officers are drug-screened randomly or any time they are involved in a car accident, a use-of-force incident, or a misconduct allegation. Most officers who fail a drug test are fired and blacklisted for future law enforcement jobs. Since every jurisdiction collects its own data, numbers are difficult to track. Among federal law enforcement officers, which make up between 3-4% of the country’s entire police force, “we saw about 60 cases in the last two to three years,” says union president Cosme, “and it seems like the numbers have been rising.” There have also been more reports of cops who, after testing positive for THC, admitted they had taken CBD with the belief that it contained no THC. Some keep their jobs after a battery of tests and lengthy internal investigations. But those are exceptions. “The burden of proof is always on the officer who tests positive,” warns Vaughan, the training coordinator from Georgia who also handles critical incident response for his agency. Even if a failed drug screen doesn’t lead to termination, he says it’s a situation that’s “very hard to recover from.” It could impact a cop’s future career, including promotions and pay raises. The specter of a positive drug screen, combined with the lack of a regulated CBD industry, “tends to keep CBD off the radar screens of many law enforcement administrators,” says Chris Harvey, deputy executive director of the Georgia Peace Officer Standards and Training Council, the state’s accreditation agency for cops. Even though CBD could be “a useful tool for people serving in sensitive law enforcement positions,” he adds. There is plenty of anecdotal and some scientific evidence that CBD is effective in helping with a range of conditions that cops typically struggle with, says Cydney McQueen, a professor of pharmacy at the University of Missouri–Kansas City. While federally funded studies on medical cannabis are still limited because of its status as a Schedule 1 substance, McQueen says, “we’re seeing more data and clinical trials involving CBD.” The effect of CBD varies between patients, and genetic differences play a big role, McQueen says. Still, early studies suggest that “for a significant number of people, CBD can be helpful in soothing certain types of chronic pain, improving sleep, and decreasing anxiety.” Police officers experience high rates of post-traumatic stress disorder and burnout. About 40% of cops suffer from a sleep disorder, which puts them at risk for cardiovascular disease, diabetes, and depression. Many develop long-term back and hip problems. McQueen says there’s research underway to examine the effect of CBD on driving, “which obviously is critical for law enforcement.” A small Australian study recently found that CBD use “is unlikely to impair driving performance.” Trials have also shown that cannabidiol doesn’t lead to withdrawal symptoms and is not addictive, McQueen adds. Generally, adverse effects from CBD tend to be minor. Taken in higher doses, it can cause diarrhea and, in rare cases, liver function problems. Early case studies suggest that CBD interacts with some common prescription medications. Taken with blood thinners like warfarin, CBD can potentially lead to excessive bleeding. Still, McQueen insists CBD could be a benign alternative compared to, for example, opioid painkillers, prescription sleeping pills, and above all, alcohol. Research results vary, but some studies estimate that up to 30% of police officers have a substance abuse problem. Alcohol dependence is on top of the list. “CBD is not a panacea,” McQueen says. “But it’s good to have another tool in the tool bag of potential treatments”—especially if combined with non-medication approaches like exercise, peer-to-peer support, and professional counseling. Vaughan says he could have used another tool. In 2018, the 36-year-old policeman ruptured a disc in his lower back during SWAT training. He tried physical therapy, chiropractic care, epidurals, and cortisone shots, and he finally had surgery. Still, the pain was slow to subside. Being a cop—engaging in physical altercations, sitting for long hours in a patrol car, and wearing some 30 extra pounds of weapons and tools on the duty belt—did not help. Taking prescription pain medication was restricted by department policy. “There weren’t too many options for me,” he says, shrugging his shoulders. Vaughan, who served as a patrol officer for a different agency until last year, says he also experienced bouts of insomnia, burnout, and what he now believes was post-traumatic stress. He says working overnight shifts had him living on just a few hours of sleep. “That eventually affects your job performance. You become short-tempered and lose focus.” For a while, he took melatonin, a hormone that regulates the sleep-wake cycle, but it only exacerbated the nightmares he was already having. He shared with other officers some of his experiences on the street. He relied on family support and leaned on a few trusted friends. He says he looked into yoga and meditation but hasn’t tried either. “The closest to meditation that I’ve done is prayer.” During periods of high stress and after particularly grueling shifts, Vaughan says he sometimes turned to alcohol to calm his racing mind. He quickly realized that wasn’t a solution. Over his career, he’s seen peers go from self-medication to self-destruction to self-harm and, in some cases, suicide. Last year alone, 136 law enforcement officers reportedly took their lives—more than twice the number of cops killed by gunfire. And a recent study from the Ruderman Family Foundation, provided to USA Today, suggests that police suicides are often undercounted due to stigma. “That’s certainly not a path I wanted to go down,” Vaughan says, his eyes scanning the traffic driving by the police station. Another officer, Mike Edwards, worked for 11 years at a metro Detroit police department. He quit in 2020 amid anti-police protests following the deaths of George Floyd in Minneapolis and Rayshard Brooks in Atlanta. While still on active duty, he became a social media influencer on all things police, branding himself as “Mike the Cop.” In 2019, he says, he decided to try CBD to help with stress, trouble sleeping, and especially muscle aches after Brazilian jiu-jitsu practice, he says. He took a CBD tincture, a few drops under the tongue. “After two or three weeks, I didn’t need ibuprofen after jiu-jitsu training anymore,” he recalls. He also noticed that the usual swelling went down and felt the “recovery from the physical wear and tear of grappling was quicker.” Edwards says he researched a lot of different CBD brands to make sure the product contained no traceable amounts of THC. He ended up using a broad-spectrum, hemp-derived CBD oil. He screened for drugs at work several times—always with negative results. He also chose not to tell his superiors he was taking CBD. “I have the personal conviction that this was none of their business,” he says. “This was my private medical decision.” But Edwards understands the apprehension and fear that many cops have about using or even discussing CBD. “It’s a shame that red tape can hinder some common sense,” he adds. Change may be on the horizon, driven by workforce needs and generational shifts. According to Savannah State University research, more than 25% of police departments in the U.S. have relaxed their screening criteria for new hires’ past drug use, especially cannabis. In 2019, the Arizona Peace Officer Standard and Training Board issued a statement clarifying that police officer applicants would no longer be disqualified if they previously used CBD, explains executive director Matt Giordano. Until that point, CBD had been put in the same category as marijuana, meaning that aspiring police officers in Arizona—as in many other states to this day—were barred from applying for up to seven years if they had previously used cannabis. The adjustments come at a time when police departments are struggling to fill their ranks after a recent wave of mass resignations left many agencies short-staffed. “These young recruits come in telling us, ‘Yeah, I put some CBD oil on my knee before I went for a run last weekend,’” says Giordano. “For them, it’s normal.” An increased focus on cops’ physical, emotional, and mental health could also promote change—not just for new hires but for cops already on the force. “The unique roles and responsibilities of police officers require rigorous performance standards,” says Harvey from Georgia’s standards and training board. “But a reasonable exploration of new treatments should not be dismissed reflexively.” Cosme, the federal police association president, believes that CBD holds promise for officers’ health. He says that “agencies need to adapt their guidelines on CBD use”—once there’s clear regulatory guidance. McQueen says making hemp-based CBD federally legal is an important first step, but it will take broader cannabis legalization for a tidal shift to occur and the stigma to fade. “And I don’t see that happening anytime soon.” Vaughan eventually pushed through his challenges. His back pain is still there every day, he says. But it’s manageable—with lots of exercise and an occasional Tylenol. Vaughan would like to see more research into the potential benefits of CBD for cops. “Like any other tool in law enforcement, this needs to be heavily evaluated before we put it into practice,” he says—before it becomes an accepted and safe option for police officers to use. from https://ift.tt/f6cmyZS Check out https://takiaisfobia.blogspot.com/
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When Jodi Byfuglin, 56, was diagnosed with bladder cancer, it felt like cruel irony. Byfuglin had lost both her parents to cancer in their 50s, and as a single mother of two, she was all her kids had left. “I promised that I would not leave them,” Byfuglin says. Bladder cancer is the sixth most common cancer in the United States, and older men are at highest risk. But about one-tenth of cases are in people younger than 55, and an estimated 19,480 women will be diagnosed with bladder cancer in 2022 (compared to about 61,700 men), according to the American Cancer Society. “I had no idea about bladder cancer,” Byfuglin says. “It’s like a silent killer; it goes from zero to 1,000 really quick.” For high-grade or muscle-invasive bladder cancer, urologists perform a radical cystectomy in which they remove the patient’s bladder and some of the surrounding organs. In men, that can include the prostate and seminal vesicles; in women, the ovaries, fallopian tubes, and uterus. Surgeons then create a new way for patients to urinate via one of three diversions: the urostomy, neobladder, or Indiana pouch. The vast majority of patients choose the urostomy, in which surgeons create a stoma—a beefy red spout protruding from the belly—so that urine can flow from the kidneys, through an intestinal conduit, and out the body. Urine drains into a clear oval-shaped pouch attached to the stoma that needs to be emptied every four to six hours and changed twice a week. Of the three options, the urostomy is typically the shortest and simplest operation, with the fewest potential complications. Byfuglin received the second most popular urinary diversion, the neobladder. Dr. Anne Schuckman, an associate professor of clinical urology at the University of Southern California, took out two feet of Byfuglin’s intestines, fileted it open, and formed a sphere that could collect urine inside her pelvis. Typically recommended for younger, healthier patients, the neobladder offers the closest thing to normal anatomy, but patients initially struggle with incontinence and may have to self-catheterize their neobladder to fully empty it. “I really didn’t want something external,” Byfuglin says. “It’s not that I’m vain, but I didn’t want people to see I have cancer. Or even to remind myself.” The Indiana pouch is the final option, combining aspects of both the urostomy and neobladder. Surgeons use a piece of intestine to create a collection reservoir inside the abdomen but then connect this pouch to the skin to create a stoma. Unlike the urostomy, urine doesn’t naturally flow out this stoma, so patients need to insert a soft thin plastic tube into their Indiana pouch to relieve themselves. Although these patients have the highest urine control satisfaction, the Indiana pouch is the least common diversion because “somebody has to be willing to catheterize every three to four hours for the rest of their life,” Schuckman says. Radical cystectomy with any urinary diversion is a life-saving procedure, but recovery can be challenging given a 35% complication rate in the hospital, according to a 2021 review of 66 studies in the British Medical Journal Open. In fact, Schuckman usually tells patients “to give themselves a year to really feel like they’re back at their physical baseline.” Although creating a new normal takes time, patients and health care professionals have tips for navigating the key challenges around living with radical cystectomy. Read More: The Latest Breakthroughs That Could Help Bladder Cancer Patients Mental health and body imageA 2018 study published in Cancer found that more than half of patients with bladder cancer were diagnosed with a mental health condition, such as bipolar, anxiety, or substance use disorder, after radical cystectomy. In particular, “there’s quite a bit of depression early on,” says Dr. Bruce Kava, professor of urology at the University of Miami. North Carolina resident Allen Beckett, 71, had his radical cystectomy eight years ago and now volunteers with the Bladder Cancer Advocacy Network (BCAN). He’s often seen how radical cystectomy can damage one’s sense of self. For some people, it causes a jolt to their independence because they have to put their lives on hold to recover. Others struggle to accept the major changes to their body and, with a urostomy, having to wear a plastic pouch 24/7. “They got over the physical part of it, but they can’t get over the mental part,” Beckett says. Beckett explains that he overcame his own struggles when “my brain kicked in and said, ‘you’re cancer-free, you’re alive, and you probably got several years ahead of you.’” While refocusing can help, he admits that adapting to his new body took a while. “Time is your ally and your friend,” he advises his fellow survivors. Beckett now wears darker patterned shirts to help cover his stoma and says he feels self-conscious only when wearing a suit. Stoma guards, support bands, underwear, bathing suits, and other specialized clothing can cover the urostomy pouch and help patients feel discreet, confident, and fashionable. “Most people can’t even tell,” Beckett says. For those who continue to struggle with their mental health, patient support groups, WOC (wound, ostomy, continence) nurses, and counseling can all play an important role. In fact, Beckett was recently chatting with another radical cystectomy patient through BCAN’s Survivor to Survivor program, talking through his body image struggles. Sometimes, informal peer counseling can help people adjust, but Beckett ultimately advised him to seek professional help. Mental health struggles are perfectly normal after a major surgery like radical cystectomy, Kava says, and the health care team is there to support patients. “We reassure them that life is not about where you pee or how you pee; it doesn’t define you in any way.” Device issues and urinating in a new wayTami Walker is a WOC nurse at the University of Michigan, and she sees her job as not only treating patients’ physical wounds, but also rebuilding their self-esteem. “The surgeon goes through a lot of the clinical part of it,” Walker says, “but not how to live every day.” Although Walker counsels some neobladder patients pre-operatively, she spends most of her time helping patients with their urostomies: Walker introduces them to different pouching systems; shows them how they attach to the stoma, empty out, and need to be replaced; and provides direct care for complications. “General leakage from not having the proper fit is the biggest problem,” she says. The adhesive on urostomy pouches doesn’t always stick well to a patient’s abdomen, especially as their body contour shifts in the first eight weeks after surgery. Months after her operation, Florida resident Nikki Saltzburg, 48, is still trying to figure out how her stoma works. Every time she changes her urostomy bag, she carries a toolbox of materials into the bathroom: an anti-adhesive aerosol to remove the old pouch, a stencil and pair of scissors to cut a hole in the new pouch, a sticky paste to attach the pouch to her stoma, and a handheld fan to dry her skin. “It still takes me a while, and the challenge is the stoma doesn’t stop leaking urine,” Saltzburg says, “so urine can be running down your stomach or spraying somewhere.” She needs to be meticulous because leaked urine can cause rashes, lumps, and fungal infections. Other common issues include urinary tract infections, hernias where intestinal organs bulge out of the abdomen, and bowel symptoms like flatulence and diarrhea. Although there are typically fewer devices for neobladder patients, Byfuglin, like 10% of men and up to 50% of women, has to self-catheterize her urethra to fully relieve herself. As such, Byfuglin always tries to be mindful in new places: “It’s like when you have a toddler and you just potty trained him, and you have to think ahead of time where the restroom is.” Because the neobladder is not connected to the brain, patients don’t have a typical sensation of “fullness,” rendering accidents common, especially while sleeping. Experts say pelvic floor therapy, pads, and nighttime drainage bags can help address such incontinence. It takes on average three months, Walker says, for patients to become comfortable with urinating in a new way. Beckett has been living with urostomy for almost a decade now, and initially, he used to have accidents three to four times a month. Now, he can go six weeks without one. For him, the difference was finding the right device system that works for his body. “It stays on, it doesn’t leak, and it’s lightweight,” Beckett says. Read More: Changing Cancer Care, So Patients No Longer Feel Like a Number Returning to normalcyFrom physical activity to working to traveling to intimacy, radical cystectomy can disrupt a person’s life, at least in the short term. Saltzburg, who has been paraplegic since infancy, used to compete on the U.S. national wheelchair tennis team. She would love to go back to playing recreationally but is “scared to right now.” Beyond feeling weak, Saltzburg’s tennis chair strap goes across her abdomen and could put pressure on her stoma. Walker emphasizes that, while patients initially feel like they can’t return to their day-to-day activities, they can eventually do almost everything they used to. One of her patients worried that a urostomy would end his Lake Michigan boating adventures, but he’s now back on the water, active as ever. Another BCAN volunteer, Robert Schreiber, 69, flew from Massachusetts to Oregon three months after his radical cystectomy to see the solar eclipse. As Beckett says, “There’s nothing you can’t do unless you’re afraid to do it.” One of the best ways to adjust to life with radical cystectomy, according to Walker, is to be prepared. When traveling, it’s important to bring plnety of easily accesible supplies, she says, because patients need to have their urostomy pouches, catheters, and other critical supplies within reach. “Bring double what you normally would need.” For everyday outings, it can also be a good idea to carry a bag of supplies. Byfuglin learned that the hard way when she stepped out for a few hours, leaving all her catheters behind as a fire broke out in Ventura County, California. “I couldn’t get home,” Byfuglin says. “It was the biggest panic of my life!” Her advice for other radical cystectomy patients? “You have to plan ahead.” Of course, despite all the planning and optimism, the path to normalcy is far from linear. It took eight months for Byfuglin to return to work, but she was almost immediately laid off because “they felt like I couldn’t do my job anymore.” For many patients with bladder cancer, there’s also a constant veil of fear that their tumor will come back. “You have to give yourself grace to not be okay,” Byfuglin says. “I just keep using the word ‘living.’ At least I’m here.” from https://ift.tt/0GqMCcV Check out https://takiaisfobia.blogspot.com/ Two climate-related health risks are converging with alarming frequency: record high temperatures, and air pollution from things like car exhaust and wildfire smoke. Separately, these conditions can make people acutely sick and exacerbate existing health problems. But what happens when they coincide? Recently, researchers at the University of Southern California set out to answer that question. Their results, based on mortality data from California between 2014 and 2019 and published at the end of June in the American Journal of Respiratory and Critical Care Medicine, indicate that the combined mortality risk of extreme temperatures and thick pollution is significantly more than the sum of their individual effects. As the chart below shows, a person’s odds of dying increased 6.1% on extreme temperature days and 5% on extreme pollution days compared with non-extreme days. But on days with both extreme conditions, the risk of death jumped by 21%. Like vehicle emissions, wildfires release PM2.5, a type of very fine particulate matter that measures less than 2.5 micrometers across. (For comparison, the diameter of a hair is 30 times larger than the largest of these fine particles.) While the USC researchers analyzed PM2.5 pollution levels regardless of its source, they found that days with extremely high pollution happened to coincide with California wildfire events. “When you consider our top 1% of most polluted days, the pollution concentration is really very, very high… four times higher [than normal],” says Md Mostafijur Rahman, a postdoctoral researcher in the Department of Population and Public Health Sciences at USC’s Keck School of Medicine and one of the study’s co-authors. “That is definitely driven by another source. It’s not like the normal source from the traffic.” Fine particulate matter can penetrate deep into the lungs and enter the bloodstream, says Francesca Dominici, a biostatistics professor at Harvard’s T.H. Chan School of Public Health who has studied the noxious stuff. But, while PM2.5 is known to cause cardiovascular diseases, respiratory problems, and cancers, some forms of it are worse than others. “Fine particulate matter during wildfires tends to be even more toxic,” Dominici says. “We have buildings burning, we have cars burning, we have all kinds of stuff that is burning. There is emerging research to show that the chemical composition is even more dangerous.” What’s more, when those tiny particles react with high temperatures and sunlight, they can worsen ground-level ozone—smog—which can trigger respiratory effects like asthma attacks. One study from Washington State University published earlier this year found that periods of high PM2.5 and ozone have “become significantly more frequent and persistent” across the western U.S. in the last 20 years, due to “simultaneous widespread heat and wildfire activity.” A notable 12-day stretch in the summer of 2020 included one August day where nearly 70% of that region—encompassing 43 million people—was affected by harmful levels of air pollution due to unprecedented wildfire activity around that time. Make no mistake, though. The American West is certainly not the only place grappling with the double threats of heat and pollution. Extreme temperatures have touched just about every corner of the country this summer, and fires are searing through forests as far north as Alaska. Eastern Australia, known for its hot summers and dangerous bushfires, had an historically devastating 2019-2020 season. Russia experienced one of its largest wildfires on record last year in Siberia amid hot and dry conditions. In Europe, infernos ravaged Turkey and Greece last year; this year they’re sweeping through Spain and France, fueled by heat waves that smashed records for both how early in the year they appeared and how high the mercury rose. This confluence of events during summer months, when temperatures soar to unbearable levels that our bodies cannot handle, are becoming more common: The heat waves make dry regions even drier—and ideal for wildfires which spew smoke plumes far and wide. Erika Garcia, assistant professor in the Department of Population and Public Health Sciences at USC’s Keck School of Medicine who co-authored the study with Rahman, warns that even though wildfires are episodic, their effects can last for weeks. “With climate change progression, we will continue to experience more frequent, more intense, and longer extreme heat events, and extreme particulate pollution events,” she says. “We really need to have better interventions and adaptation policies so that we can save lives during these extreme heat and pollution days.” from https://ift.tt/ACqh3PU Check out https://takiaisfobia.blogspot.com/ Hard-won progress against HIV has stalled, putting millions of lives at risk, according to an alarming report Wednesday on how the COVID-19 pandemic and other global crises are jeopardizing efforts to end AIDS. Worldwide, the years-long decline in new HIV infections is leveling off. Worse, cases began climbing in parts of Asia and the Pacific where they previously had been falling, according to the United Nations agency leading the global AIDS fight. The number of people on lifesaving HIV treatments grew more slowly last year than it has in a decade. Inequities are widening. Every two minutes last year, a teen girl or young woman was newly infected — and in sub-Saharan Africa, they’re three times as likely to get HIV as boys and men the same age. And 650,000 people died from AIDS-related illnesses last year, the report found. “This is an alarm to the world to say that COVID-19 has blown the AIDS response significantly off track,” said Matthew Kavanagh, deputy executive director of UNAIDS. The U.N. set a goal of fewer than 370,000 new HIV infections by 2025. Last year, there were about 1.5 million — meaning it would take a major turnaround to get anywhere near that target. Yet low- and middle-income countries are $8 billion short of the funding needed, as international aid also has dropped, the report found. Things might be even worse considering that HIV testing slowed or even stopped in many places when COVID-19 hit, potentially leaving even more virus spread uncounted. “People are exhausted with epidemics and pandemics,” said Dr. Anthony Fauci, the U.S. government’s leading AIDS expert. “We have to fight twice as hard to get HIV back on the radar screen where it belongs.” The sobering news comes as the International AIDS Conference begins this week in Montreal — where some promising science is being reported. Among the highlights: — A man who had lived with HIV for about 30 years is in long-term remission and just might be one of only a handful of people worldwide ever considered cured, thanks to a special bone marrow-like transplant. That rigorous treatment is only an option for HIV patients who also develop leukemia and need transplanted blood stem cells to fight the cancer. This man’s donor happened to carry a rare gene mutation that makes the newly transplanted cells resistant to HIV. Read More: What Researchers Have Learned About Whether it’s Possible to ‘Cure’ HIV The man, now 66, underwent the transplant in 2019. Soon after, the COVID-19 pandemic began and he decided to stay on HIV medication until he could get vaccinated. He’s now been off anti-AIDS medication for 17 months with no signs of HIV, Dr. Jana Dickter of City of Hope, a California cancer research center, said Wednesday. That makes him the oldest and longest-living person with HIV to undergo this potentially curative transplant. Scientists hope these rare cases might offer clues that eventually lead to better care for more people. Also Wednesday, University of Barcelona researchers reported that a woman’s own immune system seems to have kept her HIV tamped down to an undetectable level for 15 years. The woman was part of a research study in 2006 that included some immune-boosting treatments but it’s not clear why she’s faring so well. — Another study presented Wednesday found that taking an antibiotic after unprotected sex could reduce the chances of getting gonorrhea, chlamydia or syphilis. Those sexually transmitted diseases are caused by different types of bacteria. They are a rising threat, especially among people who also have — or are at high risk for — HIV. Read More: For HIV/AIDS Survivors, COVID-19 Reawakened Old Trauma—And Renewed Calls for Change In Seattle and San Francisco, researchers gave study participants — gay men, bisexual men and transgender women — the antibiotic doxycycline with instructions to take a single dose within 72 hours whenever they had sex without using a condom. Those who did saw their risk of infection drop more than 60%, said Dr. Annie Luetkemeyer of the University of California, San Francisco. Before experts recommend that strategy, they’ll need to know if it could worsen antibiotic resistance, making either the STDs themselves or other bacteria people encounter harder to treat. The Centers for Disease Control and Prevention said it will examine that carefully, but it posted online some cautions for anyone considering this use of doxycycline in the meantime. — The UNAIDS report showed the public health fight against HIV is getting harder, but there are a few bright spots. Researchers reported Wednesday that Botswana, which is hard-hit by HIV, already has achieved a key 2025 goal: 95% of HIV-infected people know their status, more than 95% of those who know are getting treated, and more than 95% getting treated show signs their virus is being suppressed. Kavanagh praised Botswana for strong policy changes that “helped more and more people into care,” including free HIV medications, pushing home HIV testing and decriminalizing same-sex relationships. UNAIDS executive director Winnie Byanyima said it’s not too late to get back on track despite the continued COVID-19 and economic crises. “Ending AIDS would cost much less money than not ending AIDS,” she said. “The actions needed to end AIDS are also key for overcoming other pandemics.” from https://ift.tt/8QRzOyV Check out https://takiaisfobia.blogspot.com/ For Rachel Robles, getting diagnosed with Long COVID was an uphill battle. She caught the virus in March 2020, when nearly nothing was known about its long-term effects and testing was inaccessible for most people. To this day, she is sensitive to looking at screens—doing so can prompt pressure in her head and ringing in her ears—and has to manage COVID-19-related injuries to her liver and brain. But since she never got tested for COVID-19 when she first got sick, Robles had to “fight tooth and nail for every diagnosis I’ve received,” convincing doubtful doctors that she’d caught the virus and developed Long COVID. She was eventually diagnosed with Long COVID, but it likely would have been easier if she had had the proof of infection that a test result provides, she says. Robles now recommends that anyone who suspects they have COVID-19 get a laboratory test, just in case they go on to develop Long COVID and need documentation of a previous infection for diagnosis or care. “I never got proof of my initial COVID infection, and I was gaslit so much,” says Robles, who is an administrator at the Long COVID support group Body Politic and a contributor to the Patient-Led Research Collaborative for Long COVID. “So I always tell people, ‘This is something you need to do if you have a COVID infection, just in case.’” David Putrino, a Long COVID researcher at New York’s Mount Sinai health system who co-authored a chapter of the forthcoming Long COVID Survival Guide with Robles and neurologist Dr. Dona Kim Murphey, says he “wholeheartedly” agrees that people should get as much documentation of an infection as possible. Getting a PCR test is “100% the recommendation”—but if all you can do is take an at-home test, at least keep photos of the results, Putrino says. “Covering your bases as soon as you start to feel unwell and keeping good records is super important,” he says. (In the book chapter, Putrino, Murphey, and Robles even recommend that people consider getting blood tests and chest X-rays done soon after they get diagnosed with COVID-19, so they have a baseline record in case they later experience complications.) PCR tests are still considered the gold standard for accuracy, so some doctors recommend getting one to confirm the results of an at-home swab. But people are increasingly forgoing that step now that rapid tests are widespread and increasingly accepted. A PCR test isn’t even required to get a prescription for the antiviral Paxlovid. It may seem paranoid to plan ahead for a possible case of Long COVID—but the odds of getting it aren’t so long. Recent federal data suggest that one in five people who catches COVID-19 will develop symptoms of Long COVID, which can include fatigue, cognitive dysfunction, and chronic pain, among many others. If someone does develop Long COVID, having documentation of a previous COVID-19 case could make it easier to get properly diagnosed or treated in a Long COVID clinic, some of which require either proof of previous infection or a positive antibody test. But not all patients have such proof. In July, Hannah Davis—who is also part of Body Politic and the Patient-Led Research Collaborative for Long COVID—said in Congressional testimony that PCR and antibody tests “are often required for sick leave, entry into Long COVID clinics, health care, and participation in research,” even though some people get false negative results and others can’t get tested at all. Davis added that some people who catch COVID-19 do not produce antibodies, or see their antibody levels drop to undetectable levels over time. Dr. Hector Bonilla, who co-directs Stanford’s Post COVID-19 Syndrome Clinic, says his facility accepts a patient as long as they have a positive test result linked to their name—that is, one done by a clinician or testing service, as opposed to a do-it-yourself home test—or evidence of infection-related antibodies. Having a COVID-19 test result can help determine whether someone has Long COVID or other, similar illnesses, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Bonilla says. (Some Long COVID patients also meet diagnostic criteria for ME/CFS.) But Dr. Benjamin Abramoff, who directs Penn Medicine’s Post-COVID Assessment and Recovery Clinic, says he thinks fewer clinics will require official test results now that at-home tests are the norm. “Realistically, everybody’s going to be getting home tests,” he says. “I can’t imagine anyone requiring [formal testing] moving forward.” And while many Long COVID patients without PCR test results were outright dismissed by doctors early in the pandemic, Abramoff thinks that’s happening less now that Long COVID is more widely known. “It still happens, but much less than it did,” he says. Even without a PCR test result, documentation from a doctor can be enough to get disability benefits, insurance coverage, and work accommodations, he says. Many long-haulers struggle to get disability benefits even with proper documentation, however. Maria Van Kerkhove, the World Health Organization’s (WHO) technical lead for COVID-19, said in a statement to TIME that “the lack of proof of prior infection shouldn’t be an impediment for people to get access to diagnosis and care” for Long COVID. The WHO’s definition of Long COVID specifies that it can occur among people who have either a “probable or confirmed SARS-CoV-2 infection,” she noted. Still, Putrino says it’s better to be safe than sorry, as the criteria for getting a Long COVID diagnosis or being admitted to a treatment center vary by institution and could change in the future. “Those diagnostic criteria can change based on who’s in power,” he says. “Making sure that you have very clear documentation of a positive test is important, because it gives you your best chance of being able to receive services as long as you need them.” from https://ift.tt/1caNW86 Check out https://takiaisfobia.blogspot.com/ More research suggests it’s time to abandon the craze over vitamin D. Taking high doses of “the sunshine vitamin” doesn’t reduce the risk of broken bones in generally healthy older Americans, researchers reported Wednesday. It’s the latest in a string of disappointments about a nutrient once hoped to have wide-ranging protective effects. That same study of nearly 26,000 people already had found that popping lots of vitamin D pills didn’t prevent heart disease, cancer or memory loss either. And while getting enough vitamin D is important for strong bones, “more is not better,” said Dr. Meryl LeBoff of Boston’s Brigham and Women’s Hospital, the study’s lead author. An estimated third of Americans 60 and older take the supplements and more than 10 million blood tests for vitamin D levels are performed annually—despite years of controversy over whether the average older adult needs either. The newest findings—added to other trials with similar results—should end that debate, wrote Drs. Steven Cummings of California Pacific Medical Center and Clifford Rosen of Maine Medical Center Research Institute in a commentary in the medical journal. “People should stop taking vitamin D supplements to prevent major diseases”—and doctors should stop the routine screenings that fuel concern, the pair concluded. They weren’t involved in the latest study. Read More: What the Science Says About the Health Benefits of Vitamins and Supplements Just how much vitamin D should people get? The U.S. recommends 600 to 800 international units a day to ensure that everyone, young and old, gets enough. While our skin makes vitamin D from sun exposure, that can be tougher in winter. Milk and certain other foods are fortified with the nutrient to help. The bigger question was whether more than that recommended amount might be better, to prevent fractures or maybe other disorders, too. To address conflicting scientific reports, Brigham and Woman’s preventive medicine chief Dr. JoAnn Manson started the largest study of its type to track a variety of health outcomes in nearly 26,000 generally healthy Americans in their 50s or older. The latest results compare bone fractures in those who took either a high dose—2,000 international units of the most active form of vitamin D, called D-3—or dummy pills every day for five years. The supplements didn’t reduce the risk of broken hips or other bones, LeBoff reported in the New England Journal of Medicine. While vitamin D and calcium work best together, she said even the 20% of study participants who also took a calcium supplement didn’t benefit. Nor did the small number of study participants who had low blood levels of vitamin D. Still, LeBoff cautioned that the study didn’t include people who may require supplements because of bone-thinning osteoporosis or other disorders, or those with severe vitamin D deficiencies. And Manson said more research is needed to tell if there are additional high-risk groups who might benefit. Overall, “these findings overturn dogma and cast doubt on the value of routine screening for vitamin D blood levels and blanket recommendations for supplementation,” Manson said. “Spending time outdoors, being physically active and having a heart-healthy diet will lead to greater gains in health” for most people. from https://ift.tt/G9WvyYg Check out https://takiaisfobia.blogspot.com/ Hong Kong Had the Worlds Highest COVID-19 Death Rate. It May Not Be Ready for Another Surge7/27/2022 Wong Wing-yan has taken to closing the doors of the empty bedrooms at the suburban Hong Kong nursing home where she works, so she doesn’t have to think about the residents who once occupied them. Some of the rooms are now being used as haphazard storage closets, stacked with mothballed furniture, wheelchairs, and boxes of personal protective equipment (PPE). Marks left by tape can still be seen on the walls, where photos of loved ones were once displayed. “There are many empty rooms now,” said Wong, a bespectacled nurse in her thirties, as she walked TIME through the facility in late April. “I’ve known [the inhabitants] for so long, and now when I see those empty rooms, I am depressed.” COVID-19 finally came to the Kei Tak (Tai Hang) Home For the Aged on Feb. 13, after sparing it for two years and four previous waves of the disease. The next day, 17 residents tested positive. The day after that, it was 30. Soon, 98% of the residents had been infected—and after two months, 27 of the nursing home’s 200 residents had died. “Our elderly home turned into a battlefield as hospitals were overloaded and the healthcare system collapsed,” said Wong, who has worked at Kei Tak for more than 10 years. She was a foot soldier in Hong Kong’s battle against the fifth wave of COVID-19—a fight the city spectacularly lost. For much of February to April, Hong Kong turned from pandemic success story to the place with the highest COVID-19 death rate in the world. Out of a population of 7.5 million, some 9,000 lives were lost in a 10-week period as Hong Kong appeared to be taken off guard by the highly contagious Omicron variant. The hospital system was quickly overburdened. Horrifying photos began circulating on social media of frail, mostly elderly people, bundled in blankets, lying on gurneys in the driveways of hospitals too full to accommodate them. Morgues filled up, and thousands of corpses had to be kept in refrigerated containers. In some hospitals, body bags were piled up between the beds of still living patients. Coffins could not be obtained quickly enough and crematoriums struggled to keep up with demand, leaving many bodies to decay before they could be buried or cremated. Read More: How Hong Kong Became China’s Biggest COVID Problem The tragedy took place despite vaccines being widely available for a year prior and Hong Kong imposing some of the toughest infection control measures in the world—including periodic entry bans for non-residents, mandatory quarantine for travelers, strict mask mandates, a mandatory track-and-trace app, and quarantine camps or hospitalization for anyone testing positive. But overreliance on such measures led to vaccine complacency. An alarmingly low vaccination rate among the elderly made that population especially vulnerable, once faster spreading variants appeared. In January, only about 25% of Hong Kong residents aged 80 and older had been jabbed, with the rate among care home residents even lower. Almost all of those who perished in the fifth wave, about 72%, were unvaccinated. The heavy toll at Kei Tak mirrored what was happening at other elderly care facilities. By the end of the fifth wave, about 1.5% of all Hong Kong residents aged 80 or over had died, with the vast majority of those fatalities in nursing homes. Now, as COVID-19 begins to spike in the city once more, it’s not clear that Hong Kong has learned the lessons from earlier this year. On July 25, the government announced three new deaths from COVID-19, all over the age of 70. Two of the dead hadn’t received any vaccine doses at all. The vaccination status of the third has not yet been reported. Hong Kong’s vaccination campaign failed its elderlyMost experts attribute the high toll of Hong Kong’s fifth wave to the low rate of elderly vaccination. The authorities have made two vaccines available at no cost to the public: CornaVac, an inactivated virus vaccine developed by mainland Chinese firm Sinovac, and an mRNA vaccine manufactured by BioNTech in Germany that uses the same technology as the Pfizer vaccine widely used in the United States. Wong says she and other nurses at Kei Tak tried their best to get their residents jabbed, but in many cases this required authorization from the residents’ families, who were often hesitant, fearing that underlying conditions like high blood pressure, or a history of strokes, made elderly people unsuitable recipients of a dose. This was despite the fact that vaccines were being safely administered to millions of patients with those conditions in the U.S. and Europe. Read More: Global Shortages Loom as China’s Lockdowns Continue Unfounded rumors circulated about deaths linked to vaccination. Local newspapers sowed stoked fears by repeatedly publicizing instances of people who died within 14 days if being vaccinated—even if vaccination played no part in the fatalities. Government messaging added to the uncertainty. On Mar. 6, then health secretary, Sophia Chan, suggested “to the public that if they are uncertain about their own situation whether they have serious chronic illness or uncontrolled chronic illness, they can actually consult their family doctors to understand more before they make a booking for vaccination.” In such an atmosphere, many people in aged care, and their families, simply concluded that vaccines were risky. The consequences at Kei Tak were grimly predictable. Poon Yui-pan, a 42-year-old doctor and the deputy head of the facility, said he tried to treat infected residents with acetaminophen, ice packs, and vitamin C he bought from the local supermarket. Calling emergency services didn’t bring immediate assistance. At the height of the fifth wave, wait times for an ambulance stretched more than 30 hours, according to local media. Hospitals were so crowded that many in Hong Kong recovered while waiting for a bed. Like many other nursing homes, Kei Tak did not have enough space to keep infected residents isolated, and the virus spread uncontrollably. The facility struggled with staff shortages as some workers, worried about catching the virus, stopped coming in or quit. Wong tested positive for COVID-19 herself, but continued with her duties. The residents she looked after had all contracted the virus by then. “I felt a great sense of responsibility to take care of them,” she says. Read More: The Chinese Public Is Divided Over Its Zero-COVID Approach Wong recalls a particularly cherished, 92-year-old resident that she called kai ma—Cantonese for godmother—and anxiously touches her necklace while she talks about how the woman’s family had declined to have her vaccinated. She reminisces about afternoons spent with kai ma, watching her favorite TV show, a local drama from the 1990s. The resident, who was a farmer when she was younger, was always smiling and often shared stories about her family. At mealtimes, she would always ask if Wong had eaten before beginning to eat herself. “She was like family to me,” the nurse says. The elderly lady died during the fifth wave, one of many Hong Kong’s COVID-19 victims who have passed away in relative anonymity. There has been little public expression of mourning for the many lives lost. No memorials have been erected and the local press is oddly devoid of stories about the lives of those who died. The family members of several patients from Kei Tak nursing home who died of COVID-19 declined to be interviewed by TIME or even have the names of their family members shared. Very few people feel comfortable talking about death. But in Hong Kong, the reticence is particularly acute. “In Chinese culture, people avoid talking about death because they believe it may bring bad luck,” says Chan Kai-woon, a 31-year-old funeral director. Accountability for Hong Kong’s pandemic failuresMonths later, there still has been no real reckoning over the large number of preventable deaths. In a rare admission, the city’s then leader, Carrie Lam, said in a mid-June interview with Bloomberg TV that her administration could have done more to prevent elderly deaths with a stronger vaccination drive. But when asked if she wanted to apologize to the Hong Kong people for anything that happened during her tenure, she said no. In her last appearance in the legislature in late June, outgoing health chief Chan ignored questions about whether she was personally responsible for the fifth wave. Some things have since improved. COVID-19 vaccines are now mandatory for new nursing home residents. The government has also sent outreach teams to elderly homes and began offering a home vaccination service for those 70 or older. The vaccination rate is higher, but still, on July 20, only 59% of the population aged 70 to 79, and only 38% of those 80 and older, had received three doses of a vaccine. By contrast, 80% of people 75 and older in the U.K. had received a fourth dose by May 2022, two months after they became eligible. Read More: Taiwan Is Abandoning Its Zero-COVID Strategy For now, the city is still clinging to social distancing, track and trace, mask mandates and other COVID-19 countermeasures in a bid to protect the unvaccinated. That could be problematic. Hong Kong reported 4,276 new cases on July 26, and officials are again warning that the hospital system is in danger of becoming stretched. Spikes may occur if the government yields to intense pressure from the business community to open Hong Kong’s borders and loosen COVID-19 controls. About 100 care homes had reported new cases by early July, though Grace Li Fai, chairwoman of the Elderly Services Association of Hong Kong, told local media that transmission chains are being cut off faster, due to increased testing for staff and residents. Instead, it appears that COVID-19 is spreading among elderly who don’t live in care facilities. Only about 10% of those currently hospitalized for COVID-19—the great majority of whom are over the age of 65—are residents of care homes, according to the South China Morning Post. Wong says that life is moving on at Kei Tak. Residents who were too depressed to eat after the fifth wave have regained their appetites, and some of the empty rooms are being occupied again. “We’re accepting new residents, so there are a lot of new faces,” she says. She adds that Kei Tak is better prepared for a new surge. The vaccination rate at the home has reached almost 100%, officials have inspected its ventilation system, and stocks of PPE have been amassed. There have been no new confirmed cases at the home. “I have been mentally ready that there might be a sixth wave,” Wong says. But the scars remain. She describes COVID-19 as “a catastrophe” for the city’s aged care facilities. “Hong Kong is supposed to be a civilized society,” says Wong. “How could something like this happen here?” from https://ift.tt/5b2VaAX Check out https://takiaisfobia.blogspot.com/ Hong Kong Had the Worlds Highest COVID-19 Death Rate. It May Not Be Ready for Another Surge7/27/2022 Wong Wing-yan has taken to closing the doors of the empty bedrooms at the suburban Hong Kong nursing home where she works, so she doesn’t have to think about the residents who once occupied them. Some of the rooms are now being used as haphazard storage closets, stacked with mothballed furniture, wheelchairs, and boxes of personal protective equipment (PPE). Marks left by tape can still be seen on the walls, where photos of loved ones were once displayed. “There are many empty rooms now,” said Wong, a bespectacled nurse in her thirties, as she walked TIME through the facility in late April. “I’ve known [the inhabitants] for so long, and now when I see those empty rooms, I am depressed.” COVID-19 finally came to the Kei Tak (Tai Hang) Home For the Aged on Feb. 13, after sparing it for two years and four previous waves of the disease. The next day, 17 residents tested positive. The day after that, it was 30. Soon, 98% of the residents had been infected—and after two months, 27 of the nursing home’s 200 residents had died. “Our elderly home turned into a battlefield as hospitals were overloaded and the healthcare system collapsed,” said Wong, who has worked at Kei Tak for more than 10 years. She was a foot soldier in Hong Kong’s battle against the fifth wave of COVID-19—a fight the city spectacularly lost. For much of February to April, Hong Kong turned from pandemic success story to the place with the highest COVID-19 death rate in the world. Out of a population of 7.5 million, some 9,000 lives were lost in a 10-week period as Hong Kong appeared to be taken off guard by the highly contagious Omicron variant. The hospital system was quickly overburdened. Horrifying photos began circulating on social media of frail, mostly elderly people, bundled in blankets, lying on gurneys in the driveways of hospitals too full to accommodate them. Morgues filled up, and thousands of corpses had to be kept in refrigerated containers. In some hospitals, body bags were piled up between the beds of still living patients. Coffins could not be obtained quickly enough and crematoriums struggled to keep up with demand, leaving many bodies to decay before they could be buried or cremated. Read More: How Hong Kong Became China’s Biggest COVID Problem The tragedy took place despite vaccines being widely available for a year prior and Hong Kong imposing some of the toughest infection control measures in the world—including periodic entry bans for non-residents, mandatory quarantine for travelers, strict mask mandates, a mandatory track-and-trace app, and quarantine camps or hospitalization for anyone testing positive. But overreliance on such measures led to vaccine complacency. An alarmingly low vaccination rate among the elderly made that population especially vulnerable, once faster spreading variants appeared. In January, only about 25% of Hong Kong residents aged 80 and older had been jabbed, with the rate among care home residents even lower. Almost all of those who perished in the fifth wave, about 72%, were unvaccinated. The heavy toll at Kei Tak mirrored what was happening at other elderly care facilities. By the end of the fifth wave, about 1.5% of all Hong Kong residents aged 80 or over had died, with the vast majority of those fatalities in nursing homes. Now, as COVID-19 begins to spike in the city once more, it’s not clear that Hong Kong has learned the lessons from earlier this year. On July 25, the government announced three new deaths from COVID-19, all over the age of 70. Two of the dead hadn’t received any vaccine doses at all. The vaccination status of the third has not yet been reported. Hong Kong’s vaccination campaign failed its elderlyMost experts attribute the high toll of Hong Kong’s fifth wave to the low rate of elderly vaccination. The authorities have made two vaccines available at no cost to the public: CornaVac, an inactivated virus vaccine developed by mainland Chinese firm Sinovac, and an mRNA vaccine manufactured by BioNTech in Germany that uses the same technology as the Pfizer vaccine widely used in the United States. Wong says she and other nurses at Kei Tak tried their best to get their residents jabbed, but in many cases this required authorization from the residents’ families, who were often hesitant, fearing that underlying conditions like high blood pressure, or a history of strokes, made elderly people unsuitable recipients of a dose. This was despite the fact that vaccines were being safely administered to millions of patients with those conditions in the U.S. and Europe. Read More: Global Shortages Loom as China’s Lockdowns Continue Unfounded rumors circulated about deaths linked to vaccination. Local newspapers sowed stoked fears by repeatedly publicizing instances of people who died within 14 days if being vaccinated—even if vaccination played no part in the fatalities. Government messaging added to the uncertainty. On Mar. 6, then health secretary, Sophia Chan, suggested “to the public that if they are uncertain about their own situation whether they have serious chronic illness or uncontrolled chronic illness, they can actually consult their family doctors to understand more before they make a booking for vaccination.” In such an atmosphere, many people in aged care, and their families, simply concluded that vaccines were risky. The consequences at Kei Tak were grimly predictable. Poon Yui-pan, a 42-year-old doctor and the deputy head of the facility, said he tried to treat infected residents with acetaminophen, ice packs, and vitamin C he bought from the local supermarket. Calling emergency services didn’t bring immediate assistance. At the height of the fifth wave, wait times for an ambulance stretched more than 30 hours, according to local media. Hospitals were so crowded that many in Hong Kong recovered while waiting for a bed. Like many other nursing homes, Kei Tak did not have enough space to keep infected residents isolated, and the virus spread uncontrollably. The facility struggled with staff shortages as some workers, worried about catching the virus, stopped coming in or quit. Wong tested positive for COVID-19 herself, but continued with her duties. The residents she looked after had all contracted the virus by then. “I felt a great sense of responsibility to take care of them,” she says. Read More: The Chinese Public Is Divided Over Its Zero-COVID Approach Wong recalls a particularly cherished, 92-year-old resident that she called kai ma—Cantonese for godmother—and anxiously touches her necklace while she talks about how the woman’s family had declined to have her vaccinated. She reminisces about afternoons spent with kai ma, watching her favorite TV show, a local drama from the 1990s. The resident, who was a farmer when she was younger, was always smiling and often shared stories about her family. At mealtimes, she would always ask if Wong had eaten before beginning to eat herself. “She was like family to me,” the nurse says. The elderly lady died during the fifth wave, one of many Hong Kong’s COVID-19 victims who have passed away in relative anonymity. There has been little public expression of mourning for the many lives lost. No memorials have been erected and the local press is oddly devoid of stories about the lives of those who died. The family members of several patients from Kei Tak nursing home who died of COVID-19 declined to be interviewed by TIME or even have the names of their family members shared. Very few people feel comfortable talking about death. But in Hong Kong, the reticence is particularly acute. “In Chinese culture, people avoid talking about death because they believe it may bring bad luck,” says Chan Kai-woon, a 31-year-old funeral director. Accountability for Hong Kong’s pandemic failuresMonths later, there still has been no real reckoning over the large number of preventable deaths. In a rare admission, the city’s then leader, Carrie Lam, said in a mid-June interview with Bloomberg TV that her administration could have done more to prevent elderly deaths with a stronger vaccination drive. But when asked if she wanted to apologize to the Hong Kong people for anything that happened during her tenure, she said no. In her last appearance in the legislature in late June, outgoing health chief Chan ignored questions about whether she was personally responsible for the fifth wave. Some things have since improved. COVID-19 vaccines are now mandatory for new nursing home residents. The government has also sent outreach teams to elderly homes and began offering a home vaccination service for those 70 or older. The vaccination rate is higher, but still, on July 20, only 59% of the population aged 70 to 79, and only 38% of those 80 and older, had received three doses of a vaccine. By contrast, 80% of people 75 and older in the U.K. had received a fourth dose by May 2022, two months after they became eligible. Read More: Taiwan Is Abandoning Its Zero-COVID Strategy For now, the city is still clinging to social distancing, track and trace, mask mandates and other COVID-19 countermeasures in a bid to protect the unvaccinated. That could be problematic. Hong Kong reported 4,276 new cases on July 26, and officials are again warning that the hospital system is in danger of becoming stretched. Spikes may occur if the government yields to intense pressure from the business community to open Hong Kong’s borders and loosen COVID-19 controls. About 100 care homes had reported new cases by early July, though Grace Li Fai, chairwoman of the Elderly Services Association of Hong Kong, told local media that transmission chains are being cut off faster, due to increased testing for staff and residents. Instead, it appears that COVID-19 is spreading among elderly who don’t live in care facilities. Only about 10% of those currently hospitalized for COVID-19—the great majority of whom are over the age of 65—are residents of care homes, according to the South China Morning Post. Wong says that life is moving on at Kei Tak. Residents who were too depressed to eat after the fifth wave have regained their appetites, and some of the empty rooms are being occupied again. “We’re accepting new residents, so there are a lot of new faces,” she says. She adds that Kei Tak is better prepared for a new surge. The vaccination rate at the home has reached almost 100%, officials have inspected its ventilation system, and stocks of PPE have been amassed. There have been no new confirmed cases at the home. “I have been mentally ready that there might be a sixth wave,” Wong says. But the scars remain. She describes COVID-19 as “a catastrophe” for the city’s aged care facilities. “Hong Kong is supposed to be a civilized society,” says Wong. “How could something like this happen here?” from https://ift.tt/5b2VaAX Check out https://takiaisfobia.blogspot.com/ How long the COVID-19 pandemic will last is one of the biggest questions facing the world at present—and one of the major issues addressed at the TIME100 Health Summit that took place on July 15. At the summit, White House COVID-19 adviser Dr. Ashish Jha said this pandemic will end, just as all previous pandemics have ended, but that’s not likely to happen in the next few months. “We need to get to a point where we have vaccines that are truly variant-resistant,” he told Senior Correspondent Alice Park at the virtual event, which was sponsored by Fujifilm. He said such vaccines could still be three to five years away, though that timeline might be sped up with strategic investments, as the science is “moving very quickly.” [time-brightcove not-tgx=”true”] The TIME100 Health Summit also addressed mental well-being. Michelle Williams, a mental-health advocate and former member of Destiny’s Child, opened up about how she has struggled with depression since the seventh grade—even though she didn’t receive an official diagnosis until her 30s. She told TIME100 Talks host Lola Ogunnaike that while her success did not “heal the pain” of mental illness, it gave her a way to afford therapy, hospitalization, and retreats. Executive editor John Simons interviewed Michael Acton Smith, the co-CEO and co-founder of meditation app Calm, and James Park, Fitbit vice president and general manager, about their work at the intersection of health and technology. Park said Fitbit has helped him personally develop healthier habits, like spreading out exercise throughout the workday, and Smith explained how, when Calm data showed usage spiked around 11 p.m. as people listened to meditations to fall asleep, he worked to create a line of bedtime stories read by stars like LeBron James and Harry Styles. Representative Lauren Underwood, a nurse and Democratic Congresswoman representing a northern Illinois district, talked about the challenges of governing since the U.S. Supreme Court overturned Roe v. Wade in June. She called for the end of the filibuster so that the U.S. Senate, which has a narrow Democratic majority, could take up the Women’s Health Protection Act, passed by the U.S. House of Representatives, which enshrines abortion protections into law. “The Senate Republicans are united in their opposition to protect[ing] our health care despite the majority of the American people wanting this solution,” she told senior correspondent Janell Ross. You can watch the entire summit at time.com/time100-talks. from https://ift.tt/2dvxXBo Check out https://takiaisfobia.blogspot.com/ Toward the end of the 19th century, a New York City surgeon named Dr. William Coley purposely injected one of his patients with streptococcal bacteria. Coley wasn’t crazy. He hoped the bacterial infection would stimulate an immune response that would slow the spread of his patient’s cancer, which was inoperable. The experiment worked; the patient’s tumor shrank. For the next 40 years, Coley and his research collaborators would test similar remedies on more than 1,000 cancer patients. They had failures but also many successes, especially among people with bone or soft-tissue cancers. Today, Coley is sometimes called the father of immunotherapy, which is a branch of medicine that attempts to activate or modify a person’s immune system in ways that help treat disease. Cancer remains one of the most active areas of immunotherapy research, and people with bladder cancer are among those who stand to benefit most from these medicines. “Bladder cancer is one of the cancers—along with melanoma, head and neck cancers, and kidney cancer—that are highly responsive to immunotherapy,” says Dr. Joaquin Bellmunt, director of the Bladder Cancer Program at the Harvard-affiliated Beth Israel Deaconess Medical Center in Boston. Bellmunt says that bladder cancer is characterized by a high number of tumor mutations. The human body tends to regard these sorts of mutations as “antigens”—meaning unwelcome threats that would normally instigate an immune response. However, cancer cells have features that allow their mutations to fly under the radar and evade the immune system’s antibodies. Immunotherapies work in part by counteracting these defenses. In Bellmunt’s words, they “release the brakes” that prevent the immune system from launching a more formidable attack. Any discussion of new treatments for bladder cancer must highlight the newest immunotherapies, which have been game changers. But experts say that other recent advancements—including refinements in chemotherapies, radiation treatments, and surgery—are improving prognoses for people diagnosed with bladder cancer. Here, oncologists and other bladder-cancer specialists describe the newest breakthroughs, as well as areas of research that could yield greater improvements in the future. The latest in immunotherapyImmunotherapy for the treatment of bladder cancer is not new. Since the 1970s, doctors following closely in Coley’s footsteps have given some bladder-cancer patients injections of bacillus Calmette–Guérin, or BCG, a bacteria that triggers a helpful kind of inflammation. “BCG has been standard treatment for non-invasive bladder cancers”—meaning early-stage cancers that have not spread beyond the bladder—“for the last 40 years,” Bellmunt says. “But when BCG failed, we had nothing left but cystectomy,” or bladder removal surgery.” The situation was much the same for people with advanced bladder cancers that had metastasized to other parts of the body. If chemotherapy didn’t work, there were few alternatives. (Even when these therapies do work, the median survival time tends to be measured in months, not years.) The newest immunotherapies are helping rewrite the script for people with both early-stage and later-stage bladder cancers. “2016 is the year the newer immunotherapies show up, and immediately some of these drugs were conditionally approved based on Phase 1 and 2 trials,” Bellmunt says. Many of these relatively new immunotherapies are known as checkpoint inhibitors. They prevent (or inhibit) the action of certain immune pathways that would otherwise block a more robust immune response. Also known as anti-PD-1 or anti-PD-L1 drugs, these medications have “changed the treatment landscape” for people with advanced bladder cancers, according to a 2020 study in the New England Journal of Medicine (NEJM). “With immunotherapy, if you actually look at the overall benefits, it’s pretty modest,” says Dr. Simon Crabb, a bladder-cancer specialist and associate professor in medical oncology at the University of Southampton in the U.K. To his point, that 2020 NEJM study found that, compared with standard treatment (like chemotherapy), immunotherapy lengthened average overall survival duration by about seven months. “But in a minority of patients, maybe 20% to 30%, you see exceptional responses,” Crabb says. “I’ve got people who’ve been on these drugs for four or five years.” Figuring out why this happens—why some respond so much better than others to immunotherapy—is a focal point of current research efforts. “Something we’ve come to understand is that this isn’t one disease, it’s a subset of diseases that can be divided up based on genetic subtypes,” he explains. By mapping the genetic characteristics of different bladder cancers, experts hope to gain a -stronger understanding of how each responds to the current therapies—whether that involves a single immunotherapy medication or, as is becoming more common, immunotherapies mixed with chemotherapies or other drugs. Researchers are also actively exploring the use of immunotherapies in earlier-stage bladder cancers. For example, there’s some hope that administering these drugs before bladder-removal surgery may be beneficial. “A long time ago, we found out that you can improve survival by giving chemotherapy before surgery, but it’s quite toxic,” says Dr. Yair Lotan, chief of urologic oncology at UT Southwestern Medical Center at Dallas. “Now we’re looking at using immunotherapy, or a combination of immunotherapy with targeted therapies, to avoid the need for systemic chemotherapy.” Immunotherapies, like all drugs, have their downsides. The side-effects of the treatment can be hard to predict. “If the immune system is overstimulated, almost any organ system can be impacted,” Bellmunt says. Skin reactions—dry or itchy skin, rashes—are the most common complaint among people on these drugs. A smaller percentage of patients, 5% or less, develop inflammation of the bowels, lungs, or thyroid. This inflammation can cause symptoms like diarrhea, shortness of breath, or weight gain. “In rare cases we’ve even seen cardiovascular toxicity where patients developed myocarditis [heart inflammation] and died,” he says. Here again, researchers are working to better understand—and better predict-—how a person will respond to these treatments. While plenty of work remains, these drugs have provided a life-saving step forward for some. “Once you boost the immune system, there are patients whose immunologic memory prevents the tumor from recurring,” Bellmunt says. “These patients have a clear improvement in survival.” Read More: Changing Cancer Care, So Patients No Longer Feel Like a Number New improvements in targeted therapiesDespite the excitement and advancements involving immunotherapies, chemotherapy remains the first-line treatment for advanced bladder cancers. There, too, medical researchers are making progress. The cells of bladder-cancer tumors contain a high number of surface antigens, which are molecules capable of triggering an immune response. These antigens are the reason immunotherapies can be effective for the treatment of bladder cancer, and these antigens also assist the action of newer chemotherapy medicines known as antibody-drug conjugates. “These drugs use these quite clever molecules that have an antibody on one end—something that will hopefully bind onto the antigens on cancer cells in a selective manner—and a chemotherapy agent on the other,” Crabb says. The big problem with conventional chemotherapy, he explains, is that it struggles to differentiate between normal cells and cancer cells. Fast-growing cells that resemble cancer cells—such as those of the bone marrow, digestive tract, mouth, and scalp—typically draw friendly fire. This is why people on chemo often experience multiple severe side-effects, including hair loss, fatigue, nausea, and sores. Antibody-drug conjugates, by selectively binding to antigens on bladder cancer cells, can reduce this kind of collateral damage. “What it does is lock the chemotherapy onto this molecule that exists on top of the cancer cells, which hopefully spares the normal cells the direct exposure to chemotherapy,” Crabb says. Bellmunt likens these drugs to -microscopic taxis that have a bomb strapped into the passenger seat. “The taxi drives to the cancer cell, which internalizes it, and then it releases the bomb,” he says. “This is a new way of delivering chemotherapy that helps avoid side effects, and some trials have also shown a survival advantage compared to standard chemotherapy.” Right now, he says these drugs are used as a “third-line” treatment, or only in cases where standard chemotherapy and immunotherapy fail. But there’s hope that improvements in these drugs may soon push them higher up in the pecking order. Antibody-drug conjugates are just one of several new “targeted” treatments for bladder cancer. Another is a type of drug called a tyrosine kinase inhibitor. “This is a drug that’s able to switch off a genomic trigger identified in the tumor,” Bellmunt explains. Switching off this trigger is helpful because, in some cases, it may be contributing to the growth or progression of that tumor. Researchers are looking at tyrosine kinase inhibitors and related precision drugs alongside chemotherapy or immunotherapy treatments. Combining these drugs may lead to treatment breakthroughs in the years to come. “We all hope that the right combination might change the future,” Bellmunt adds. Read More: 4 Important Steps to Take After a Cancer Diagnosis What’s next in bladder-cancer treatment?The advancements mentioned here are among the most promising, but there are plenty more. For example, new imaging techniques may soon make radiation treatments more precise. Genetic sequencing of cancer cells is also a hot area of research. “We’re getting better at identifying biomarkers of the disease that allow us to tailor our approaches,” Lotan says. “In just the last three or four years, we’ve moved forward in identifying underlying signatures of cancers and gene expressions that can help us personalize treatment options.” Lotan notes that many in his field are also hopeful that the future will yield accurate screening protocols for bladder cancer. “From a detection standpoint, there hasn’t been any major advancement,” he says. “Newer detection methods use panels of RNA or DNA, which are more sophisticated, but so far we have not done the large scale studies needed to demonstrate clinical utility.” Those trials involve thousands of people and “a lot of money,” he adds, and will hopefully happen soon. “It may be possible to use urine as a screening approach, and there’s quite a lot of work going on in that area,” Crabb adds. He’s optimistic this work will eventually bear fruit. “I think urine screening is the way forward,” he says. “It’s all well and good to develop these expensive new treatments, but prevention, or at least early detection, would be better.” There was a time when cancer experts hoped for a single breakthrough cure that would, by itself, eradicate any and all cancers. As their understanding of the disease has broadened, those hopes have faded. Today, most affirm that cancer is too variable to succumb to any silver bullet, and so the path forward will be paved with a diverse array of tailored remedies. The good news for people with bladder cancer is that each new year seems to yield meaningful strides in medical science’s ability to fight the disease. The picture now is radically changed from what it was 10 or even five years ago. People with bladder cancer are living longer and with fewer side effects than ever before. There’s reason to expect more improvements in the near future. from https://ift.tt/sbXcvaZ Check out https://takiaisfobia.blogspot.com/ |
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