WASHINGTON — A massive recall of millions of sleep apnea machines has stoked anger and frustration among patients, and U.S. officials are weighing unprecedented legal action to speed a replacement effort that is set to drag into next year. Sound-dampening foam in the pressurized breathing machines can break down over time, leading users to potentially inhale tiny black particles or hazardous chemicals while they sleep, manufacturer Philips warned in June 2021. Philips initially estimated it could repair or replace the units within a year. But with the recall expanding to more than 5 million devices worldwide, the Dutch company now says the effort will stretch into 2023. That’s left many patients to choose between using a potentially harmful device or trying risky remedies, including removing the foam themselves, buying second-hand machines online or simply going without the therapy. The devices are called continuous positive airway pressure, or CPAP, machines. They force air through a mask to keep passageways open during sleep. Read More: Is Snoring Dangerous? Here’s When to Worry Untreated sleep apnea can cause people to stop breathing hundreds of times per night, leading to dangerous drowsiness and increased heart attack risk. The problem is more common in men than women, with estimates ranging from 10% to 30% of adults affected. Most patients are better off using a recalled device because the risks of untreated sleep apnea still outweigh the potential harms of the disintegrating foam, physicians say. But doctors have been hard pressed to help patients find new machines, which generally cost between $500 and $1,000, and were already in short supply due to supply chain problems. “What happened is the company just said, ‘Talk to your doctor.’ But doctors can’t manufacture new machines out of the blue,” said Dr. John Saito, a respiratory specialist near Los Angeles. Risks from the foam include headache, asthma, allergic reactions and cancer-causing effects on internal organs, according to the Food and Drug Administration. The recalled devices include Dreamstation and SystemOne CPAP models and several other Philips machines, including Trilogy ventilators. Last March, the FDA took the rare step of ordering Philips to expand its communication effort, including “clearer information about the health risks of its products.” Regulators estimated then that only half of U.S. consumers affected had registered with the company. The agency hadn’t issued such an order in decades. Read More: Narcan Can Save an Opioid User’s Life. What to Know About the Drug In a statement, Philips said ongoing testing on the recalled devices is “encouraging” and shows low levels of particles and chemical byproducts emitted by its leading brand of machine. Philips said its initial communication about the dangers posed by the foam was “a worst-case scenario for the possible health risks.” The deterioration appears to worsen with unauthorized cleaning methods, the company noted. The FDA has received more than 70,000 reports of problems attributed to the devices, including pneumonia, infection, headache and cancer. Such reports aren’t independently confirmed and can’t prove a causal connection. They can be filed by manufacturers, patients, physicians or attorneys. Jeffrey Reed, of Marysville, Ohio, had been using his Philips machine for about a year when he began seeing black specks in the tubing and mask. His equipment supplier said the debris was caused by improper cleaning, so he continued using it. Over the next seven years, Reed says he experienced persistent sinus infections, including two bouts of pneumonia, that didn’t resolve with antibiotics. After hearing about the recall, he suspected the foam particles might be playing a role. “Once I got off their machine, all of that cleared right up,” said Reed, 62, who obtained a competitor’s device after several months. Like other users, Reed can’t definitively prove his problems were caused by Philips’ device. More than 340 personal injury lawsuits against Philips have been consolidated in a Pennsylvania federal court and thousands more are expected in coming months. Reed isn’t part of the litigation. Like the vast majority of U.S. CPAP users, Reed got his device through a medical equipment supplier contracted by his insurer. The company went out of business before the recall and he never heard from them about a replacement. Even in normal circumstances, those companies typically don’t track patients long term. Read More: For Kids with Long COVID, Good Treatment Is Hard to Find “After a couple years, you’re just forgotten in the system,” said Ismael Cordero, a biomedical engineer and CPAP user. “I stopped hearing from my supplier about three years after I got my machine.” Cordero learned that his Philips machine had been recalled through his work at ECRI, a nonprofit that reviews medical device safety. In May, the FDA put Philips on notice that it was considering a second order that would force the company to improve and accelerate its repair-and-replace program. Medical device companies typically conduct recalls voluntarily, and former FDA officials say the agency has never actually used its authority to force additional steps. “The FDA shares the frustrations expressed by patients who are awaiting a resolution for this recall,” the agency said in a statement. Philips still hasn’t provided “all information we requested to evaluate the risks from the chemicals released from the foam.” Philips disclosed earlier this year that it received a Department of Justice subpoena over the recall. The agency hasn’t publicly commented on the matter, per federal rules. But an FDA inspection of Philips’ Pennsylvania offices uncovered a spate of red flags last fall, including emails suggesting the company was warned of the problem six years before the recall. In an October 2015 email, one customer appeared to warn Philips that the polyester polyurethane foam could degrade, according to FDA. Between 2016 and early 2021, FDA found 14 instances where Philips was made aware of the issue or was analyzing the problem internally. “No further design change, corrective action or field correction was conducted,” the FDA inspectors repeatedly note. In a May 2018 email, foam supplier William T. Burnett wrote to Philips in an email: “We would not recommend use of polyester foam in such an environment. … It will eventually decompose to a sticky powder,” according to an affidavit filed as part of a lawsuit over the foam. Since the recall, Philips has been using a new type of foam made from silicone to refurbish machines. But FDA alerted consumers last November that the new material had failed one safety test. And regulators asked the company to perform more testing to clarify any health risks with both the new foam and the recalled material. Philips says independent testing has not identified any safety issues. The company says it has replaced or repaired about 69% of recalled devices globally and aims to ship 90% of those requested by year’s end. On average, the company produces about 1 million sleep devices annually. “We have scaled up by more than a factor of three, but inevitably it still takes time to remediate 5.5 million devices globally,” the company said. About half are in the U.S. Jeffrey Reed is among those still waiting. Reed registered for a replacement device in June 2021 — within a week of the recall. This month, he received an email from Philips indicating that his device has been discontinued and isn’t available for immediate replacement. Instead, the company offered him $50 to return the machine or an option of providing additional information to get a newer one. “For them to wait until October to tell me that my machine is too old, when they’ve known exactly what device I have since the day I registered — that’s frustrating,” Reed said. “It’s disappointing that a provider of life-saving equipment treats people like this.” from https://ift.tt/3pzk8Eu Check out https://takiaisfobia.blogspot.com/
0 Comments
Flu and respiratory syncytial virus (RSV) season has just begun in the northern hemisphere, and the consensus among experts is that the 2022-2023 season is shaping up to be more severe than in the past few (relatively mild) years. It might even be worse than seasons before COVID-19. Health data company IQVIA has been analyzing data from insurance claims filed by doctors’ offices, hospitals, and urgent care centers in the country for three decades, and focused on case trends over the previous year. The team found that diagnoses of flu are already tracking at record highs. Even before flu season began, back in spring 2022, cases of influenza began trending well above average for the past three years, reaching nearly 950,000 cases weekly by mid-October (compared to around 400,000 at the same time in 2019, just before the pandemic began). These higher rates aren’t completely unexpected. Influenza cases dropped significantly during the pandemic’s first two years, when people had less contact with one another and generally followed mitigation measures for controlling COVID-19, such as wearing masks and social distancing. Those behaviors helped to suppress the spread of flu. But, says Murray Aitken, executive director of the IQVIA Institute, the current flu numbers are “trending above every year since 2012 by a significant amount.” Experts are also concerned about another troubling flu trend. Flu season in the southern hemisphere, which often gives the U.S. a preview of what to expect, struck early and hard this year. Australia, for example, confronted its worst flu season in five years, with nearly 30,000 lab-confirmed cases of influenza at its weekly peak in June; flu season there tends to peak later, between July and September. Other respiratory viruses—SARS-CoV-2 and RSV—are also on the rise. COVID-19 is still responsible for about 260,000 infections each week in the U.S. on average, and labs that are part of the U.S. Centers for Disease Control and Prevention’s National Respiratory and Enteric Virus Surveillance System have reported a 500% increase in percent of positive tests for RSV from early September. RSV affects children and the elderly most severely. “This virus is hitting extremely hard this year,” says Dr. Juanita Mora, spokesperson for the American Lung Association and an allergist and immunologist at the Chicago Allergy Center. One reason why cases are climbing so quickly (especially among younger children), and so early in the season, could be because COVID-19 restrictions that closed schools and kept kids at home protected many of them from getting any infections over the past two years. “Generally 100% of kids will have had RSV by age two, but that’s not the case now,” Mora says. “Over the past three years, we have had no RSV season, so we have a cohort of kids who are lacking the immunity they might normally have.” While a vaccine to protect kids from RSV exists, it’s only approved for kids at highest risk of developing severe disease, such as premature babies and those born with lung or heart disease. The vaccine requires monthly injections throughout the infection season, and most kids aren’t eligible to get vaccinated. For them, says Mora, the best protections are the same behaviors that shield kids from flu and COVID-19: keeping kids up to date with the flu and COVID-19 shots, washing hands often, and avoiding close contact with kids who are coughing or sneezing.
With flu and RSV cases rising so fast, hospitals in some parts of the country are already feeling strained. But the situation could get worse as new COVID-19 variants, some of which are evading vaccination protections, continue to proliferate this winter.
What’s contributing to the rapid and historic rise in respiratory diseases? It’s likely a combination of factors, including the mild seasons during the earlier part of the pandemic as well as sluggish vaccination rates against flu. Although it’s still relatively early in flu season, flu vaccine uptake is running nearly 9% behind where it normally is by now during pre-pandemic years. Experts say that while these signs are concerning, the U.S. isn’t necessarily doomed to suffer a viral season as severe as countries like Australia. If more people get their flu and COVID-19 shots, that could dampen the effects of the viruses circulating more heavily than usual. from https://ift.tt/o0OPIhj Check out https://takiaisfobia.blogspot.com/ The White House is asking businesses to help employees get updated coronavirus vaccines by hosting on-site clinics and will initiate a new program providing some Americans with free home delivery of COVID-19 treatments before an expected surge of the virus this fall. President Joe Biden will announce the effort Tuesday at the White House, where he’s set to receive the latest version of the COVID shot targeting the Omicron BA.4/BA.5 subvariants. He’ll be joined by executives from major pharmacies including CVS Health Corp., Rite Aid Corp., and Walgreens Boots Alliance Inc. Only about 20 million Americans have received the latest version of the vaccine, according to data from the Centers for Disease Control and Prevention. Hospitalizations and deaths from coronavirus have begun to rise in some European countries and areas of the U.S., as new versions of the virus have become better able to evade immunity from vaccines or previous infections to spread more widely. The White House will release new guidance asking employers to host clinics for flu and coronavirus vaccines on site, email workers urging them to get the shots, and offer paid time off for workers experiencing side effects. The White House is also asking businesses to improve air quality in their buildings, and ask employees to test regularly—and get treatment if they are infected. As part of that push, Walgreens is expected to start a program in coming weeks that will allow Americans living in areas designated by the government as “socially vulnerable” to fill prescriptions of Pfizer Inc.’s Paxlovid coronavirus treatment online, and have them delivered for free by Uber Inc. and DoorDash Inc. drivers. CVS, Rite Aid, and Albertsons Cos Inc. are providing customers with coupons and discounts if they receive an updated version of the booster. from https://ift.tt/AiT23O0 Check out https://takiaisfobia.blogspot.com/ Ambition can feel like a dirty word in the era of quiet quitting and the Great Resignation. Many Americans have realized that an always-striving mindset can come at a cost to mental wellness; in an October report, the U.S. Surgeon General even named workplace mental health a new public-health priority in the wake of the pandemic. Research has also linked chasing extrinsic goals, such as power, to anxiety and depression. But is abandoning your ambition outright the secret to inner peace? Not necessarily. Instead, research suggests, the key is harnessing your ambition for a goal that serves your well-being. “We want to make sure that our ambition is being directed in ways that we care about,” says Richard Ryan, a clinical psychologist and a pioneer of Self-Determination Theory, a school of thought focused on human motivation. Striving is only healthy if “we do it in ways that don’t spoil the rest of our lives.” Ambition isn’t inherently good or bad for mental health. One famous 2012 study, based on data from hundreds of people who were tracked for seven decades, found that ambition strongly predicted career success, but was only weakly related to life satisfaction. Ambitious people weren’t drastically happier or unhappier than people who weren’t as driven, explains co-author Tim Judge, who is now a professor at the Ohio State University’s Fisher College of Business. The target of your ambition may have a stronger impact on mental health. Studies have consistently shown that people who are motivated by “extrinsic” markers of success, such as wealth, status, or popularity, aren’t as psychologically fulfilled as people fueled by “intrinsic” motivators, such as personal growth, deep relationships, or knowledge. Reaching an extrinsic goal may briefly satisfy you, “but it’s not long-lasting,” says Tim Kasser, a professor emeritus of psychology at Knox College. With some practice and introspection, you can retrain your ambition to feed, rather than harm, your mental health. Here are five research-backed ways to do just that. Prioritize your relationshipsAmbition can become harmful when it “crowds out” other important parts of life, Ryan says. “Ambition is effortful,” he says. “If you’re going to be successful and ambitious, you have to put a lot into it.” If that drive comes at the expense of psychologically fulfilling things like strong relationships or autonomy over your time, it can take a toll on mental health. Focus on the task, not the rewardsResearch suggests you’ll feel more fulfilled if you focus on achievement for achievement’s sake—mastering a task, learning something, or creating positive change for your clients or community—rather than striving only for the next promotion or pay raise. (Some research even suggests that people who follow these internal motivators end up achieving more in the end.) “You can have ambition and be intrinsically motivated at the same time,” Ryan says. “You can love your work … but it’s in harmony with the rest of who you are.” Strive for growthInstead of letting ambition rule your life, you can adopt a “growth mindset,” which refers to the belief that intelligence is not fixed and can be fostered. Judge says it may be healthier to strive for growth—learning or honing a skill, or cultivating a trait you admire in others—rather than concrete goals like getting a certain job title or salary. Practice gratitudePeople naturally have some materialistic tendencies, especially in capitalist societies. But Kasser’s research suggests that suppressing those desires can yield mental-health gains. Mindfulness and gratitude can help. In one study, people who meditated daily were more satisfied with their financial status and had greater well-being. Regular reflections on gratitude, relationships, or mortality have also been shown to reduce materialism, which can in turn improve mental wellness. Don’t try to monetize everythingHave you ever lost interest in a beloved hobby after turning it into a side hustle? There’s a science-backed explanation. Decades ago, researchers found that attaching extrinsic motivators (such as cash rewards) to activities that people enjoyed decreased their internal motivation to keep doing them. If psychological satisfaction is your goal, you may be better off without the extra cash. from https://ift.tt/HxEAeBI Check out https://takiaisfobia.blogspot.com/ Ayden Varno was outside doing chores one day in April 2021 when he felt an excruciating pain, like “a hot knife was being stabbed into my back multiple times,” he says. Ayden, who is now 13, spent most of the next eight months in pain so extreme he couldn’t walk unassisted, sleep through the night, or follow a full school curriculum. He also suffered frequent non-epileptic seizures related to his pain. Doctors near his home in Ohio had no idea why Ayden was in so much pain or what to do about it; some suggested he was having a psychotic episode or being abused at home, says his mother, Lynda Varno. The family’s first lead came in July 2021, after they drove 14 hours to a pediatric hospital in Philadelphia. A doctor there mentioned that the pandemic seemed to be driving an increase in pain disorders, giving the Varnos a clue that COVID-19 might be to blame for Ayden’s pain. When, in December 2021, a clinician at Cleveland’s Rainbow Babies and Children’s Hospital finally diagnosed Ayden with Long COVID, both he and his mother broke down crying with relief. “We finally had a physician who believed us, who supported us, who didn’t think that my husband and I did something terrible to our child,” Varno says. Families across the country are on similar odysseys for pediatric Long COVID care. While research is accumulating and doctors are learning more, multiple families interviewed by TIME say they faced ignorance, dismissal, or disrespect from doctors, leaving desperate parents to fight for their children’s recovery themselves. “I’ve done more medical research than Johns Hopkins in the last two years,” jokes Jennifer Cira, who has Long COVID herself and is mother to a 12-year-old girl and 9-year-old boy with the condition. “I have gotten zero support [from the medical system]…We’ve decided to not listen to anyone and just do our own thing now.” Cira has tried everything from melatonin supplements and meditation to massage therapy and Epsom-salt baths to help ease her kids’ symptoms, but she’s yet to find something that cures them entirely. COVID-19 is often described as essentially harmless to children, and it’s true that young people have extremely low odds of dying or becoming hospitalized after catching the virus. But Long COVID can and does affect children even after mild initial cases. It’s just not clear exactly how often it does. One recent study from researchers in Germany compared children and adolescents who’d had COVID-19 to children who’d been exposed to the virus in their homes, but ultimately tested negative. With the exception of girls ages 14 to 18, COVID-positive kids weren’t significantly more likely to report moderate or severe persistent symptoms a year later. That finding should not discount the fact that some children develop long-lasting symptoms after mild cases, but it suggests that the percentage who experience these complications may not be massive. Other studies have found that around 25% of kids who contract COVID-19 have symptoms for at least four weeks. That’s shy of the threshold at which many experts would diagnose Long COVID—three months of otherwise unexplained symptoms—but longer than is typically expected of a “mild” disease. And among kids who were sick enough to be hospitalized with COVID-19, about 25% still had symptoms up to four months later, according to one recent study. Even if the exact prevalence isn’t known, “the takeaway is that this is a real problem,” says Dr. Daniel Blatt, an infectious-disease physician who works in the post-COVID clinic at Norton Children’s Hospital in Kentucky. “There are a lot of kids out there who are suffering.” Fatigue, sleep issues, and mood disorders are the most common Long COVID symptoms for kids, research suggests, but that’s far from an exhaustive list. Many children experience gastrointestinal issues, chronic pain, crashes after physical or mental effort (known as post-exertional malaise), brain fog, nervous system dysfunction, and more. These symptoms can turn a child’s life upside down. “The worst part is not being able to do things I used to do,” says Darya Raker, 13, who has had Long COVID symptoms including headaches and stomachaches, brain fog, dizziness, post-exertional malaise, and insomnia since February. (She caught COVID-19 and developed flu-like symptoms in December 2021.) Darya often doesn’t feel well enough to see her friends or play her favorite sport, water polo. Her school has tried to accommodate her with a modified schedule, but Darya still frequently has to miss class because she doesn’t feel well or has doctor’s appointments, says her mother, Elham Raker. There are more than a dozen pediatric Long COVID clinics scattered across the U.S., according to a directory kept by the support group Long COVID Families, but getting into them isn’t always easy. Blatt says his team tries to see every patient within a week of receiving their referral, but other centers have much longer wait times. The pediatric Long COVID clinic at Children’s National Hospital in Washington, D.C., has a waitlist three to four months long, says director Dr. Alexandra Yonts. That’s “problematic,” Yonts says, but it’s the best she and her small team can do without additional funding. As it is, they see Long COVID patients just one afternoon per week, and only because all the clinicians happened to be free from other responsibilities during that window of time. Even specialty clinics are still learning a lot about pediatric Long COVID, which has been researched much less than adult Long COVID. Among adults, many researchers now believe the condition occurs either because the virus lingers in the body or sparks an abnormal immune response that can last much longer than an acute case. But “there really hasn’t been a lot of strong data to tell us what an organic or biologic cause of Long COVID is in children,” Blatt says. Pediatricians often say that kids are not just little adults; their developing bodies and immune systems often respond to pathogens differently than adults’ do. For that reason, research into the triggers of adult Long COVID isn’t always directly applicable to kids. Still, there are some clues about why some kids develop lingering complications. Some studies suggest that children with preexisting conditions—particularly allergic diseases like eczema, asthma, and food allergies—are at heightened risk of Long COVID. Girls seem more likely to develop the condition than boys, and older children seem to be at higher risk than babies and toddlers. Some people may be genetically predisposed to the condition, research suggests, and Yonts confirms that she has treated children whose parents also have Long COVID. That’s not proof that susceptibility to Long COVID is hereditary, but it raises the possibility that it is. Even without knowing exactly what causes Long COVID in kids, specific symptoms—like chronic pain, fatigue, or digestive issues—can be treated, Yonts says. But for more patients to get that care, all doctors need to understand the condition, not just specialists. Yonts says she’s working to educate other doctors about best practices, but there’s a long way to go. Sarah Lamb has been trying to find a doctor who can help her 10-year-old son, Adam, for more than six months. He’s lived with Long COVID symptoms including gastrointestinal issues, fatigue, and widespread inflammation since early 2022. “Every doctor we’ve seen—from cardiology to GI to his pediatrician—they all say, ‘We don’t know,’” Lamb says. “Almost everything I’ve learned that has helped him has actually not come from his doctors. It’s come from Facebook [support] groups.” Pacing—an energy-management strategy that involves alternating activity and rest—has helped his fatigue, Lamb says, and taking over-the-counter heartburn drugs seems to have helped bring back some of his energy and appetite. Raker has also struggled to get adequate care for her daughter, even though she and her husband are both physicians. Frustrated by doctors who don’t understand the condition, the Rakers decided to fly from their home in California to Colorado’s National Jewish Health for Kids COVID-19 Assessment Program—an option Raker knows not every family has, but one she felt was necessary for hers. Since insurance doesn’t cover the clinic’s care, the Rakers are paying for it with money they’d saved for Darya’s bat mitzvah, which had to be canceled due to her health. “I really wasn’t okay with the idea of my daughter [only] being able to sit up in bed and tolerate life,” Raker says. “I wanted her to be back. I want her to be her sassy teenage self, doing sports and not being exhausted by taking a shower.” National Jewish Health takes an intensive approach to treating kids with Long COVID, says program director Dr. Nathan Rabinovitch. For a week or longer, kids meet with numerous specialists for assessments and treatment planning. The clinic only sees one or two patients a week, so its approach isn’t something that could be easily duplicated at large scale—but Rabinovitch says they’ve had success with customized treatment plans. Despite these positive outcomes, Rabinovitch remains concerned about the future of his patients. “How much of this is transient, and how much of this is permanent?” Rabinovitch asks. “How much of what happens as a teenager or as a kid is going to continue into adulthood?” That question haunts Jenessa, whose 9-year-old daughter has had Long COVID symptoms for about five months and who asked to use only her first name to preserve her family’s privacy. Due to symptoms including post-exertional malaise, dizziness, nausea, stomach pain, rapid heart rate, headaches, and cognitive dysfunction, her daughter can only handle three hours of school per day and has had to eliminate extracurricular activities. Jenessa’s “worst fear,” she says, is that her daughter will never get better. She tries not to think beyond the present—in part because her daughter’s condition varies drastically from one day to the next—but says it’s hard not to worry about Long COVID sticking around forever. “It’s a very real possibility, and it’s terrifying,” she says. “As a parent, you’re constantly having to suck down this terror that you have about what’s going on. You can’t really process it because you’re trying to function and not completely freak out your child.” There are long-haulers who remain sick more than two years after getting infected, and finding treatments for them is critical. But Yonts says lots of kids get better within a year—sometimes even without formal treatment. “It’s on the rare side that they have zero improvement over time,” she says. Ayden Varno can attest to that. After being essentially disabled by his pain for almost a year, his symptoms have improved since entering Rainbow Babies’ post-COVID clinic and trying a mixture of physical therapy, acupuncture, massage, sleep and nerve-pain medication, and supplements. Though his mobility is still limited and he struggles with brain fog, fatigue, and seizures, he’s back at school on a modified schedule and able to be active for a few hours at a time and see friends. “Just keep pushing, and look on the bright side,” Ayden says. “Don’t look at the negative side. There’s always hope.” from https://ift.tt/gQ9e6nx Check out https://takiaisfobia.blogspot.com/ Asthma isn’t always a quick and easy diagnosis in children. According to a 2014 task force assembled by the American Thoracic Society and the European Respiratory Society, pediatric severe asthma can be diagnosed if a child’s symptoms require treatment with high-dose inhaled corticosteroids plus a second “controller” medication for a full year, and/or systemic corticosteroids for half a year or longer. In other words, its diagnostic criteria are based on the intractability of its symptoms. “It’s definitely a limitation when you’re defining a disease state based on how much medicine is needed to control it, but part of that is because asthma is such a heterogenous disease,” says Dr. Jonathan Gaffin, co-director of the severe asthma program at Boston Children’s Hospital and an assistant professor of pediatrics at Harvard Medical School. In some children with severe asthma, the condition causes daily breathing problems but few outsize exacerbations. In others, this trend is reversed; extended periods of symptom-free living are broken up by infrequent but serious flares. In fact, a young person’s lung function may appear normal and healthy in between exacerbations, which experts say is one difference between severe asthma in children as opposed to severe asthma in adults. Severe asthma has another defining trait: it tends to show up very early in life. “By the time they walk through the school gate for the first time, they already have permanently impaired lung function and, in most, symptoms are there,” says Dr. Andrew Bush, an asthma specialist and director of the Imperial College London Centre for Paediatrics and Child Health. He says that in some cases, the asthma may only become severe and unmanageable later in childhood. But it’s exceedingly rare for a child with no signs of asthma to develop the condition beyond the first years of life. “There are cases that appear to be later onset, but if you look back, you find most had symptoms they forgot about as younger children,” Bush explains. While severe asthma in kids is defined by its resistance to treatment, there are some newer medications that can bring the condition under control and prevent the need for systemic corticosteroids or other aggressive remedies, which may be especially risky for growing and developing kids. However, experts say that long before those medications are deployed, important diagnostic work must be done to reveal if a child’s asthma truly is severe. Uncertain prevalenceAsthma is one of the most common medical conditions in young people. By some estimates, almost 1 in 10 American children under the age of 15—which equates to nearly 6 million—has asthma. Experts agree that rates of asthma in children have risen dramatically during the past 40 years (although there’s evidence that this increase has slowed considerably in recent years). When it comes to severe asthma in children, there’s more room for disagreement. While some estimates peg its prevalence, roughly, at between 2% and 5% of all pediatric asthma cases, experts say it’s hard to know for certain. That’s because many kids with hard-to-control symptoms may be struggling due to poor medication adherence, regular contact with allergens, or other factors. “More than half of the children referred to me with possible severe asthma in fact have a problem with environmental exposures or with how they’re using their inhaler—that sort of thing,” Bush says. These situations are sometimes termed “difficult to treat” asthma. In other cases, a child’s breathing problems may turn out to be the result of non-asthma conditions, which explains why the medications aren’t helping. For example, inducible laryngeal obstruction is a reversible and temporary narrowing of the larynx that can mimic the symptoms of asthma. Chronic infections can also cause asthma-like symptoms. To diagnose severe asthma, those must be ruled out. While the exact prevalence of severe childhood asthma is hard to nail down, experts agree that the condition is responsible for a large share of asthma-care expenditures. According to a 2017 study in the Journal of Allergy and Clinical Immunology, of the $10 billion spent every year on childhood asthma in the U.S., as much as half of that money is used to treat kids with severe asthma, whether for hospitalizations, medications, or in-office visits. Read More: What to Know About the Latest Advances in Managing Severe Asthma Causes, presentation, and diagnosisWhy do children develop severe asthma? The usual suspects—environmental exposures combined with a genetic susceptibility—are a safe bet. But elucidating the specific causes of severe asthma is challenging. “The pathogenesis of asthma is really complex in children, and many mechanisms may be responsible,” says Dr. Marielle Pijnenburg, head of the department of pediatric respiratory medicine and allergology at Erasmus University Medical Center in the Netherlands. Pijnenburg says that allergic triggers, viral infections, diet, air pollution, tobacco smoke, and microbiome disturbances are all being looked at as possible contributing factors. But filling in the existing knowledge gaps will be difficult. “To look into the lungs and see what’s going on requires invasive tests that are not feasible in children,” she says. When it comes to the disease’s presentation, for many kids, the very first symptoms appear quite early in life—by age 1 or 2. “The child has a viral cold and develops a wheeze, or often has severe attacks of wheeze,” Bush says. Among those kids who will go on to have severe asthma, he says that several factors predict this progression: in-home exposure to tobacco smoke before the age of 3, sensitivity to multiple allergens, and severe wheezing attacks that require hospitalization. While the first symptoms usually begin at a very young age, it can be difficult to assess lung function or other asthma-related diagnostic criteria in small children. And so in most cases, it’s hard to know if severe asthma is present until children are school aged—at least 5 or 6 years old. Again, this diagnosis requires a lot of process-of-elimination work. It is becoming increasingly common for a young person’s care team to perform an in-home evaluation. “Someone goes to the home of the child to see if there are dust mites or mold or pets, or if one of the parents smokes,” Pijnenburg explains. She says that one of the things that differentiates childhood severe asthma from severe asthma in adults is the commonness of allergic triggers. While about half of adults with severe asthma have allergies that make the condition worse, this rises to 80-85% of kids with severe asthma. Identifying and attempting to remove allergic triggers is a crucial step. It’s also becoming common for kids with symptoms of severe asthma to receive an evaluation from a multidisciplinary care team that includes a pulmonologist, but also an allergist and even a mental health counselor or specialist. “Kids with asthma can experience scary episodes where they are really having trouble breathing, and by the time we see them, they’ve been admitted to the hospital or ICU, and they’ve experienced a lot of poking and prodding that can lead to anxiety,” Gaffin says. This anxiety can cause distress, which can make asthma symptoms worse and also harder to manage. Once these contributing or exacerbating factors have been assessed and ideally resolved, and assuming other tests confirm the presence of asthma, a diagnosis of severe asthma is warranted if a young person continues to experience severe symptoms or flares. Read More: How Alternative Medicine Can Help People With Asthma How severe asthma is treatedAsthma specialists talk a lot about “getting the basics right.” That means long before the newest and most-aggressive class of drugs are considered, it’s essential to ensure that young people are taking their medications properly. “Medication adherence is probably the biggest issue,” Gaffin says. Again, a lot of kids with severe asthma feel pretty good between flares, which can cause them to neglect their inhalers or other meds. “But even children with severe asthma who [have]symptoms have difficulty taking their medications as prescribed on a regular basis,” Gaffin says. “Are they holding their breath after inhaled corticosteroids for 10 seconds to make sure the medicine gets deep into the lungs?” These are the types of lapses that he sees in both kids and in adults with severe asthma. In some cases, fixing these issues can bring the asthma under control. Once medication lapses and all other modifiable triggers have been dealt with, kids with severe asthma may be eligible for a “biologic” drug, so named because it is derived from a living organism. For severe asthma, all of the biologic therapies are monoclonal antibodies—specialized proteins that affect the function of the immune system in ways that mitigate the kind of inflammation that drives asthma symptomology. The U.S. Food and Drug Administration has approved three of these drugs for use in children with severe asthma, and all three are given via skin injection, typically at the doctor’s office. Sometimes doctors will observe kids for up to two hours after administering an injection. “Usually they’re given every two or four or eight weeks, and they tend to be very effective,” Gaffin says. In most cases, kids on these drugs experience fewer severe flares and daily symptoms. But there are potential drawbacks to these drugs, including pain from the injections, headache, sore throat, fatigue, and a risk for allergic reactions. The potential long-term effects of the drugs are also unknown. “One of the issues is that even though these drugs are tested, there usually aren’t as many pediatric participants in clinical trials, so a lot of the data is extrapolated from adults,” Gaffin says. Bush puts it more bluntly. “It’s a scandal that almost all the data are in children 12 and older and adults,” he says. “Younger children are a forgotten population.” He agrees that biologics often work well, and he prescribes them when appropriate. “But they are hardcore expensive, and nobody knows the optimal duration of treatment,” he adds. Severe asthma, unlike asthma that is milder and more manageable, tends not to resolve or improve as a child matures into adulthood. However, Bush says the disease does change, and it’s hard to know based on the current available evidence whether biologics are needed indefinitely, or whether temporary courses could be effective. Pijnenburg reiterates many of these concerns, but also emphasizes that biologics can be “life changers” for some kids. “We don’t know if we need to continue them forever, or if we can wean kids off them, or how we should wean them,” she says. “But we often get excellent control with biologics, so kids go into adulthood with not too many symptoms.” While severe asthma is a complex and hard-to-manage condition in children, the newest medications—coupled with a more rigorous approach to identifying environmental and lifestyle factors that may contribute to a child’s symptoms—is helping more kids find relief from their asthma. That kind of progress is worth celebrating. from https://ift.tt/DYRjKw8 Check out https://takiaisfobia.blogspot.com/ The Arkansas Trial on Gender-Affirming Care Has Serious Implications for Trans Youth Across the U.S.10/21/2022 This week, a federal court in Arkansas is hearing testimony about whether a ban on access to gender-affirming health care passed by the state’s legislature in 2021, and stayed by court injunction, should be upheld or struck down. In Arkansas, up to 1,800 transgender youth under the age of 18 could be prohibited from accessing health care that is recommended by many professional associations, including the American Academy of Child and Adolescent Psychiatry, as evidence-based patient care. This ban has direct and severe consequences for the lives and safety of transgender children in Arkansas, and generates unnecessary stress for transgender youth and families across in the U.S. The importance of access to gender-affirming care for transgender youth cannot be understated. More than a third of transgender high school students who completed a 2017 survey conducted by the Centers for Disease Control and Prevention report attempting suicide in the prior 12 months--at four to six times the rate reported by their cisgender peers. Research has shown that access to puberty blockers is associated with lower odds of lifetime suicidal ideation and receipt of gender-affirming medical care is associated with lower risk of suicide attempts among transgender adults surveyed in 2015 who wanted and received such care (6.5%), compared to those who did not (8.9%). It’s clear that efforts to support transgender youth in living according to their gender identity are associated with better mental health, while efforts to change the gender identity of transgender people increases risk of suicidality. Gender-affirming care includes access to hormones to delay puberty, which is fully reversible, and hormones to promote the development of secondary sex characteristics (such as facial hair or breasts) that are consistent with a child’s gender identity. These are the same hormones that are used by pediatricians to treat children who start going through puberty too soon (younger than eight or nine) and are also used in birth control pills and are prescribed to cisgender men with low levels of testosterone. In other words, hormones have been around for a long time and are used by many people to treat a range of conditions. Read More: Trial Begins Over Arkansas Ban on Gender-Affirming Care for Trans Youth The negative impact of being denied gender-affirming care on mental health doesn’t occur in a vacuum, but impacts young people who are already under a monumental amount of stress. Transgender youth are exposed to much higher levels of school-based violence, including being threatened or injured with a weapon at school, than their cisgender peers. Some experience rejection from their own families because they are transgender, and 93% worry about access to gender-affirming medical care for transgender people while 83% worry about transgender people being denied the ability to play sports due to the actions of policymakers in more than half of U.S. states. Cumulative stress exposure is a risk for poor mental and physical health, in general, and has been shown to increase risk for suicidality in a study of more than 27,000 transgender people. Research also suggests that the negative health effects of denying transgender youth gender-affirming care starts not with their enforcement, but with the public discussion of the issue and the law’s enactment and approval by courts. Studies on other LGBTQ+ issues has shown that having your life and your rights publicly debated can have negative impacts on health, as does the passage of laws that codify anti-LGBTQ+ laws. This court decision will have serious implications for the 1,800 transgender youth who reside in Arkansas, the many more who will be born and raised in the state, and for the mental health of nearly 300,00 transgender youth who reside elsewhere in this country. from https://ift.tt/tKeriqh Check out https://takiaisfobia.blogspot.com/ NEW YORK — COVID-19 shots should be added to the lists of recommended vaccinations for kids and adults, a panel of U.S. vaccine experts said Thursday. The panel’s unanimous decision has no immediate effect—COVID-19 shots already are recommended for virtually all Americans. Rather, it would put the shots on the annually updated, formal lists of what vaccinations doctors should be routinely offering to their patients, alongside shots for polio, measles and hepatitis. The expert panel’s decisions are almost always adopted by the CDC director and then sent to doctors as part of the government’s advice on how to prevent disease. State and local officials often look to the lists in making decisions about vaccination requirements for school attendance, but local officials don’t always adopt every recommendation. Flu and HPV shots, for example, aren’t required by many schools. Usually, vaccines placed on the schedules are fully licensed, but that has not yet happened for every COVID-19 vaccine product in every age group. COVID-19 shots initially were approved under emergency authorization measures starting in late 2020. Over time, the government has licensed many of the shots, but full approval has not yet happened for booster doses or for shots for kids younger than 12. Because the shots have already been recommended under emergency authorization for Americans older than 6 months, however, the decision makes no real difference, federal officials say. Earlier this week, the same expert panel voted unanimously to add COVID-19 shots to a program that provides vaccines at no cost to children who might not otherwise be vaccinated. This is in preparation for the day in the future when the federal government transitions out of paying for all COVID-19 shots, as it has been doing.
from https://ift.tt/0Yya7AZ Check out https://takiaisfobia.blogspot.com/ Millions of Americans spend weeks each year sneezing and sniffling due to allergies to seasonal triggers such as tree, grass, or ragweed pollen. And for the subset of people who are allergic to year-round household irritants like dust mites, mold, and cockroaches, any season can turn into allergy season. Allergy symptoms happen when your immune system interprets what should be a relatively benign substance as a threat. The severity of symptoms and the difficulty of treating them can vary depending on your genes, how many substances you’re allergic to, and your level of exposure, says Dr. H. James Wedner, an allergy and immunology specialist at Washington University in St. Louis. For many people with mild symptoms, the misery of seasonal or environmental allergies can be tamed by over-the-counter medications—but for others, all the pills and nasal sprays in the world don’t seem to make a difference. Some allergy sufferers genuinely don’t respond to treatment, and researchers are still studying why that is, Wedner says. But others may be able to find relief with the right remedy. “I feel like we normalize allergies” to the point that people think they have to live with them, says Dr. Caroline Sokol, principal investigator at Massachusetts General Hospital’s Center for Immunology and Inflammatory Diseases. But “we have tools in our belt to actually help people.” Here’s what has the best efficacy, and what’s on the horizon. Antihistamines and corticosteroidsFor many people, antihistamines (which block the effects of a chemical created by your immune system) and/or corticosteroids (anti-inflammatory drugs) are enough to get allergies under control. These drugs can be administered orally or through nasal sprays, and are typically available in over-the-counter and prescription-strength forms. Wedner recommends introducing medications several weeks before peak allergy season to blunt symptoms before they start. It’s also important to take these drugs exactly as directed. Sokol notes that some sprays take about a week to work. If your medication isn’t effective, you may not be using the right one. Antihistamines are great for symptoms like itchy eyes, Sokol says, but corticosteroids are better for congestion. You may need to mix and match to find the right regimen for your symptoms. Environmental control“Nobody’s allergic to something that isn’t there,” Wedner says, so decreasing allergen exposure is sometimes the best way to ease symptoms (though it’s often easier said than done). Mite-blocking encasements for bedding can be helpful for those with dust allergies, Sokol says, and replacing carpet with tile or hardwood can eliminate hiding places for allergens. HEPA air filtration systems can also help, she says, as long as they’re the right size for your space. Pet allergies can be the hardest to manage through source control, Wedner says, because pet owners often refuse to rehome their animals even if they’re allergic to them. For years, Wedner’s lab tried to reduce the allergenicity of cats by washing them, something that wasn’t terribly effective and that both people and cats hated, he says. That effort didn’t pan out, but his team recently tested a specialty food that neutralizes allergens in cat saliva--which spread to cats’ coats while they clean themselves—and found it to be effective. Keeping pets out of your bedroom can also reduce symptoms, Sokol adds. ImmunotherapyPeople with chronic environmental allergies may want to try immunotherapy, which gradually acclimates the body to allergens through a series of injections. It’s “one of the few ways that we as physicians can actually change your immune system,” Wedner says. But immunotherapy is not a quick-and-easy solution. It requires weekly shots for about six months, followed by years of less-frequent maintenance shots. Studies show that about 85% of people get at least some relief from immunotherapy, but some patients eventually relapse and others don’t respond at all. Researchers aren’t totally sure why, but it’s likely in part because there is no commercially available test to determine exactly which protein within an allergen is causing someone’s symptoms, says Dr. Gabriele de Vos, an associate professor of allergy and immunology at Albert Einstein College of Medicine in New York City. “Even if you have 10 people who all have dust-mite allergies,” de Vos says, “their allergies may be very different.” Without granular testing, it’s impossible to create an individually tailored immunotherapy regimen, de Vos explains. Such tests are in development, but it’s not clear if or when they’ll be used clinically, de Vos says. Immunotherapy using pills that dissolve under the tongue, instead of shots, is now available for dust-mite and grass allergies, and studies have shown that this method can be effective. The caveat, Sokol says, is that people who are allergic to many things may still experience symptoms, since the pills are specific to dust or grass. Research has also shown that injecting allergens directly into the lymph nodes can be effective. BiologicsBiologics—protein-based drugs that, in the case of allergies, neutralize parts of the immune system that cause inflammation—are an up-and-coming treatment option. These drugs could be used to promote “long-term tolerance to our environment,” or in conjunction with allergy shots to speed up their efficacy, Sokol says. Biologics are still the subject of active research, but some can already be prescribed to patients who need something stronger than over-the-counter treatments. from https://ift.tt/lQTOxWJ Check out https://takiaisfobia.blogspot.com/ As the human resources director for family Destinations Guide, a website that offers kid-friendly vacation ideas, Bonnie Whitfield always makes sure employees feel comfortable disclosing their medical conditions so the company can provide accommodations. For Whitfield, it’s not just professional—it’s personal, because she has inflammatory bowel disease (IBD). “Since I have IBD myself, and I’ve been through a few flare-ups at work, I know what it’s like to be in that situation,” she says. Employees are often trying to navigate not just the symptoms of a chronic illness, but also anxiety over questions like: Should I tell my employer and coworkers? Will people feel like they can’t count on me? What if I’m embarrassed to talk about it? These are all common concerns, says Whitfield, and unfortunately, worrying about such issues can actually put you at higher risk for an IBD flare that could affect your work. IBD encompasses two conditions--Crohn’s disease and ulcerative colitis—that are characterized by inflammation of the gastrointestinal tract, leading to symptoms like diarrhea, abdominal cramping, fatigue, and sudden weight loss. Treatment options help many people go into remission so their condition becomes a non-issue, but even on medication, symptoms may return in a flare-up that can range from mild to debilitating and might last days or weeks. The unpredictability of the disease is another source of potential anxiety when considering how it will affect work performance, Whitfield says. “Sometimes, pushing yourself can make your flare worse,” she adds. “Having a plan in place beforehand can go a long way toward keeping you productive while still taking care of yourself. It’s important to remember that being sick shouldn’t mean you can’t be an effective employee.” Here are some tips to consider when balancing your health and your workplace, even if your IBD is in remission right now. Let your employer know—and put it in writingAlthough the symptoms of IBD—like frequent trips to the bathroom, gassiness, and bloating—can feel embarrassing, it’s important to recognize you have a chronic illness and that it should be handled as such, Whitfield advises. She suggests telling your direct supervisor and HR director not just about your condition, but also what you need in terms of accommodation and why that will help you function better in the workplace. For example, many people with IBD benefit from having an office or cubicle closer to the bathroom, which can shorten the amount of time spent going back and forth during a flare. Also, simply being closer might reduce worry about the issue, and in itself that could tamp down some symptoms. Having to use a wheelchair may also come into play, since side effects used to treat ulcerative colitis can lead to mobility challenges, so letting an employer know that could be a possibility—and ensuring you have access to all the areas you need—is crucial for planning ahead. There may be multiple doctor visits as well, especially when flares are more dominant, and treatment could include options like surgery in the future. Preparing an employer for that possibility should be part of the conversation about your condition. Whitfield says putting information like this into writing is the best approach, since it provides the most clarity about what you need. Plus, it ensures that all parties are receiving the same information. “Explain how IBD affects your work performance and how you can still do your job effectively while keeping up with treatment regimens and any other responsibilities required by the company, such as working overtime,” she adds. “The more specific you can be about what accommodations would help keep you healthy and productive, the better equipped your employer will be to develop a plan that works for both of you.” Another benefit to writing it down: It may feel easier than saying everything in a meeting, particularly with multiple people or those you don’t know well. For instance, when Los Angeles-based Span Chen was working as a cashier, every day felt like a battle due to pain and the inability to leave a line of customers. Treatment helped reduce flare-ups, but also led to more fatigue. He felt hesitant to bring up his struggles. “What helped was writing a letter to my boss explaining what was going on, and that I needed to take time off in order to heal fully,” says Chen. “Because I wrote it down, I didn’t forget key points, like saying that being able to have more time away from work would allow me to return in full health.” Read More: How to Maintain Your Social Life When You Have IBD Establish some code words and contingency plansEven just having a key phrase can be useful, says Cassie Mahon, who leads client meetings for her employer in Columbia, Missouri. She informed her boss about her IBD, and together they formulated a plan of action about what to do if Mahon had to leave suddenly. “If I say that it’s time for a short break, she understands what’s going on and we don’t have to tell everyone else in the room what’s happening,” she says, adding that sometimes her boss will step in to continue a presentation if necessary. That might seem like a minor tweak to the process, but Mahon says it provides much-needed reassurance that her work can continue with minimal disruption. Stick to your routineAlthough IBD might not be predictable, your work schedule still can be, if you have the option of being flexible about location. That means making sure you’re able to work from home occasionally and that there’s a plan in place for those days, including having a home office setup and access to online company resources. “Stay true to your usual routine as much as possible, which can help take some of the stress out of an IBD flare,” Whitfield says. “This can keep your life feeling normal while also giving your body time to recover.” Of course, not everyone has the option of working from home, but if it’s a possibility for you and can alleviate some of the worry around being in the office, it’s helpful to incorporate at-home time when you can. If it’s not possible, Whitfield says that creating a more flexible work schedule could be another beneficial strategy. For instance, if being around so many coworkers makes you anxious about flares, you might swap one weekday for working on a weekend day so you’re in the office with fewer people. Keep supplies on handAnother part of preparation is knowing what you need so you have items at the ready, no matter what. For Boston-based Keyla Caba, being anywhere that’s not home can be difficult with her IBD, particularly because she wears an ileostomy pouch—a special bag that collects waste from the colon—which must be emptied regularly. After years of fretting over the distance between her desk and restroom, she decided to make it a priority to make her experience more comfortable, and address her fears about not making it to the bathroom in time. That has meant always having spare clothes at the office, as well as some sort of deodorizing spray, and a sign she would hang on her desk to let colleagues know she was having a flare and needed extra time away. “This was the start of how I transformed the office bathroom into a peaceful experience for myself, and relieved my restroom anxiety,” Caba says. “Knowing that I have what I need on hand can reduce my fears about flares.” Know your rightsEven if company management and HR are happy to accommodate your needs as someone with IBD, it’s still essential to know your rights as an employee, says Kia Roberts, principal and founder of Brooklyn, New York-based Triangle Investigations, which handles assessments of workplace misconduct. For example, she recently worked on a harassment case for a person with Crohn’s disease who wasn’t given accommodations by her manager. “Most workplaces today understand the importance of not discriminating against employees based on protected characteristics like race, sexuality, gender, and ethnicity, but many employers do not understand the importance of having a policy on how employees with health issues should be treated within the workplace,” says Roberts. “If an employee feels they are being singled out for different treatment based on their health issues, that could represent discrimination on the part of the employer.” Another important aspect of your rights: If your IBD is disabling, it’s protected under the Americans with Disabilities Act, which means your employer must make reasonable accommodations. You may also be covered under the Family and Medical Leave Act, which entitles eligible employees to take unpaid, job-protected leave for medical reasons—up to 12 weeks of leave within a 12-month time period. Focus on gut-healthy lifestyle habitsPart of being more productive at work comes from what you do outside of the office, and that means implementing the right lifestyle behaviors, according to Dr. Ashkan Farhadi, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif. In addition to making sure you follow treatment protocols like medication you may be prescribed, you can lower risk of flares by focusing on gut health, he says. “Diet will, of course, play a major role in your IBD management, but equally important are other habits that improve your gut microbiome,” Farhadi says. “The three most prominent are sleep, stress reduction, and exercise, because if you get those on track along with your diet, it can significantly reduce the frequency and severity of flares.” For example, there’s a strong association between sleep difficulties and gut function, which can lead to more than just daytime sleepiness or flares at work. A 2018 study in the journal Frontiers in Psychiatry found that insomnia has been linked to poor immune function, difficulty absorbing certain nutrients, and depression. Read More: These Environmental Factors Increase the Risk of IBD Stay aware of potential overwhelmStress is another big challenge when it comes to avoiding flares, adds Dr. Rudolph Bedford, a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, Calif. “Chronic stress has a ripple effect on your gut microbiome, which means it can impair your gastrointestinal system and keep it from functioning well,” he says. “When you have IBD, that means it could make your flares more intense, or could cause flares even if they’ve been well managed in the past.” A significant part of better stress control comes from evaluating all aspects of your everyday activity, and that includes work. If you’re feeling frazzled, that’s another conversation to start with your supervisor and HR. “When someone has a chronic illness like IBD, remember that it should be a team effort in terms of management,” Whitfield says. “The more that people around you understand what’s going on, the more it will benefit you, your company, and your coworkers.” from https://ift.tt/ROBcbHy Check out https://takiaisfobia.blogspot.com/ |
Authorhttps://takiaisfobia.blogspot.com/ Archives
April 2023
Categories |