About 140 million babies were born globally last year—the equivalent of adding an entire new Russia to the world’s population. Not counted among those typically blessed events are the number of families whose pregnancies end tragically. According to the United Nations Interagency Group for Child Mortality Estimation, about 2 million pregnancies around the world end in stillbirth each year. The causes of natal death are numerous—from fetal abnormalities to labor complications to maternal hypertension to infections to placental malformation. Now, according to a new study in Nature Communications, there is another, particularly pernicious cause that may account for up to 39.7% of stillbirths in low- and middle-income countries: air pollution, specifically in the form of fine particles measuring 2.5 microns—or millionths of a meter—or less. The particles, about 3% of the width of a human hair, typically come from vehicle exhaust, the burning of coal and heating oil, and natural sources like wildfires. According to the new research, led by environmental scientist and public health specialist Tao Xue at Peking University Health Science Center in Beijing, every 10 micrograms—or millionth of a gram—of so-called PM2.5 particles per cubic meter of air increases the risk of stillbirth by 11%, with the toll greater on older mothers than younger ones. “The United Nations calls the global burden of stillbirths a neglected tragedy,” the paper’s authors write. “Preventing stillbirths depends on a comprehensive understanding of the underlying risk factors.” The World Health Organization (WHO) has established a so-called reference level—or maximum safe exposure—of PM2.5 at 5 micrograms per cubic meter of air. Above that level, the particles can contribute to heart disease, asthma, decreased lung function, and premature death in people with pre-existing heart or lung disease. Researchers have long drawn a potential link between PM2.5 exposure and stillbirth, but what they hadn’t done, until Tao and his colleagues took the topic on, is to study how the burden falls disproportionately on people in poorer countries. According to the World Bank, the average global concentration of PM2.5 is an alarming 46 micrograms per cubic meter—or nine times the WHO’s reference level. But the burden is not spread equally. In Australia, it’s a more tolerable 9 micrograms; in Canada, it’s just six. The Bahamas clocks in at just 5.58. It’s elsewhere, in the less developed world, that the pollution problem hits the hardest. To conduct their study, the investigators selected 137 low- and middle-income countries in which data from the Department of Health Surveys (DHS), a division of the U.S. Agency for International Development (USAID), show are home to 98% of the world’s incidence of stillbirths. They cross-indexed those mortality figures with other data from the WHO’s Air Quality Guidelines detailing the severity of PM2.5 pollution in each of those countries. The results drew a bright line between the particulate emissions and the incidence of stillbirths. India, the hardest-hit country, with an annual average of 217,000 stillbirths (out of 25 million live births), had a PM2.5 concentration of 60.15 micrograms per cubic meter of air—or 12 times the WHO’s reference level. Pakistan, the second most severely affected country, with 110,000 stillbirths per year (compared to 6.075 million live births), weighed in at 63.16 micrograms of pollution. Following them were Nigeria (93,000 stillbirths, 7.8 million live births, and 69.66 micrograms); China (64,000 stillbirths, 10,6 million live births, and 51.11 micrograms), and Bangladesh (49,000 stillbirths, 2.8 million live births, and 69.58 micrograms). In addition to PM2.5 air pollution, the study also cites the possibility of naturally occurring high concentrations of dust—particularly in sub-Saharan Africa and the Arabian Desert region—as another source of dangerous particles. Maternal age played a significant role in the mortality risk. Relying on DHS data, as well as two existing meta-analyses of stillbirth incidence, the researchers calculated that mothers who lost their children at birth were, on average, 3.81 years older than those whose babies were born successfully. The greatest risk of stillbirth in high PM2.5 countries was among mothers ages 34 years or older. Just what the mechanism is that links PM2.5 concentration to stillbirth is uncertain. “Although potential biological mechanisms for the association of PM2.5 exposure and pregnancy loss are not clear yet,” the researchers wrote, “some pathways can explain it to some extent.” The researchers propose three possibilities. First, when a pregnant person inhales PM2.5 particles, they enter the bloodstream and may directly cross the placental barrier where they flow into the fetus, leading to low oxygen levels or immune problems in the baby, both of which can be associated with fetal death. There is also the possibility that exposure to PM2.5 can lead to the development of methemoglobin in the parent—a form of hemoglobin that does not bind with oxygen and thus does not deliver sufficient quantities of oxygen to the fetus, also leading to immune problems and potentially death in the womb. Finally, PM2.5 can lead to abnormalities or malformations in the placenta itself, preventing it from sustaining a fetus throughout pregnancy. The outlook was not entirely bleak. The study notes that the global stillbirth rate actually decreased by 1.95% from 2000 to 2009, and fell again by 2.05% from 2009 to 2019. It attributes the trend to improved air quality in multiple countries‚ notably China, that are taking slow steps away from coal-fired power plants and cleaning up their power grid with renewable sources of energy. In the meantime, pregnant people can take steps to reduce their exposure to PM2.5 pollution and better monitor the potential impact of the particles. Wearing N95 or KN95 masks outdoors on heavily polluted days, avoiding the outdoors when air quality is at its worst, and installing air purifiers in the home can all help. So too can improvements in prenatal care and timely intervention—including cesarean sections—in the case of premature or complicated labor. Pregnancy and childbirth have never been easy. But more often than they do now, they should result in a happy outcome. In 137 countries at least, our own poor stewardship of the health of the planet is too often denying families that joy. from https://ift.tt/PyrRH42 Check out https://takiaisfobia.blogspot.com/
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Over the past few years, Alzheimer’s patients and their caregivers have been on a roller-coaster ride full of highs and lows in the search for treatments—and new research presents another emotionally thrilling loop. In data presented at the annual Clinical Trials in Alzheimer’s Disease meeting in San Francisco, and published in the New England Journal of Medicine, scientists from the Japanese pharmaceutical company Eisai showed that its drug for Alzheimer’s led to improvements in people’s cognitive functions. The improvements weren’t huge, or even the first to be reported with an Alzheimer’s medication. But they do come from the most comprehensive and advanced study on Alzheimer’s patients to date. In a phase 3 trial, Eisai researchers showed that people taking the drug lecanemab, which targets the amyloid protein that builds up in the brain during Alzheimer’s, slowed cognitive decline by 27%, as measured by standard clinical tests, compared to people assigned to a placebo. Those results mean that lecanemab is a disease-modifying drug: one that impacts the course of Alzheimer’s, rather than simply treat its symptoms, which all but one of the approved drugs for the condition do. But as encouraging as the results are, they come at a bewildering time for the Alzheimer’s community, which has been buoyed by hopeful news only to have those expectations dashed in short order. In June 2021, the Food and Drug Administration (FDA) approved the first drug to treat Alzheimer’s, aducanumab (brand name: Aduhelm). As with people who took lecanemab, those taking aducanumab showed improvements in cognitive tests compared to people taking a placebo. But the benefits of aducanumab—unlike with lecanemab—were reported in an earlier phase 1 study that involved a smaller number of patients and that was designed to test the safety, not the efficacy, of the therapy. These benefits were not robustly and consistently repeated in phase 3 studies of the drug. Still, the FDA approved the medication in a controversial decision based on the assumption that lowering levels of amyloid in the brain, which aducanumab did, would translate into meaningful clinical benefits. But given the uncertainty of the data, the Centers for Medicare and Medicaid Services decided not to cover the high cost of the drug, which runs $56,000 a year, and required additional trials to confirm the treatment’s effectiveness. The Alzheimer’s community of patients and physicians have been reluctant to take the risk of trying the therapy—and despite being the first disease-modifying drug approved by the FDA, aducanumab has remained under-utilized. Eisai, which had partnered with the U.S. biotech company Biogen to develop and test aducanumab, now has stronger results with lecanemab to support the connection between lowering amyloid and measurable brain benefits for Alzheimer’s patients. That will likely boost so-called anti-amyloid strategies, which focus on shrinking or ridding the brain of the protein plaques that build up in order to slow the neurodegeneration that’s the hallmark of the disease. But the scientific ride isn’t over yet; even with the encouraging results, the amyloid strategy still has a lot to prove. At the same conference at which the lecanemab data were presented, Roche is reporting on its anti-amyloid treatment, but with more disappointing results. Roche found that its compound, gantenerumab, did not lower amyloid significantly and did not help patients improve their scores on cognitive tests. What are patients and the doctors who care for them to make of these reports? To start, “not all anti-amyloid drugs are the same,” says Dr. Pierre Tariot, director of the Banner Alzheimer’s Institute. “We are still learning what it means to mitigate amyloid dysregulation in terms of longer term benefit. But we now have an array of results with some encouraging signals that look like some of these drugs bully the disease process, and that is associated with some measurable clinical benefit for people with mild symptoms.” The keys to lecanemab’s successEisai’s positive results were a long time coming. Research on lecanemab began in the mid-1990s, as the company’s scientists continued their hunt for a drug to treat Alzheimer’s. In 1996, the company had successfully brought the second medication ever for the disease, donepezil (brand name: Aricept), to the market after the FDA approved it for people with mild-to-moderate Alzheimer’s. The drug does not change the progression of the disease but can improve some of its cognitive symptoms. Encouraged by that success, while at the same time realizing that donepezil fell short of treating the disease, Eisai’s scientists focused on tackling the amyloid buildup in the brain that contributed to memory loss and other cognitive symptoms of Alzheimer’s. They decided to find and target one of amyloid’s more noxious forms: protofibrils, which are particularly toxic to nerve cells in the brain. But isolating just the right form of amyloid, and finding ways to remove it without causing other side effects, was a long and arduous process. Researchers trying to develop Alzheimer’s treatments reported many false starts, and patients and families became more desperate. “When we met with patient advocacy groups, most of the time the first thing I said to them was, ‘Sorry,’” says Ivan Cheung, chairman and CEO of Eisai Inc. “They wanted to know why it was taking so long, and were we not trying hard enough, or were we not intelligent enough? We disappointed a lot of families.” Read More: How Sleep Could Ward Off Alzheimer’s Disease Amyloid, a protein made in the brain and other parts of the body, only becomes problematic when it sticks together and form plaques that strangle neurons and their delicate connections. One form, amyloid beta, can become especially molecularly clingy, sticking together to first form oligomers and protofibrils—and eventually clump together into plaques. After painstaking work testing compound after compound, Eisai’s scientists found that lecanemab binds to protofibrils with a 1,000-fold greater affinity than it does to amyloid beta, which means it can drastically reduce the most dangerous forms of the protein. While Eisai was collaborating with Biogen on both aducanumab and lecanemab, each of the two companies called dibs on one compound and took on the responsibility for developing and testing it. Biogen claimed aducanumab, and Eisai took responsibility for lecanemab. Biogen notched the first victory, when its phase 1 study of aducanumab stunned the Alzheimer’s community in 2014 with its tantalizingly positive results. Based on those findings, the company decided to leapfrog over phase 2 trials by conducting a more comprehensive phase 3 study, since they already had a strong signal that the drug could reduce amyloid and slow cognitive decline. An early readout of the drug in 2019, however, showed no significant improvements in brain function among people taking the drug, and the company decided to end the trial. Upon further analysis of the data, however, its scientists found glimmers of hope and restarted the study among people with mild-to-moderate Alzheimer’s. Ultimately, Biogen conducted two studies of the drug: one which turned out positive, showing drops in amyloid, and one that showed little difference between the treated and placebo patients. Because there were no treatments for Alzheimer’s, and a dire unmet need for one, the FDA decided, in an unusual and controversial move, that the reduction in amyloid, and the earlier promising phase 1 findings of improvements in cognitive function, were sufficient to approve the drug on the condition that Biogen conduct an additional study to prove its effectiveness. Many in the scientific community disagreed, and insurers sensed that skepticism and declined to cover the treatment except for people enrolled in research studies. Eisai took a different approach with lecanemab. After promising phase 1 results, which showed that homing in on protofibrils was safe for patients, it embarked in 2012 on a lengthy phase 2 study that would take 18 months. Led by the company’s senior vice president of clinical research Dr. Michael Irizarry, Eisai’s team designed a novel and complicated trial that adjusted which doses people received based on early readouts and modeling of results from the first patients. The idea was to ensure that time and resources weren’t wasted; scientists tested each of five doses at a time and waited months to see if the drug had any effect or caused any adverse reactions. The patients enrolling later in the trial benefited from what the team was learning from the participants who had come before them. “During the study, a computer algorithm looked at cognitive outcomes and predicted which dose was effective, and started to weight future randomization of the volunteers to doses that were most likely to be effective, and reducing the sample sizes of the doses that were less effective,” says Irizarry. The approach was tedious and raised questions among some experts who thought the trial was more complex than it needed to be. “We received a lot of questions about why we were doing that,” says Cheung of the phase 2 study design. “They thought we were being irrational.” It didn’t help that the drawn-out phase 2 trial occurred while the explosive news about aducanumab’s success was dominating headlines, and the trial concluded after Biogen announced that its drug didn’t appear to work after all. Eisai announced the launch of its phase 3 trail of lecanemab just weeks after Biogen closed down its trial of aducanumab. Cheung argues that the rather than making the emotional decision to give up on lecanemab after aducanumab’s troubles—even though both targeted amyloid—it was rational to forge ahead based on the strong data from the phase 2 portion that showed signs that the drug would be effective. What these results mean for Alzheimer’s patientsEisai continued to complete its phase 3 trial, in a much simpler format this time, with the confidence gained from the detailed phase 2 study that the results would likely show that lecanemab improved patients’ cognitive function. In a way, the circumstances surrounding aducanumab’s failure relieved some of the pressure for Eisai and lecanemab, as the Alzheimer’s community now set lower expectations for what to expect from an anti-amyloid drug. Complicating the study, COVID-19 created challenges for the participants, who had to visit clinics or hospitals to receive the drug as an IV infusion over about an hour twice a month. “We set up home infusions, remote safety assessments, and remote cognitive assessments,” says Irizarry. “We tried a whole lot of things to make it easier for people to participate.” Read More: We Will Find a Breakthrough for Alzheimer’s Disease Fortunately, the unmet need for a treatment for Alzheimer’s ensured that less than 20% of volunteers dropped out of the trial; previous studies of drug candidates often saw 20% to 25% of participants leave the study. In September 2022, Eisai’s long game paid off, when the company announced that lecanemab was the first anti-amyloid drug to help patients slow their cognitive decline in a phase 3 study. “The phase 2 results ended up being quite predictive of the phase 3 results, and we expected that,” says Irizarry. The study followed the participants over 18 months, but Cheung speculates that the improvements will only continue the longer people take the drug. While it won’t mean that patients can expect to be cured of Alzheimer’s, it could mean several more years of functioning at a level that allows them to live independently, or attend a child’s wedding or a grandchild’s graduation. “Based on our phase 2 results, our projection is that lecanemab can delay the time from early Alzheimer’s to moderate Alzheimer’s by about three years,” says Cheung. A drug that produces 27% improvement in performance on cognitive tests is not a slam-dunk therapy. But experts see it as a wedge into a new era of Alzheimer’s treatments: those that can chip away at the buildup of amyloid in the brain, and then eventually slow or prevent the damage to nerve cells that comes later in the disease course. So far, lecanemab appears to have fewer side effects than aducanumab. Eisai reports that 12.6% of people experienced brain inflammation known as ARIA-E that can be potentially lethal, but which is treatable if the medication is stopped or the dose reduced. Most of these were detected on brain scans and the patients did not report symptoms of the side effect. (By comparison, about a third of people taking aducanumab developed ARIA-E in the drug’s phase 3 study.) Because of this more favorable side-effect profile, lecanemab does not have to be titrated, or started at a lower dose and gradually brought up to the optimal dose with each infusion depending on whether the patient develops signs of ARIA-E. That’s critical to preserve brain function, said Dr. Sharon Cohen, medical director of the Toronto Memory Program, who oversaw the study at her site, during a briefing at the conference. “If time is brain, and other [therapies] are taking eight to nine months to reach the optimal dose, patients are losing brain during that process. With lecanemab, patients are starting from day one at the optimal therapeutic dose, and that is time-saving and brain-saving.” The data found that lecanemab is safe at the tested dose of 10mg/kg every two weeks for 18 months; while 13 people died during the trial, they were almost equally distributed among the treatment and placebo groups, with seven deaths among those taking the drug, and six in the placebo group. Read More: How Exercise Lowers the Risk of Alzheimer’s by Changing Your Brain The FDA will likely consider those deaths, as well as data from the trial showing that people taking anti-coagulant drugs may have a slightly higher risk of bleeding events, before determining whether lecanemab is safe to prescribe as it stands, or if an additional warning on the label about hemorrhage risk is warranted. The agency will also compare the risk of ARIA-E among people taking lecanumab with the risk associated with other amyloid-lowering drugs. But based on the positive results, the door is now open to investigating how these anti-amyloid therapies can best be used to slow cognitive decline. Irizarry is already studying how lecanemab might be combined with other promising therapies, for example. Experts believe that the deposition of amyloid plaques leads to the disorganized structure of another protein, tau, which creates tangles that disrupt the critical connections neurons have to each other. Combining an anti-amyloid drug such as lecanemab with an anti-tau compound could help to put the brakes of the neurodegeneration associated with Alzheimer’s. “With my patients, I start with the analogy of a life raft that has a leak,” says Tariot. “Any medication will be a patch that slows down the leak, but doesn’t prevent it altogether. For some of my patients, it’s helpful to think of drugs like these as a disease-slower-downer.” But the picture may not be as clear as patients might hope. While lecanemab seems to be an encouraging way to reduce amyloid in the brain and slow cognitive decline, other anti-amyloid drugs may not perform as well. Roche recently announced that its amyloid therapy, gantenerumab, failed to shrink amyloid plaques and show significant improvement on cognitive tests. But gantenerumab is given as an injection—not as an IV infusion—and that may lead to inadequate levels of the drug in the brain to make a difference. In addition, says Dr. Eric Reiman, executive director of the Banner Alzheimer’s Institute, the drug was reformulated slightly between the phase 2 and phase 3 studies, and that may have affected its performance as well. And while the compound did not dramatically reduce amyloid plaque, it did produce some drop in amyloid. “It’s not inconsistent with the idea that reduction in amyloid and reductions in amyloid in the blood, and cerebrospinal fluid is associated with clinical benefit,” Reiman says. Eli Lilly has reported promising early results with its anti-amyloid compound, donanemab, and plans to complete its phase 3 study in 2024. Anticipating that those results will be positive, the company filed a request in August for accelerated approval of the drug with the FDA. Eisai began an accelerated approval process as well with lecanemab based on the positive phase 2 results, and the FDA is expected to make a decision by January 6. After the agency makes that decision, Cheung says the company plans to file the phase 3 data to seek full approval. Taken together, “the picture that is emerging is that substantial [amyloid] plaque lowering seems to be associated with clinical benefit,” says Dr. Michael Weiner, professor of radiology medicine, neurology, and psychiatry at University of California, San Francisco. “At least we seem to finally be in the era of disease-modifying treatments.” Weiner says the next challenge for the scientific community will be to find ways to prevent Alzheimer’s from damaging brain neurons to begin with, and ongoing trials of other compounds, as well as planned trials using lecanemab and donanemab even earlier in high-risk patients, will reveal how feasible that may be. Blood tests for Alzheimer’s will be critical to accomplish that, and researchers are actively working to develop tests to pick up amyloid in the blood. Since 2021, doctors have been able to order the first such test in the U.S., called PreclivityAD, from C2N Diagnostics, which was approved for use by certain laboratories. “Blood testing for Alzheimer’s will be coming into the clinical arena very quickly,” says Weiner, “and that will be accelerated if lecanemab is approved, which everybody is hoping for, and if Eisai can show that a blood test is sufficient for treatment. We are just at the beginning of the beginning. We are now in the treatment era, in the blood test era for Alzheimer’s disease. The field of Alzheimer’s disease research right now is one of the most interesting in all of medicine.” from https://ift.tt/iAeGmhU Check out https://takiaisfobia.blogspot.com/ In 2017, an expert commission organized by the Lancet examined the current state of asthma care. That commission identified poor medication adherence as one of the principal barriers standing between people with asthma and improved disease outcomes. Adherence is “the biggest elephant in the room,” the commission wrote. “Although lip service is paid to optimizing basic management, in practice often very little is done beyond asking the patient if they are taking treatment.” According to research in the European Respiratory Journal, more than half of all asthma patients fail to take their medications as directed. Some other surveys put that figure as high as 80%. Clinicians who treat people with asthma affirm that many are not following their medication plan. “Personally, I would say adherence is a problem for at least 50% of patients,” says Dr. Ruchi Gupta, a professor and asthma specialist at Northwestern University’s Feinberg School of Medicine. The issue of poor adherence is so common that experts aren’t sure what percentage of asthma patients truly do have severe asthma. That’s because the condition is defined by its uncontrollability; if more people with severe asthma took their medications as instructed, it’s likely that a significant portion of them would get their asthma under control, and as a result would no longer qualify for a severe asthma diagnosis. But increasing treatment adherence is a lot easier said than done. Part of the problem, Gupta says, is that even those with severe asthma may feel fine a lot of the time. Asthma has been called a “fluctuating disease” because its symptoms ebb and flow. Treatment often requires a person to take multiple oral or inhaled medications on a daily basis, even when they’re not experiencing symptoms. “It’s challenging for anyone to take a medication, let alone several, every single day,” Gupta says. Having to do so for years on end, as is the case for many severe asthma patients, is quite a grind. Even one missed dose can contribute to a flare, but there is often a delay between a missed dose and symptom exacerbations. So people don’t necessarily connect the risks of poor adherence to asthma flares. Forgetting a dose is just one of the reasons people with severe asthma don’t take their medication as prescribed. In some cases, adherence problems may stem from a care provider’s lapses. In other instances, a patient may consciously decide not to take their meds. “The reasons for suboptimal adherence are multifactorial,” says Dr. Vanessa McDonald, a professor and lung-disease specialist at the University of Newcastle in Australia. The consequences of poor adherence are often serious, and occasionally dire. Along with symptom flares, medication lapses raise a patient’s risk for trips to the emergency department. By some estimates, 60% of asthma-related hospital visits are caused by poor medication adherence. Medication lapses also raise a patient’s risk for asthma-related mortality. The World Health Organization estimates that 250,000 people die prematurely each year due to asthma. Here, McDonald and other asthma specialists break down the different factors that contribute to poor medication adherence. They also detail the latest measures to improve adherence, including new technologies, advancements in treatment, and refinements to provider-patient interactions. Read More: How Alternative Medicine Can Help People With Asthma Dissecting the problem of poor adherenceSometimes, people with asthma simply forget to take their medication. When you consider that inhaled corticosteroids (one of the most common treatments for severe asthma) sometimes have to be taken twice a day, it’s easy to see how even very diligent patients could forget a dose now and then. Another barrier to perfect adherence has to do with operator error; the act of inhaling asthma medication is not as simple as swallowing a pill. “Inhaling of [asthma] drugs requires considerable skill and practice,” wrote the authors of a 2015 paper in the European Respiratory Journal. “Even if medication is taken daily, deposition in the lungs will be low with incorrect inhalation technique.” Clinicians say they frequently run into these sorts of issues. “Are they holding their breath after inhaled corticosteroids for 10 seconds to make sure the medicine gets deep into the lungs?” asks 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. These are the types of technique miscues that can lead to flares. This is also one area where the failure may fall in part on a patient’s care team. Researchers have found that when people with severe asthma receive more upfront training and medication education, adherence rates improve. Miscommunications between patient and provider can also drag down adherence. People with severe asthma who are younger or who have fewer years of formal education are more likely to experience medication lapses, and there’s evidence some patient groups may not completely understand their care provider’s instructions or treatment-plan justifications. Most of these are categorized as unintentional forms of non-adherence. But in some cases, patients consciously choose not to take their meds. “There is intelligent or intentional non-adherence, whereby patients make deliberate decisions to either stop the treatment, alter the way they take it, or even neglect to initiate the prescribed treatment at all,” says McDonald. There are several reasons why people deliberately choose not to take their medications. Concern about side-effects is one of them, McDonald says, and this is another area where better patient-provider communication comes into play. If a person knows exactly what to expect from their drugs, and they also fully understand the risks of non-adherence—not only symptom flares, but an increased risk of hospitalization and deadly complications—this knowledge can improve adherence. An aversion to drugs is another cause of deliberate non-adherence. “Not wanting to rely on daily medication is a common reason,” McDonald says. Financial constraints are another, she says. Some asthma medications are expensive, and a patient’s insurance may not cover enough of the cost to make the drugs affordable for them. The diverse range of factors that drive poor adherence is one reason it remains such a common and intractable problem. But there are solutions. Read More: How Climate Change and Air Pollution Affect Kids’ Health New tools and techniques for better adherenceIt’s clear that traditional approaches to starting severe asthma treatment—a doctor telling a patient what to take and how to take it, followed by an occasional check-in—are not getting the job done. A newer tactic that research supports gives patients more control and more input into the creation of their medication plan. For example, a 2010 randomized controlled trial found that when clinicians and patients discussed together the benefits, risks, and costs of different treatment plans—not solely in order to mitigate symptoms, but to suit the patient’s own priorities—adherence one year later was significantly higher when compared to a traditional top-down relationship where the clinician alone chose the treatment plan. “Involving people with severe asthma in shared decision-making can help improve adherence to treatment,” McDonald says. There’s also evidence that patients with severe asthma who are treated by a multidisciplinary team of specialists, as opposed to solely in a primary-care setting, are more likely to adhere to their medication plans. “This team could include a pulmonologist, an allergist, a nurse specialist, and some sort of mental-health support,” Gaffin says. Through the lens of their various specialties, this team can help suss out and address issues that lead to medication lapses. This team can also ensure that a person’s medication plan is part of a more comprehensive approach to asthma control—one that may also include lifestyle and environment adjustments—which may be more efficacious. Internet- or smartphone-based reminders are another solution that some preliminary research supports. According to a 2021 study in Scientific Reports, pairing a medication self-management app with an inhaler-installed electronic medications monitor (or EMM, which tracks whether a person has taken their meds) led to robust adherence improvements. The app not only alerted the patient when to take their medication, but also provided feedback on their inhaler use and continuing-education materials. Newer “smart” medication-delivery devices are also helpful. According to research in the journal Asthma, smart nebulizers are able to adapt to a person’s unique breathing pattern and respiratory capacity to ensure the right amount of medication is deposited deep in the user’s lungs. Last but not least, new forms of treatment are reducing patient reliance on inhaled medications. Biologics are the big story in this space. These drugs, delivered every few weeks via injection, work by targeting the immune cells, proteins, genes, or pathways that underlie asthma symptoms. “These have been totally transformational,” says Dr. David Jackson, a respiratory medicine specialist at King’s College London. “Since 2017, a new biologic has been added to our armory on almost an annual basis, and the number of patients with uncontrolled asthma has gotten smaller and smaller.” Biologics are usually administered in-office. This added layer of provider oversight, coupled with a comparatively infrequent dosing schedule, makes adherence much more likely. However, the cost of these drugs is still considerable, and not all patients are good candidates. Read More: What to Know About the Latest Advances in Managing Severe Asthma An urgent problemAccording to the most current data from the U.S. Centers for Disease Control and Prevention, roughly 6% of children and 8% of adults in the U.S. have asthma. The disease’s prevalence has been trending upward since 2001, and while there are signs that this increase has leveled off, recent surveys have found that severe asthma may be more common now than in years past. This may be due to the gradual aging of the American populace. Older adults with asthma are more likely to experience severe and uncontrolled disease, and the country’s average age and proportion of adults 65 or older has been steadily rising—and is expected to rise further for decades to come. All of this suggests that the number of Americans with severe asthma is likely to grow, not shrink, and so solving the problem of poor adherence is likely to take on even greater importance in years to come. “Being older is associated with better intentional adherence, but unintentional non-adherence may be an issue in this age group due to issues with the use of inhalers and age-related factors such as poor vision, decreased manual dexterity to use the inhalers correctly, and reduced ability to inhale the medication deeply,” says McDonald. She and other experts say that there is no silver-bullet solution to the adherence problem; it’s a multifactorial challenge that will require a multipronged response. But with greater development, refinement, and implementation of the tools we have today—some combination of smarter tools, better medicines, and improved provider-patient communications—asthma specialists are hopeful that they will be able to greatly improve adherence among people with severe asthma. There’s work to be done, but there’s reason to believe that major improvements are on the way—or here already. from https://ift.tt/tA9fNge Check out https://takiaisfobia.blogspot.com/ Months after catching COVID-19 in December 2021, Lavanya Visvabharathy was still testing positive on antigen tests and suffering from symptoms including headaches and intense fatigue. So Visvabharathy, a research assistant professor of neurology at the Northwestern University Feinberg School of Medicine who has studied Long COVID since 2020, decided to conduct an experiment on herself. She asked her doctor to prescribe her Paxlovid, an antiviral therapy that can treat COVID-19 by inhibiting replication of the virus that causes it. Paxlovid is meant to keep high-risk patients with acute COVID-19 from developing severe disease, but Visvabharathy thought it might have another use. Since she was still testing positive months after getting infected, Visvabharathy had a hunch—based on her research—that pieces of that virus were still in her system. She hoped Paxlovid could clear away those remnants of SARS-CoV-2 and ease her Long COVID symptoms. The results of her experiment, which she published as a case report in Frontiers in Medicine in September, were mixed. A standard five-day course of Paxlovid initially eased her symptoms, and she began testing negative. But about a month after taking the antiviral, she started testing positive again, and her headaches came back. Visvabharathy, who has the autoimmune condition rheumatoid arthritis, temporarily stopped taking her biologic immunosuppressant to see if that would help clear the virus from her system—but when she did, her symptoms worsened and she developed intense brain fog for the first time. When she resumed taking her arthritis drug, the brain fog went away and her other symptoms improved. Today, after enduring about nine months of Long COVID symptoms, Visvabharathy is finally free of them. But did Paxlovid play a role in her recovery? That’s the million-dollar question. Read More: You Could Have Long COVID and Not Even Know It Researchers don’t fully understand why some people develop long-lasting symptoms after a case of COVID-19, but one of the leading theories is that remnants of the virus linger in some people’s bodies, causing lasting issues ranging from extreme fatigue to chronic pain and neurological problems. If that’s the case, it’s logical to think—as Visvabharathy did—that an antiviral like Paxlovid could wipe out those stubborn fragments and clear up symptoms. There’s already some evidence that people who take Paxlovid shortly after getting infected have lower odds of developing Long COVID. One study posted online in November, which has yet to be peer-reviewed, compared people at risk of severe COVID-19 who took Paxlovid within five days of testing positive with COVID-19 patients of similar risk profiles who did not take the drug. Those who took Paxlovid were about 26% less likely to report Long COVID symptoms 90 days later, the researchers found. People who survive severe cases of COVID-19 are at increased risk of developing Long COVID, so it makes sense that a drug that lessens the disease’s severity would also shrink the risk of long-term complications. Whether it can reverse lingering symptoms among people who already have them, however, is a separate question—and one to which patients and advocates from the Long COVID community demand an answer. Until recently, research on Paxlovid as a treatment for Long COVID was limited to small case studies like Visvabharathy’s. (For the record, Visvabharathy does not recommend that other Long COVID patients follow in her footsteps by DIYing treatment; she recommends consulting a doctor first.) Another case report, published in the journal Pathogens and Immunity in June, found that three patients reported improvements in their post-COVID symptoms after taking Paxlovid anywhere from several weeks to more than two years after their symptoms began. The person who took Paxlovid after two years of Long COVID symptoms did so after getting reinfected and saw “substantial improvement,” according to the report. Read More: First Real-World Data Show That the Bivalent Booster Is Effective Dr. Upinder Singh, a professor of infectious disease at Stanford Medicine, calls such results “titillating,” but says larger studies are needed to make any firm conclusions about Paxlovid’s role in treating Long COVID. Singh’s research team is recruiting 200 people with moderate or severe Long COVID symptoms, some of whom will receive a placebo and some of whom will be treated with Paxlovid for 15 days—the longest amount of time the drug has been proven to be safe to take. Both groups will then be tracked for four months to measure changes in their symptoms over time, Singh explains. Her group has already begun enrolling patients, but they don’t have results to share yet. A research team at Duke University will also study Paxlovid’s potential role as a Long COVID therapy through the National Institutes of Health’s RECOVER trial, a wide-ranging initiative to better understand Long COVID. Duke’s research team aims to enroll 1,700 people and compare outcomes among those who take Paxlovid for 15 days versus a placebo. If large studies show that people’s symptoms improve after taking Paxlovid, it will not only point to a promising treatment option, but also add support to the idea that Long COVID is caused by pieces of the virus lingering in the body, Singh says—a potentially important step on the road to understanding COVID-19’s long-term effects. “As a physician, I want a solution to give to my patients,” Singh says. “As a scientist, I just want an answer.” from https://ift.tt/jpb9Hr1 Check out https://takiaisfobia.blogspot.com/ Google’s AI algorithm for helping to screen for breast cancer will now be part of commercial mammograms. On November 28, the company announced it licensed its AI technology to iCAD, a medical technology company that provides breast cancer detection services to health care facilities around the world. While iCAD already includes AI-based strategies in its cancer screening services, it will now also incorporate Google’s algorithm, which Google has been testing with researchers at Northwestern University. “It’s an inflection point for us,” says Greg Corrado, co-founder of the Google Brain team and principal scientist on Google’s AI health care team. “We’re moving from academic research to being able to deploy our algorithm in the real world.” In an earlier study published in 2020 in Nature, Google’s algorithm for mammograms performed better than radiologists in logging fewer false positives and false negatives in reading the images. The study involved mammograms from more than 91,000 women in the U.S. and the U.K. In the U.S., where most women ages 50 to 74 are recommended to be screened every two years, Google’s system lowered the false positive rate by 6%, and in the U.K., where women ages 50 to 70 are advised to get screened every three years, by 1.2%. The machine learning algorithm also decreased false positives by 9% in the U.S. and nearly 3% in the U.K. That benefit will now be available commercially for the first time to the 7,500 mammography sites globally, including university health systems, that use iCAD’s services. While Corrado declined to detail how Google’s algorithm differs from those being tested by other researchers and companies in the field, he said the system incorporates data from a wide range of images, even beyond those of breast tissue, to refine the machine learning process. iCAD and Google will continue to develop and refine the technology as part of the partnership agreement. Read More: How AI Is Changing Medical Imaging to Improve Patient Care The algorithm is not designed to replace radiologists, at least not in the near term. But in Europe, says Stacey Stevens, president and CEO of iCAD, it could help to relieve the burden on radiologists, since many nations (including the U.K.) require two readings of a mammography image. iCAD is working with health regulators to earn the proper authorization so that the company’s AI-based interpretation could eventually be one of them, she says. In the U.S., Stevens expects the first product including Google’s algorithm to be rolled out in early 2024. Stevens also anticipates that the AI-based system will bring mammography to more people around the world, particularly in lower-resource areas that could not support the infrastructure required of hosting hardware related to mammography image storage. With Google’s cloud-based storage capabilities, she says, “we have the ability to expand to new geographies and new regions of the world and to scale our tools across a greater number of patients in areas of the world constrained by infrastructure challenges.” As with any machine learning system, the more data from mammograms that are fed into the algorithm, the better it gets at detecting the smallest differences that distinguish normal tissue from potentially cancerous tissue. Women receiving mammograms using the AI-based system will have their information fed back into the algorithm, minus any identifying data. At the moment, most people getting mammograms likely aren’t aware that an AI-system might be in the background complementing the radiologist, since for now, no regulatory agencies have signed off on an entirely AI-based interpretation of mammograms. But as more AI algorithms like Google’s enter the market, that may change, and radiologists may end up discussing with patients how their images are interpreted. Read More: How Researchers Are Working to Make IVF More Effective Ultimately, such machine-based readings could begin to pull out patterns that human eyes can’t see. Stevens says iCAD’s current AI-based algorithm already detects the presence of minute calcifications in the breast tissue that scientists are beginning to link to a heightened risk of heart disease. If that association is confirmed, mammograms could also become a tool for assessing women’s heart disease risk. For now, adding an AI perspective to mammograms could begin to improve how women’s risk of breast cancer is determined. AI systems can better distinguish, for example, differences that are unique to specific racial and ethnic groups; in the U.S., African-American women are at higher risk of developing more aggressive types of breast cancer and are more likely to die of the disease than other women, so training an AI system to track down the first signs of these cancers could lead to better outcomes. “We are finding that there are many cases of women with what seems like a normal mammogram, but there are things in those images that can’t be seen with the human eye,” says Stevens. If those differences can be picked up by an AI algorithm, then those women could be sent for additional screening to figure out whether they are at higher risk of developing cancer. That could set them on a path to receiving treatment sooner, which ultimately leads to a better chance of survival. That could also mean less expensive medical services, which would translate back to cost savings for the health system. “We are in the early innings of breast cancer risk assessment with AI,” says Stevens, “but we are excited about its potential.” from https://ift.tt/a3JsQ97 Check out https://takiaisfobia.blogspot.com/ For the past six years, Elyssa Barbaro has gotten screened for lung cancer. The 71-year-old New Yorker smoked for about 50 years, but she doubts she would have gotten an annual preventative CT scan if her pulmonologist hadn’t told her she should. Even though the procedure takes just 15 minutes, it saved her life—more than once. During her CT scans in 2019 and 2020, cancer was discovered in Barbaro’s lungs. At first, Barbaro was terrified to learn that she had cancer. But because her doctors had checked her lungs annually, and then every six months after her diagnoses, they were able to find the nodules soon after they started growing, when they were still very small. This meant the cancer could be easily removed by surgery, and that she didn’t need aggressive (and often painful) procedures to contain it, like chemotherapy and radiation. Now, Barbaro urges her friends who currently or formerly smoke to get screened. “I know people are afraid to find out they have something wrong with them,” says Barbaro. “But for me, the far greater fear is not knowing you have something wrong with you.” Lung cancer is the leading cause of cancer deaths, and one reason why is that many patients don’t experience symptoms until the disease becomes advanced. In the U.S., only 18.6% of all lung cancer patients survive for five years, since just 16% of lung cancers are diagnosed at an early stage. But more widespread screening can significantly improve people’s odds of lung cancer survival, new research finds. In research presented at the Radiological Society of North America’s annual meeting on Nov. 27, an international team of researchers screened more than 87,000 participants, including Barbaro, with varying levels of risk for lung cancer. The screenings were conducted at least annually at more than 80 institutions around the world. Those who were screened yearly had a significantly reduced risk of dying from lung cancer; in more than 80% of cases, the cancer was detected early. Among 1,285 patients who were diagnosed with lung cancer, their survival rate was 80% over 20 years. And 92% of patients who had the earliest stage lung cancer survived for at least 20 years. Read More: How AI Is Changing Medical Imaging to Improve Patient Care This research adds to a growing body of evidence that lung-cancer screening saves lives. Under the current recommendations of the U.S. Preventive Services Task Force (USPSTF)—an independent body that reviews hundreds of studies on preventing and screening for different conditions—people ages 50 to 80 with a 20 “pack-year” smoking history (calculated by multiplying the number of cigarette packs smoked per day by the years a person smoked) should get screened annually. So should people in that age range who currently smoke or have quit within the past 15 years. “Lung cancer screening helps people live longer and healthier, because it catches lung cancer at an earlier, more treatable stage,” says Dr. John Wong, professor of medicine at Tufts University School of Medicine and a member of USPSTF. (Wong was not involved in the new study.) Despite these benefits, most eligible people don’t get screened. A 2017 study published in 2020 found that only about 12% of people recommended under the USPSTF criteria at the time had been scanned for lung cancer over the last 12 months. As a result, many lung cancer cases are diagnosed at a late stage, when treatment options are fewer or none. That’s part of the reason why the authors of the new study wanted to conduct this research, says Dr. Claudia Henschke, director of the Early Lung and Cardiac Action Program at the Icahn School of Medicine at Mount Sinai in New York and the lead author of the study. “The message hasn’t gotten out there enough to people who are at risk for lung cancer: that they can be cured,” says Henschke. “Coming back for the annual screening year after year is important.” Lung-cancer patients often do not experience symptoms right away because at the early stages, the cancer is too small to cause noticeable symptoms, says Dr. Michael Nissenblatt, an oncologist in New Jersey (who was not involved in the study). For instance, patients don’t start to feel pain until the cancer expands to the surface of the lung, where it can scratch against the walls of the chest. “Early stage lung cancer without screening simply won’t be discovered,” he says, unless a doctor catches it in a test for another illness. Over the last few decades, says Nissenblatt, doctors have made major strides to treat lung cancer. In recent years, more patients are surviving stage three and four lung cancers thanks to advancements in therapies, including a new course of treatment that follows a year of chemotherapy and radiation with a medicine called durvalumab. However, even with this treatment, Nissenblatt notes, more than half of people with stage three lung cancer die within five years. In this area, “we’ve made progress, but not so much,” he says. Scientific advances in surgical techniques have also made treatment for early-stage lung cancer easier. While 20 years ago patients had to remain in the hospital for 10 days after surgery, he says, the newest procedures enable patients to leave the hospital the same day or the following morning. “It becomes no more of a problem than removing a gallbladder or removing an appendix,” he says. For patients who fit a certain profile, the choice to screen is clear, Nissenblatt says. “The earlier the diagnosis,” he says, “the greater the opportunity we will have to cure you.” from https://ift.tt/Pci1lpX Check out https://takiaisfobia.blogspot.com/ LONDON — The World Health Organization has renamed monkeypox as mpox, citing concerns the original name of the decades-old animal disease could be construed as discriminatory and racist. The U.N. health agency said in a statement Monday that mpox was its new preferred name for monkeypox, saying that both monkeypox and mpox would be used for the next year while the old name is phased out. WHO said it was concerned by the “racist and stigmatizing language” that arose after monkeypox spread to more than 100 countries. It said numerous individuals and countries asked the organization “to propose a way forward to change the name.” Read More: What It Really Feels Like to Have Monkeypox In August, WHO began consulting experts about renaming the disease, shortly after the U.N. agency declared monkeypox’s spread to be a global emergency. To date, there have been more than 80,000 cases identified in dozens of countries that had not previously reported the smallpox-related disease. Until May, monkeypox, a disease that is thought to originate in animals, was not known to trigger large outbreaks beyond central and west Africa. Outside of Africa, nearly all cases have been in gay, bisexual or other men who have sex with men. Scientists believe monkeypox triggered outbreaks in Western countries after spreading via sex at two raves in Belgium and Spain. Vaccination efforts in rich countries, along with targeted control interventions, have mostly brought the disease under control after it peaked in the summer. In Africa, the disease mainly affects people in contact with infected animals such as rodents and squirrels. The majority of monkeypox-related deaths have been in Africa, where there have been almost no vaccines available. U.S. health officials have warned it may be impossible to eliminate the disease there, warning it could be a continuing threat mainly for gay and bisexual men for years to come. Read More: How the Monkeypox Virus Does—and Doesn’t—Spread Mpox was first named monkeypox in 1958 when research monkeys in Denmark were observed to have a “pox-like” disease, although they are not thought to be the disease’s animal reservoir. Although WHO has named numerous new diseases shortly after they emerged, including Severe Acute Respiratory Syndrome, or SARS and COVID-19, this appears to be the first time the agency has attempted to rechristen a disease decades after it was first named. Numerous other diseases, including Japanese encephalitis, German measles, Marburg virus and Middle Eastern Respiratory Syndrome have been named after geographic regions, which could now be considered prejudicial. WHO has not suggested changing any of those names. from https://ift.tt/HTNvkDS Check out https://takiaisfobia.blogspot.com/ The biggest lesson COVID-19 taught hospitals is how thin they can be stretched—and that includes morale, says Dr. Yves Duroseau, chair of emergency medicine and co-chair of disaster planning services at Lenox Hill Hospital in New York. Over the past nearly-three years, “We saw widespread burnout of staff trying to go above and beyond, every single day. That’s not sustainable—it’s too overwhelming,” he says. “That’s why we’re looking at what to do now, because COVID is still a threat, and now we’re looking at issues like monkeypox and polio. Everyone wonders: What’s next?” Yet a new pandemic surge is far from the only potentially debilitating event facing hospitals. Most health-care centers are continuously revamping their emergency-preparedness strategies on multiple levels, Duroseau says. Like a seemingly endless action movie, threats fire from all directions. Some vary by location: Hospitals need to be prepared for hurricanes along the Gulf and Atlantic coasts, for example, and earthquakes and wildfires on the West Coast. Taking steps to plan for the next emergency—even if no one knows exactly what it will look like—can help boost resilience. Here’s a look at the top five challenges hospitals are currently facing, followed by the preparedness plans they’re putting into place. 1. The next epidemicWhile COVID-19 may have caught many hospital systems off guard, it highlighted how much an infectious agent can spread—and how quickly. Hospital systems now need to ensure they’re ready next time. “No one believes we’re past current and future threats when it comes to epidemics and pandemics,” says Eric Alberts, senior director of emergency preparedness at Orlando Health in Florida. “Every hospital is still on high alert when it comes to trying to anticipate what’s next.” 2. Violence inside the hospitalThe U.S. Bureau of Labor Statistics reports that the rate of injuries from violent attacks against medical professionals grew by 63% from 2011 to 2018, and the Association of American Medical Colleges (AAMC) notes that it’s only gotten worse since then. In a recent survey conducted by National Nurses United, almost half of nurses who responded said they’d experienced workplace violence, mainly initiated by patients. The situation is so serious that some hospitals have created de-escalation teams to calm aggressive patients. The emergency department is particularly prone to violent outbursts. In one AAMC study, nearly half of ER physicians said they’ve been assaulted, and 70% of ER nurses report being hit or kicked while at work. 3. Climate changeThe U.S. Environmental Protection Agency notes that rising global temperatures are associated with significant changes in weather patterns, which can lead to extreme weather events such as heat waves and droughts, more intense hurricanes, frequent tornadoes, flooding, and wildfires. Of course, this means that more people will require medical attention due to weather events. But it also sets hospitals up for more disruption and possible closure. When Hurricane Ian hit Florida this fall, 16 hospitals in the state had to evacuate patients. In December 2021, a hospital in Colorado had to evacuate a full neonatal intensive care unit due to wildfires—at a time when it was short-staffed due to winter holidays. Incidents like these will continue to become more prevalent, Alberts believes, putting enormous strain on patients and their caregivers. 4. Cyber threatsCybersecurity threats against health-care systems have been increasing over the past few years. Ransomware—when an attacker paralyzes a hospital’s computer system and demands a ransom to release it—is particularly on the rise. According to AAMC, this type of cyberattack spiked during the pandemic, with one estimate noting that about 1 in 3 health-care organizations globally were hit by ransomware in 2020. These incidents don’t just put organizations at risk—they can also affect patient care. For example, in October 2020, the University of Vermont Medical Center suffered a ransomware attack that locked employees out of electronic health records, payroll programs, and other digital tools. Patient appointments couldn’t be scheduled, and most surgeries had to be delayed. Although the health-care system refused to pay the ransom, it estimated that the attack cost $50 million in lost revenue. 5. Limited internal resourcesHospitals that are striving to be well-prepared for emergencies often have to struggle with issues like a lack of funding, says Dr. Russ Kino, an emergency medicine specialist and medical director of the Weingart Foundation Emergency Department at Providence Saint John’s Health Center in California. “Most hospitals already work on thin margins, and those are contracting as insurers reduce coverage,” he says. “Financially and organizationally, we’re in a tight and difficult place.” Plus, he points out, the average tenure of a hospital CEO is about 18 months. “So you tend to have turnover in leadership, and that can reset all emergency preparedness plans.” Staffing overall is another issue. According to a report from NSI Nursing Solutions, which surveyed over 3,000 U.S. hospitals in January 2022, the average hospital turnover rate is 25% annually, and even higher for nurses at 27%. At the same time, demand is increasing—the American Nurses Association estimates more nursing jobs will be available in 2022 than any other profession in the country. All of that means that as hospitals need to do more when it comes to emergency preparedness, they’re often accomplishing it with a smaller workforce. Read More: Caring for the Caregivers Post-Pandemic How hospitals step upAlthough the top threats facing hospitals might sound unrelated—cyber threats and hurricanes don’t seem to have much overlap, for example—they’re connected in part because of the way they need to be dealt with, Duroseau says. Many hospitals utilize several main strategies: planning for the worst-case scenario; conducting training drills for these possibilities; boosting collaboration inside and outside the hospital; and renovating with climate change in mind. For instance, Providence Saint John’s Health Center regularly executes unplanned drills for active-shooter situations, which help ensure that staff can seal off parts of the hospital and lock down within minutes. Lenox Hill Hospital does the same, and staff there are also trained on potential mass-casualty events that might bring dozens of seriously injured people into the ER at once. “These types of drills let us see where the gaps are with process and staffing,” Duroseau says. “That’s particularly important during times of high staff turnover, which we experienced over COVID.” Similarly, Lenox Hill runs drills for cyberattacks that would disable an entire computer system or threaten patient care. Duroseau notes that many pieces of hospital equipment, such as infusion machines that deliver medications, run on a web-based platform, which means they could theoretically be hacked. The idea that a cyberattacker could deliver a fatal dose of pain medication from thousands of miles away is terrifying, he says, which is why the hospital trains staffers on how to switch to a manual, offline system during such a scenario. “It’s hard to play offense on a cyber situation,” he says. “At least we can train people to handle downtime disruptions in a way that protects patients. In general, we all know the areas of vulnerability we have with every kind of threat, and there’s only so much we can do to counter that. But we can try.” Another crucial aspect for threat management is collaborating with local and national services like fire departments, law enforcement, the state department of health, and the Federal Emergency Management Agency, Alberts says. “If you take threats seriously, there’s a lot you can do ahead of time if you plan in advance,” he adds. “Coordination internally and with these external stakeholders truly helps us better prepare for and respond to crises of all types and sizes. Having the right people in the right place at the right time is a big factor for any hospital system’s response to a threat.” That type of collaborative perspective can help mitigate strain in other ways as well, by creating stronger policies between hospitals and their suppliers, he adds. For example, during the first year of the COVID-19 pandemic, health-care systems struggled to secure sufficient personal protective equipment. That situation is unlikely to happen again since hospitals have developed much more robust purchasing and storage policies, Alberts says. The same philosophy extends to cyber-attack prevention. For instance, Lenox Hill now works closely with its software providers to ensure there are multiple levels of electronic security protections in place. “We never used to ask our technology vendors what they have built in for security—we only wanted to know about functionality overall,” Duroseau says. “Now, it’s the first thing we consider when [evaluating] a new tech contract.” Planning for weather events can be more straightforward. Hospital staffers might analyze the type of weather issues that have caused problems in the past—and then magnify those to an extreme degree. For instance, that might mean prepping for record snowfall in North Dakota, fortifying walls for multiple tornadoes in Kansas, building new facilities on higher ground in Florida, or ensuring a fireproof perimeter in California. Some hospitals may even relocate—administrators at several of those damaged by Hurricane Ian have said they’re considering moving inland as a buffer against future storms. “This is an ongoing issue we’re continually trying to better understand, because the effects of climate change will continue to be a major threat,” Alberts says. “Hurricane Ian showed everyone how much rainfall there can be in such a short amount of time, giving us all a great opportunity to leverage this data for future efforts.” Looking aheadOne of the toughest challenges in preparing for major threats isn’t unique to hospitals: it’s simply not knowing what’s ahead. As Kino points out, there’s no way to plan for every possible contingency. But there’s always the hope that when a threat evolves, it can be handled with resiliency and efficiency. “Despite everything that’s happened in the past two years, we know we’re doing amazing and uplifting work,” Kino says. “Even on rough days, we’re still a team, and deep down, we love our jobs—that’s why we’re here. It’s pretty incredible to look back and see what we’ve accomplished through a pandemic, widespread burnout, mass-casualty events, and climate change. We found a way, and I think that’s what is fueling every hospital right now: We know we’ll always find a way.” from https://ift.tt/hv8w4OP Check out https://takiaisfobia.blogspot.com/ Julie, who is 38 and lives in North Carolina, considers herself, her husband, and their two children “zero COVID people.” Motivated by studies about COVID-19’s potential long-term effects on the body, they orient their lives around not getting the virus. That means avoiding indoor spaces where people won’t be masked, often wearing masks outside, and seeking out service providers who are still taking precautions, such as masking and using air purifiers. For the most part, Julie says, this is fine. “There’s not a whole lot we don’t do,” she says—they just do it all in high-quality masks. (Like others interviewed for this story, Julie asked to be identified by only her first name to protect her family’s privacy.) The holidays, however, present some challenges. Julie’s relatives are no longer willing to take the safety measures that would make her family feel comfortable gathering with them in person, she says, so her family pod will celebrate by “making better food” than usual and eating it at home. The hardest part, she says, is watching family members who were once open to isolating for 14 days before visits now forgo precautions, knowing that means Julie and her family won’t feel comfortable joining the festivities. “We’re not skipping; we’re being excluded,” Julie says. If her relatives were willing to wear good masks inside and eat outside, she says she’d be “mostly” comfortable getting together. But that willingness—so strong in 2020—has by now faded away. Other COVID-cautious people are likely facing similar disagreements with loved ones. According to data from the Harris Poll collected for TIME, holiday celebrations are moving back toward their pre-pandemic norms. This year, 72% of U.S. adults plan to celebrate the holidays with at least one person outside their household—down from the 81% who did so before the pandemic, but up from 66% last year. About 45% plan to travel during this year’s holiday season, compared to 58% pre-pandemic and 42% last year. But even as much of the country moves on from pandemic-era policies, plenty of families are still planning to spend the holidays gathered around Zoom screens and outdoor heat lamps, doing their best to take “a side dish and gift to the holiday dinner, not a virus,” as Claire, 39, puts it. About 55% of U.S. adults said COVID-19 will affect their holiday plans, according to the TIME-Harris Poll data. Even among those who will be gathering with others in person, about a third plan to limit the size of their celebrations, while 12% said they’d require masks or hold the event outdoors. Claire and her husband, who live in the South, will do all of the above. They were careful about disease spread even prior to the pandemic, since they have a 4-year-old who was born prematurely and could experience serious complications from respiratory illnesses. This holiday season, they’ll bundle up and wear masks to celebrate on the patio at Claire’s in-laws’ house. For Thanksgiving dinner, they’ll eat at opposite corners of the patio before putting their masks back on. If it’s too cold on Christmas to open presents outside, they’ll exchange gifts and then head back to their respective homes to unwrap them. That’s the way they’ve done it since 2020, Claire says, but she acknowledges that the system requires sacrifices. She doesn’t feel comfortable attending her grandmother’s large, multi-family Thanksgiving dinner and she mostly sees her friends and their children via Zoom these days. But for Claire, the downsides pale in comparison to keeping her family healthy in the face of a virus that, for a subset of people who catch it, can potentially lead to life-long disability. “I’m in a situation where I’m able to protect my child and protect us, and I’m going to do everything that I can,” she says. Read More: COVID-19 Is Linked to Detectable Brain Changes, Study Shows Other families with risk factors are also going to great lengths to avoid the virus. Karen, who is 39 and lives in Tennessee, has had post-viral illness complications including chronic fatigue and fibromyalgia for 22 years, ever since she caught mono as a teenager and never fully recovered. A common cold can land her in bed for six weeks. COVID-19, her doctor warned her in 2020, could be catastrophic for her health. With the virus still spreading widely, Karen, her husband, and their toddler remain almost completely locked down, venturing out primarily for medical appointments and distanced outdoor activities such as bike rides, picnics, and hikes. When friends come over, her family visits with them through a window. That means big holiday gatherings are off the table for the foreseeable future. “It’s always been very important for me to have an open house for anybody who didn’t have a place to go” over the holidays, Karen says. But these days, her doors remain closed to everyone except her husband’s parents, who live locally and lead a similarly locked-down lifestyle. Max, who is 26 and lives in New York City, is following his parents’ lead when it comes to the virus. His parents wear masks everywhere and avoid riskier environments, such as restaurants and movie theaters, since COVID-19 can be severe for people in their age group. Max opted to spend Thanksgiving with his girlfriend’s family rather than his own to avoid making his parents anxious about potentially getting sick. He may go home for the winter holidays, he says, since he’ll have more time to quarantine and test beforehand. Max says he’d feel fine dropping those precautions if his parents no longer requested them, but for now, he’s happy to do what will make them comfortable. “I understand the principle that the more at-risk people set the rules,” he says. Not everyone is so understanding. Kara Darling, who is 46 and lives in Delaware, is in the process of divorcing her husband because he was ready to “reintegrate” into society around the time vaccines rolled out, and she has chosen to remain highly COVID-cautious by working remotely, homeschooling her kids, and socializing only with those who are willing to take strict precautions. Darling’s stance is informed both by her work as a practices and research manager at a clinic that treats people with complex conditions, which has exposed her to the realities of life with Long COVID, and by the fact that three of her children have overactive immune systems. Read More: How to Tell If Your Health Concerns Are Normal—Or a Sign of Something More “You grieve your plans and the reality you thought you were going to have and what you thought life was going to look like,” she says. “When you get to acceptance, then the question becomes, ‘Am I going to sit around and bemoan the existence of a life I wish I had, or am I going to pivot?’” Darling has chosen to pivot. She runs multiple Facebook groups for people who are “still COVIDing”—that is, still taking precautions against getting the virus. She also set up a recurring outdoor meetup for homeschooled kids in her area and has cultivated a community willing to build new holiday traditions for the pandemic era. Families in her “still COVIDing” circle mail cards ahead of Valentine’s Day and treats for Halloween. They exchange home-cooked dishes on Thanksgiving and eat them together over Zoom. They leave gifts on porches for birthdays and honk when they drive by to say hello. Darling’s Thanksgiving will be small this year—just her household, her oldest son, and her son’s girlfriend, cooking and eating together at home. (Darling’s son and his girlfriend don’t live with her, so they’ll avoid any unnecessary public activities, wear respirators, and test multiple times in the 10 days before coming over.) But outside the walls of her house, Darling has built connections that help her get through the dark moments. “It’s about being part of a community,” she says. “We built a trusted family.” from https://ift.tt/WiqhBvV Check out https://takiaisfobia.blogspot.com/ In a report published in the Morbidity and Mortality Weekly Report, scientists at the U.S. Centers for Disease Control and Prevention (CDC) provided the first real-world evidence on the effectiveness of the bivalent booster shot that the CDC and the U.S. Food and Drug Administration (FDA) authorized in September. The researchers conclude that the bivalent booster, which contains genetic material from both the original SARS-CoV-2 virus and the Omicron BA.4/5 variants, is effective in protecting people from severe COVID-19. The relative effectiveness among people ages 18 to 49 who received the bivalent booster—compared to those who received more than two shots of the original vaccine—ranged from 30% if their last original vaccine dose was two to three months earlier, to 56% if their last original vaccine dose was more than eight months prior to the new one. The effectiveness was slightly lower for older people, ranging from 28% to 48% among those 50 years and older. The fact that the vaccine effectiveness increased with more time since the last original vaccine dose shows that the new booster replenishes waning levels of virus-fighting antibodies, the researchers write. Read More: You Can Still Get Free COVID-19 Tests Through Insurance The data came from the national Increasing Community Access to Testing program, which provides free COVID-19 tests at pharmacies around the country. Between Sept. 14 and Nov. 11, more than 360,000 tests for SARS-CoV-2 were performed at nearly 1,000 sites, and people were asked to report their vaccination status and previous infection history. During that time, Omicron variants BA.4/5 were dominant, but newer variants, including BQ.1 and BQ.1.1, which now account for nearly 50% of cases in the U.S., were beginning to increase. The researchers say that the data during periods when just BA.4/5 dominated were not significantly different with respect to the Omicron booster’s effectiveness when compared to periods when other variants emerged. Still, the researchers acknowledge that the results may change as newer variants take over. Other researchers are investigating how the updated bivalent booster affects immunity—not just to the variants it targets, but also to previous and even potentially newer variants that evolve from BA.4/5. Some data suggest that vaccine-induced immunity might provide higher levels of virus-neutralizing antibodies than getting infected with the virus might, possibly because the immune system sees and reacts to vaccines in a different way than it sees and responds to pathogens like viruses. And each vaccination may also help the immune system to become more efficient at recognizing and disabling the virus. The current real-world findings, the study authors say, point to the need to stay up to date with COVID-19 vaccines, including getting the latest Omicron booster. Bivalent boosters “provide protection against symptomatic SARS-CoV-2 infection during circulation of BA.4/BA.5 and their sublineages and restore protection observed to wane after monovalent vaccine receipt,” the study authors write. from https://ift.tt/AJfGPFl Check out https://takiaisfobia.blogspot.com/ |
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