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Workplace Wellness Programs Barely Move The Needle, Study Finds

Workplace wellness programs have become an $8 billion industry in the U.S. But a study published Tuesday in JAMA found they don’t cut costs for employers, reduce absenteeism or improve workers’ health.

Most large employers offer some type of wellness program — with growth fueled by incentives in the federal Affordable Care Act.

A host of studies over the years have provided conflicting results about how well they work, with some showing savings and health improvements while others say the efforts fall short.

Many studies, however, faced a number of limitations, such as failing to have a comparison group, or figuring out whether people who sign up for such wellness programs are somehow healthier or more motivated than those who do not.

Now researchers from the University of Chicago and Harvard may have overcome these obstacles with one of the first large-scale studies that is peer-reviewed and employs a more sophisticated trial design.

They randomly assigned 20 BJ’s Wholesale Club outlets to offer a wellness program to all employees, then compared results with 140 stores that did not.

The big-box retailer employed nearly 33,000 workers across all 160 clubs during the test.

After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled.

But the efforts did not result in differences in health measures, such as improved blood sugar or glucose levels; how much employers spent on health care; or how often employees missed work, their job performance or how long they stuck around in their jobs.

“The optimistic interpretation is there is no way we can get improvements in health or more efficient spending if we don’t’ first have changes in health behavior,” said one study author, Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago. (Dr. Zirui Song, an assistant professor of health policy and medicine at Harvard Medical School, was its co-author.)

“But if employers are offering these programs in hopes that health spending and absenteeism will go down, this study should give them pause,” Baicker said.

The study comes amid widespread interest in wellness programs.

The Kaiser Family Foundation’s annual survey of employers found that 53% of small firms and 82% of large firms offer a program in at least one of these areas: smoking cessation, weight management and behavioral or lifestyle change. (Kaiser Health News is an editorially independent program of the foundation.)

Some programs are simple, offering gift cards or other small incentives to fill out a health risk assessment, take a lunch-and-learn class or join a gym or walking group. Others are far more invasive, asking employees to report on a variety of health-related questions and roll up their sleeves for blood tests.

A few employers tie financial incentives to workers actually lowering risk factors, such as high blood pressure or cholesterol — or making concerted efforts to participate in programs that might help them do so over time.

The Affordable Care Act allowed employers to offer financial incentives worth up to 30% of the cost of health insurance, leading some employers to offer what could be hundreds or even thousands of dollars off workers’ deductibles or premiums to get them to participate. That led to court challenges about whether those programs are truly voluntary.

In the study reported in JAMA, the incentives were modest. Participants got small-dollar gift cards for taking wellness courses on topics such as nutrition, exercise, disease management and stress control. Total potential incentives averaged $250. About 35% of eligible employees at the 20 participating sites completed at least one module.

Results from those workers — including attendance and tenure data, their self-reported health assessment and results from lab blood tests — were specifically compared with similar reports from 20 primary comparison sites where workers were not offered the wellness gift cards and classes. Overall employment and health spending data from all worksites were included in the study.

Wellness program vendors said details matter when considering whether efforts will be successful.

Jim Pshock, founder and CEO of Bravo Wellness, said the incentives offered to BJ’s workers might not have been large enough to spur the kinds of big changes needed to affect health outcomes.

Amounts of “of less than $400 generally incentivize things people were going to do anyway. It’s simply too small to get them to do things they weren’t already excited about,” he said.

An accompanying editorial in JAMA noted that “traditional, broad-based programs like the one analyzed by Song and Baicker may lack the necessary intensity, duration, and focus on particular employee segments to generate significant effects over a short time horizon.”

In other words, don’t give up entirely on wellness efforts, but consider “more targeted approaches” that focus on specific workers with higher risks or on “health behaviors [that] may yield larger health and economic benefits,” the editorial suggested.

It could be, the study acknowledges, that 18 months isn’t enough time to track such savings. So, Baicker and Song also plan to publish three-year results once they are finalized.

Still, similar findings were recently reported in another randomized control trial conducted at the University of Illinois, where individuals were randomly selected to be offered wellness programs.

In one interesting point, that study found that wellness-program participants were likely already healthier and more motivated, “thus a primary benefit of these programs to employers may be their potential to attract and retain healthy workers with low medical spending.”

Everyone involved in studying or conducting wellness agrees on one thing: Changing behavior — and getting people motivated to participate at all — can be difficult.

Steven Aldana, CEO of WellSteps, a wellness program vendor, said that for the efforts to be successful they must cut across many areas, from the food served in company cafeterias to including spouses or significant others to help people quit smoking, eat better or exercise more.

“Behavior is more complicated than simply taking a few wellness modules,” said Aldana. “It’s a lifestyle matrix or pattern you have to adopt.”

Related Topics

Public Health The Health Law


Article source: https://khn.org/news/workplace-wellness-programs-barely-move-the-needle-study-finds/

‘Bubble Boy’ Disease Helped By Advances In Gene Therapy : Shots – Health News

David Vetter, pictured in September 1982 inside part of the bubble environment that was his protective home until he died in 1984. Today most kids born with severe combined immunodeficiency are successfully treated with bone marrow transplants, but researchers think gene therapy is the future.

AP


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David Vetter, pictured in September 1982 inside part of the bubble environment that was his protective home until he died in 1984. Today most kids born with severe combined immunodeficiency are successfully treated with bone marrow transplants, but researchers think gene therapy is the future.

AP

Sometimes rare diseases can let scientists pioneer bold new ideas. That has been the case with a condition that strikes fewer than 100 babies a year in the United States. These infants are born without a functioning immune system.

The disease is called severe combined immunodeficiency, or SCID. “It was made famous in the mid ’70s when the ‘Bubble Boy’ was described in a documentary, and I think it captured the imagination of a lot of people,” says Matthew Porteus, a pediatrician at Stanford University.

David Vetter was the boy who spent most of his short life inside a plastic bubble to protect him from infection. He died at the age of 12 in 1984.

Opinion: The Doctor And 'The Boy In The Bubble'

All babies born in the United States are now screened for this condition, and the best treatment today — a bone marrow transplant — succeeds more than 90 percent of the time. The disease remains a source of great interest to researchers.

“This is one of those diseases in which there’s probably more doctors and scientists studying the disease than patients who have the disease,” Porteus says.

In the 1990s, European scientists actually cured SCID in some patients, using a technique called gene therapy. This process involves removing defective blood cells from a patient, inserting a new gene with the help of a virus and then putting the cells back into the body. Those cells then build up the patient’s immune system.

At first, this treatment in the 1990s and early 2000s looked really promising.

“Of the 20 patients, they all had immune recovery,” says Donald Kohn, an immunologist at UCLA’s Broad Center of Regenerative Medicine and Stem Cell Research. “But, over time, five of them went on to develop a leukemia.”

He says 18 of those original patients are still alive today, but the leukemias put an understandable pall on the whole field of gene therapy.

Scientists went to work to figure out how to inject new genes into cells without triggering leukemia, a cancer of blood cells. And they think they’ve succeeded.

Gene Therapy Keeps 'Bubble Boy' Disease At Bay In 8 Children

Since then, there has been gradual improvement in gene therapy. The latest advance, reported in the New England Journal of Medicine on Wednesday, details a study of eight infants who have a type of SCID called SCID-X1.

The gene to correct the problem was inserted into a modified version of HIV, the virus that causes AIDS. That engineered virus can’t cause AIDS, and it has been further tweaked to reduce the risk that it could trigger leukemia.

Gene therapy has been used successfully over the past decade. Scientists at St. Jude Children’s Research Hospital in Memphis, Tenn., modified the procedure for SCID by giving the infants a short course of chemotherapy before introducing the new gene. This helped the new cells take up permanent residence. The babies developed apparently healthy immune systems, according to the new study.

“I am thrilled to see these outstanding results,” says Ewelina Mamcarz, a transplant physician and first author on the new paper.

“To be able to see these babies in my clinic now as toddlers is very rewarding,” she says. “They live normal lives. They aren’t any different from my daughters.” Two more infants have been treated since the paper was prepared for publication, the team says.

Standard treatment for SCID is a bone marrow transplant. But that procedure often restores only part of a child’s immune system. As a result, patients require monthly infusions of antibodies called immunoglobulins. Jennifer Puck, a pediatrician at UC San Francisco and a collaborator in the latest study, says infants who got the gene therapy don’t need that medication.

These children are “growing normally, they’re getting colds like everyone else and they’re getting over infections — so I would say that is a cure,” Puck says.

Of course, she adds, they’ll be watched carefully for signs of leukemia and to see if the effect of the therapy is wearing off.

In her view, the key to treatment is finding these children early — through newborn screening — before they start to get life-threatening infections. Screening for SCID is now done throughout the U.S., though its introduction was gradual and state by state.

Before screening was instituted, these children used to show up in the hospital with life-threatening infections, “and now we’re seeing happy, bouncy little newborns who just look perfectly normal and they’re never sick,” Puck says. “Sometimes their families don’t understand just how profoundly affected their immune system is.”

Parents Lobby States To Expand Newborn Screening Test For Rare Brain Disorder

St. Jude hopes to commercialize its treatment. It has an exclusive licensing agreement with Mustang Bio to develop a product. A similar treatment, called Strimvelis, has already been approved by Europe’s equivalent of the Food and Drug Administration. It targets a different mutation that causes SCID, but the technique is very much the same, including the brief dose of chemotherapy.

This latest advance is not only encouraging news for these rare patients. SCID is a test case for all those scientists working to develop better gene therapy techniques.

For example, instead of inserting a healthy gene into blood cells, Matt Porteus at Stanford has used a precision gene-editing technique called CRISPR to correct the genetic error in SCID blood cells drawn from people. It works in the laboratory, “and this really sets the stage, then for a clinical trial, hopefully in the next 12 to 18 months,” he says.

All this makes the leukemia setback from the 1990s feel like a fading memory. Kohn at UCLA says for more than a decade, it seemed that the field of gene therapy was a dead end.

Clearly it has made a comeback, and has treated other rare diseases, including adrenoleukodystrophy, a neurological condition better known as “Lorenzo’s Oil” disease, after a 1992 movie that highlighted a boy with the condition, and his parents’ hunt for a cure.

Now, with continual advances in treating SCID, “it’s just nice to see another success for gene therapy,” Kohn says.

You can contact NPR Science Correspondent Richard Harris at rharris@npr.org.

Article source: https://www.npr.org/sections/health-shots/2019/04/17/714121698/gene-therapy-advances-to-better-treat-bubble-boy-disease

Volunteering can be good for your health

While many of us look forward to retirement so that we can sit on the porch and read or go fishing, many of today’s seniors are looking for a sense of purpose or an outlet for creativity. These active folks have only to look to their neighbors in need to find it. Volunteering is an excellent way for any senior to not only give back to their community but also improve their health and overall well-being.

According to the Bureau of Labor Statistics, more than 11 million seniors volunteered at least once in 2015. Overall, seniors (65 years and older) make up almost 25 percent of the volunteer population. If you include the 55-64 demographic, they make up more than 35 percent of the total volunteer population. Given that the total senior population is projected to reach 80 million by 2050, those numbers are bound to increase.

And there are plenty of good reasons why they should! Since April is National Volunteer Month, I wanted to take a moment to highlight the reasons that volunteering is an excellent way for seniors to stay healthy and active way past retirement age.

Older volunteers can meet a wide range of local needs, including socializing with seniors living in assisted living and nursing facilities, tutoring and mentoring at-risk youth, providing financial education and job training to veterans and their families, and serving meals at soup kitchens and food pantries. In fact, an older adult who volunteers typically does so for more hours in a year than any other age group.

In addition to providing valuable services to people in need, volunteering also enables older volunteers to enjoy active lives. More and more research is showing a relationship between volunteering and physical and mental health benefits. Sandy Lindberg can attest to that. The Nankin resident retired from LSS The Good Shepherd in Ashland after 42 years as a nurse. She said, “The day I retired, I went right over to the beauty salon in the building and offered to help. Now, I volunteer often. I love it. I get to see the residents and my co-workers every week. They are like family.” Sandy also says that volunteering “mentally helps to know you bless others, but usually they encourage me even more.”

Studies have shown that volunteers live longer. A recent study of Americans over the age of 60 found that those who volunteer reported less disability and higher levels of well-being relative to non-volunteers. There is also growing evidence that the positive health benefits of volunteering can be due to the increased physical, social and mental activity needed to be a volunteer. Older volunteers report lower rates in mortality and depression as well as fewer physical limitations and an enhanced sense of well-being.

For seniors, volunteering can be part of a healthy lifestyle. Volunteering regularly can significantly increase physical activity. Whether a senior is stocking shelves at a food pantry, repairing houses for a disaster relief service or walking around a medical facility as a book cart volunteer, volunteering is great to keep the body active. As we age, maintaining a healthy level of physical activity will help ward off disease, injury and even dementia.

Volunteering also has a positive effect on psychological wellness. Seniors who volunteer regularly experience greater life satisfaction, a sense of purpose and accomplishment, more stress resilience, and lower rates of depression. It also fosters positive social, family and community relationships and contributes to a positive image of seniors as a healthy and vital part of our society.

John Cadley of Ashland spends his time visiting veterans at both LSS Lutheran Village Assisted Living and LSS The Good Shepherd in Ashland. As a Vietnam veteran and retired from the Ashland Health Department, he feels that these visits are his ministry. He says, “I was blessed to come home from Vietnam, and I am thankful to all of the men and women who have served our country. They are my heroes. They make me a better man and I know they are appreciative of our conversations.” His mission makes him a blessing to the residents who look forward to his visits. Seniors and retirees in Ashland can make a world of difference as they maintain their good health.

Terry McQuillen, Director of Life Enrichment and Volunteer Coordinator at LSS The Good Shepherd, remarks, “Retired folks make the best volunteers because they enjoy chatting with people like themselves. We always need volunteers to just sit with a resident, holding their hand, reading to them, playing cards or watching a movie.

Any time spent with one of our residents is priceless and appreciated more than the volunteer will ever know.” At LSS Lutheran Village, seniors could spend time with residents reading, quilting, doing crafts, or playing card games. We are grateful for all of our volunteers.

For more information on volunteering at LSS The Good Shepherd, call Terry McQuillen at 419-289-3523 x5270 or to volunteer at LSS Lutheran Village, call Lindsey Salyers at 419-281-8403.

Lorie White is director of admissions and social services, LSS The Good Shepherd Skilled Nursing and Rehabilitation

Article source: https://www.indeonline.com/news/20190416/volunteering-can-be-good-for-your-health

CRISPR Research Moves Out Of Labs And Into Clinics Around The World : Shots – Health News

CRISPR gene-editing technology allows scientists to make highly precise modifications to DNA. The technology is now starting to be used in human trials to treat several diseases in the U.S.

Molekuul/Getty Images/Science Photo Library


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CRISPR gene-editing technology allows scientists to make highly precise modifications to DNA. The technology is now starting to be used in human trials to treat several diseases in the U.S.

Molekuul/Getty Images/Science Photo Library

The powerful gene-editing technique called CRISPR has been in the news a lot. And not all the news has been good: A Chinese scientist stunned the world last year when he announced he had used CRISPR to create genetically modified babies.

But scientists have long hoped CRISPR — a technology that allows scientists to make very precise modifications to DNA — could eventually help cure many diseases. And now scientists are taking tangible first steps to make that dream a reality.

For example, NPR has learned that a U.S. CRISPR study that had been approved for cancer at the University of Pennsylvania in Philadelphia has finally started. A university spokesman on Monday confirmed for the first time that two patients had been treated using CRISPR.

One patient had multiple myeloma, and one had sarcoma. Both had relapsed after undergoing standard treatment.

The revelation comes as several other human trials of CRISPR are starting or are set to start in the U.S., Canada and Europe to test CRISPR’s efficacy in treating various diseases.

“2019 is the year when the training wheels come off and the world gets to see what CRISPR can really do for the world in the most positive sense,” says Fyodor Urnov, a gene-editing scientist at the Altius Institute for Biomedical Sciences in Seattle and the University of California, Berkeley.

Here are highlights of the year ahead in CRISPR research, and answers to common questions about the technology.

What is CRISPR exactly?

CRISPR is a new kind of genetic engineering that gives scientists the power to edit DNA much more easily than ever. Researchers think CRISPR could revolutionize how they prevent and treat many diseases. CRISPR could, for example, enable scientists to repair genetic defects or use genetically modified human cells as therapies.

Traditional gene therapy uses viruses to insert new genes into cells to try to treat diseases. CRISPR treatments largely avoid the use of viruses, which have caused some safety problems in the past. Instead they directly make changes in the DNA, using targeted molecular tools. The technique has been compared to the cut and paste function in a word processing program — it allows scientists to remove or modify specific genes causing a problem.

Scientists Call For Global Moratorium On Creating Gene-Edited Babies

Is this the same technique that caused a recent scandal when a scientist in China edited the genes of two human embryos?

There’s an important difference between the medical studies under discussion here and what the Chinese scientist, He Jiankui, did. He used CRISPR to edit genes in human embryos. That means the changes he made would be passed down for generations to come. And he did it before most scientists think it was safe to try. In fact, there have been calls for a moratorium on gene-editing of heritable traits.

For medical treatments, modifications are only being made in the DNA of individual patients. So this gene-editing doesn’t raise dystopian fears about re-engineering the human race. And there’s been a lot of careful preparation for these studies to avoid unintended consequences.

So what’s happening now with new or planned trials?

We’ve finally reached the moment when CRISPR is moving out of the lab and into the clinic around the world.

Doctors In China Lead Race To Treat Cancer By Editing Genes

Until now, only a relatively small number of studies have tried to use CRISPR to treat disease. And almost all of those studies have been in China, and have been aimed at treating various forms of cancer.

There’s now a clinical trial underway at the University of Pennsylvania using CRISPR for cancer treatment. It involves removing immune system cells from patients, genetically modifying them in the lab and infusing the modified cells back into the body.

The hope is the modified cells will target and destroy cancer cells. No other information has been released about how well it might be working. The study was approved to eventually treat 18 patients.

“Findings from this research study will be shared at an appropriate time via medical meeting presentation or peer-reviewed publication,” a university spokesperson wrote in an email to NPR.

But beyond the cancer study, researchers in Europe, the United States and Canada are launching at least half a dozen carefully designed studies aimed at using CRISPR to treat a variety of diseases.

What other diseases are they testing treatments for?
Two trials sponsored by CRISPR Therapeutics of Cambridge, Mass., and Vertex Pharmaceuticals of Boston are designed to treat genetic blood disorders. One is for sickle cell disease, and another is a similar genetic condition called beta thalassemia.

In fact, the first beta thalassemia patient was recently treated in Germany. More patients may soon get their blood cells edited using CRISPR at that hospital and a second clinic in Germany, followed by patients at medical centers in Toronto, London and possibly elsewhere.

The first sickle disease patients could soon start getting the DNA in their blood cells edited in this country in Nashville, Tenn., San Antonio and New York.

And yet another study, sponsored by Editas Medicine of Cambridge, Mass., will try to treat an inherited form of blindness known as Leber congenital amaurosis.

That study is noteworthy because it would be the first time scientists try using CRISPR to edit genes while they are inside the human body. The other studies involve removing cells from patients, editing the DNA in those cells in the lab and then infusing the modified cells back into patients’ bodies.

Finally, several more U.S. cancer studies may also start this year in Texas, New York and elsewhere to try to treat tumors by genetically modifying immune system cells.

What can go wrong with CRISPR? Are there any concerns?

Whenever scientists try something new and powerful, it always raises fears that something could go wrong. The early days of gene therapy were scarred by major setbacks, such as the case of Jesse Gelsinger, who died after an adverse reaction to a treatment.

The big concern about CRISPR is that the editing could go awry, causing unintended changes in DNA that could cause health problems.

There’s also some concern about this new wave of studies because they are the first to get approved without going through an extra layer of scrutiny by the National Institutes of Health. That occurred because the NIH and FDA changed their policy, saying only some studies would require that extra layer of review.

“Every human on the planet should hope that this technology works. But it might work. It might not. It’s unknown,” says Laurie Zoloth, a bioethicist at the University of Chicago. “This is an experiment. So you do need exquisite layers of care. And you need to really think in advance with a careful ethical review how you do this sort of work.”

The researchers conducting the studies say they have conducted careful preliminary research, and their studies have gone through extensive scientific and ethical review.

When might we know whether any of these experimental CRISPR treatments are working?

All of these studies are very preliminary and are primarily aimed at first testing whether this is safe. That said, they are also looking for clues to whether they might be helping patients. So there could be at least a hint about that later this year. But it will be many years before any CRISPR treatment could become widely available.

Article source: https://www.npr.org/sections/health-shots/2019/04/16/712402435/first-u-s-patients-treated-with-crispr-as-gene-editing-human-trials-get-underway

Tuesday, April 16, 2019


The New York Times:
Melinda Gates On Tech Innovation, Global Health And Her Own Privilege


You would perhaps be demonstrating an excess of sympathy to feel sorry for of ultrawealthy philanthropists. But it’s fair to say that many members of that cohort have found themselves in a challenging moment, faced as they are with increasing anti-elitism and skepticism about just how much altruism, as opposed to ideological self-interest, motivates their work. “There are absolutely different points of view about philanthropy,” says Melinda Gates, who, along with her husband Bill, heads the charitable foundation that bears their name, aimed at increasing global health and reducing poverty. Its endowment, at $50.7 billion, is the largest in the world. “But we’re lucky to live in a democracy, where we can all envision what we want things to look like.” In that regard, Gates’s focus, both here and abroad, is on broadening women’s rights, a subject she explores in her new book, “The Moment of Lift.” “I have rage,” she said, about the injustices she has seen. “It’s up to me to metabolize that and use it to fuel my work.” (Marchese, 4/15)

Article source: https://khn.org/morning-briefing/tuesday-april-16-2019/

Monday, April 15, 2019


The Washington Post:
Multiple Primary Cancers Can Afflict One Patient


Noelle Johnson, 42, was diagnosed with her first cancer — a soft tissue sarcoma under her right arm — in 1999 when she was 21. In 2013, her physicians found six different cancers in her breasts. In the years that followed, surgeons discovered and removed numerous masses they deemed “premalignant” from her ovary, her uterus, her leg, arm and chest wall, aiming to get them out before they turned cancerous. Each tumor was distinct, that is, none resulted from the spread of any of the others. For Johnson, having multiple primary tumors diagnosed at an unusually young age was both scary and baffling. “It was crazy,” recalls Johnson, who lives in Windsor, Col., where she operates a day-care center in her home. “My world started to spin. It was a huge red flag.” (Cimons, 4/14)

Article source: https://khn.org/morning-briefing/monday-april-15-2019/

Measles Cases Spike Driven By Outbreaks In NY And 4 Other Regions : Shots – Health News

A nurse prepares the measles, mumps and rubella vaccine at the Rockland County Health Department in Haverstraw, N.Y. Several measles outbreaks in New York state are contributing to this year’s unusually high measles rates.

Johannes Eisele/AFP/Getty Images


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A nurse prepares the measles, mumps and rubella vaccine at the Rockland County Health Department in Haverstraw, N.Y. Several measles outbreaks in New York state are contributing to this year’s unusually high measles rates.

Johannes Eisele/AFP/Getty Images

Measles is surging. Last week the U.S. recorded 90 cases, making this year’s outbreak the second largest in more than two decades.

So far this year, the U.S. has confirmed 555 measles cases, the Centers for Disease Control and Prevention announced Monday. That’s 50 percent higher than the total number recorded last year, even though we’re only about a quarter of the way through 2019.

And the virus isn’t slowing down.

“The number of cases is accelerating,” says Dr. Amanda Cohn, a senior adviser for vaccines at the CDC. “We are on track to have one of the highest numbers of cases of measles reported since we eliminated the disease in the year 2000.”

The majority of the cases are connected to outbreaks in New York, Cohn says.

“This is a very significant outbreak,” she says. “These cases were imported from other countries, but because of low vaccination coverage in these communities, measles is spreading widely throughout these communities.”

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Last week, New York City declared a public health emergency in an ultra-Orthodox community in the Williamsburg neighborhood of Brooklyn. The city’s Health Department is mandating that parents vaccinate their children, or they may face a $1,000 fine.

The CDC pointed to four other places with ongoing outbreaks in the U.S.: Clark County, Wash.; Oakland County, Mich.; two counties in New Jersey; and a handful of counties across California.

Health officials say there are two main reasons for the virus’s surge: more international travel and lower vaccination rates.

Several countries around the world are currently experiencing massive measles outbreaks. Madagascar has recorded more than 100,000 cases since the fall, with more than 1,200 deaths. Ukraine has recorded about 37,000 cases this year. And the European Union is tallying about 1,000 cases a month.

Globally, the World Health Organization reports that measles cases in the first quarter of 2019 nearly quadrupled compared with what was reported at this time last year.

More American families are bringing measles home with them after traveling abroad, Cohn says. And once the disease lands stateside, it has a better chance of gaining a foothold because vaccination rates in some places have dropped below 93 to 95 percent, the threshold required to protect the entire community.

“When you make the decision not to vaccinate your child, please understand you’re also making that decision for the people around your child,” New York City’s deputy mayor of health and human services, Herminia Palacio, told NPR on Wednesday.

Measles can be an extremely serious disease. About 25 percent of infected children are hospitalized. About 10 percent of children develop ear infections, which can cause permanent hearing damage. In about 1 in 1,000 cases, the infection becomes life-threatening. In these cases, the virus moves to the brain, causing encephalitis and convulsions. Children can be left deaf, blind or with intellectual disabilities — if they recover.

Before the development of the measles vaccine in the 1960s, the U.S. recorded nearly a half-million cases each year, the CDC says. About 48,000 kids were hospitalized and about 500 people died per year.

“We eliminated measles from this country in 2000, and … I think we eliminated the memory of that virus,” Dr. Paul Offit of Children’s Hospital of Philadelphia told NPR’s Weekend Edition Sunday. “People don’t remember how sick it could make you.”

Article source: https://www.npr.org/sections/health-shots/2019/04/15/713508519/measles-outbreak-accelerates-health-officials-warn

Watchdogs Cite Lax Medical And Mental Health Treatment Of ICE Detainees

It’s Saturday morning and the women of the Contreras family are busy in Montclair, Calif., making pupusas, tamales and tacos. They’re working to replace the income of José Contreras, who has been held since last June at Southern California’s Adelanto ICE Processing Center, a privately run immigration detention center.

José’s daughter, Giselle, drives around in an aging minivan collecting food orders. First a hospital, then a car wash, then a local bank.

Giselle’s father crossed illegally from Guatemala more than two decades ago. He worked in construction until agents picked him up and brought him to Adelanto. José languished there for three months without his diabetes medication, Giselle said. Now, she said, the guards give it to him at odd times during the day and night. And ICE agents took his eyeglasses so he can’t read legal documents or write letters, she said.

“My aunt tried to take in glasses for him, but they don’t allow for us to give them anything,” Giselle said, steering the minivan. “They tell us that they give them everything they need.” But as to reclaiming his glasses, “No. … He doesn’t have glasses.”

Giselle said that her 60-year-old father is terrified of being deported, and that the regimented world inside Adelanto is driving him into a deep depression.

“His conversations now have become shorter,” she said. “He doesn’t talk to us and ask, ‘How’s your day? How you been?’ He’s always looking down at the ground; he doesn’t want to make eye contact for the same reason that he’s so depressed.”

Jose’s sister, Maria Contreras, visits her brother every Saturday. She has urged him to see a psychologist at Adelanto, but he tells her that even though he filled out a medical request, he doesn’t get any help. “No response, or anything,” Maria said.

Adelanto sits on a desolate stretch of road in the high desert about an hour north of the city of Riverside. Nearly 2,000 men and women are held here. Some arrived recently during the surge in border crossings. Others lived in the U.S. — undocumented and undetected — for years. In the visiting room, where detainees are brought in wearing blue, orange or red baggy pants and tops, a sign on the wall reads, “Don’t give up hope.”

The facility — run by a federal contractor, the GEO Group, a for-profit company based in Boca Raton, Fla., that runs private prisons — has a troubled past. During an unannounced visit last year, federal inspectors from the Department of Homeland Security’s Office of the Inspector General found “nooses” made out of bed sheets in 15 out of 20 cells. The inspectors found guards overlooked the nooses even though a detainee had committed suicide using a bedsheet in 2017 and several others had attempted suicide using a similar method. The government audit concluded GEO Group guards improperly handcuffed and shackled detainees, unnecessarily placed detainees in solitary confinement and failed to provide adequate medical care.

A separate investigation of Adelanto and other immigration detention facilities in California released in February by California Attorney General Xavier Becerra found similar health and safety problems and concluded that detainees were treated like prisoners, some kept in their cells for 22 hours a day, even though they have not been charged with a crime. A state law passed in 2017 directs the state to inspect and report on the treatment of immigrant detainees held in California.

The alleged cases documented in the most recent report by Disability Rights California, a watchdog group with legal oversight to protect people with disabilities in the Golden State, are grim: detainees slitting their wrists; discontinued medication for depression; and ignored requests for wheelchairs and walkers. At least one detainee claimed that guards pepper-sprayed him when he did not stand up, and a second time while he tried to hang himself.

In a written statement, the GEO Group said it “strongly disputes the claims” in the report, and that the remedies recommended by Disability Rights California “were already in place.”

“We are deeply committed,” the company said, “to delivering high-quality, culturally responsive services in safe and humane environments.” An ICE spokesperson said, in an emailed statement, that the GEO Group’s Adelanto facility is in “full compliance with the Americans with Disabilities Act.”

But Mario, who was inside Adelanto for six months in 2018, said the report describes his own experiences there.

“What’s happening is all those claims that have been made against GEO and the staff in the medical department are finally being backed up by reports,” Mario said.

He requested his last name be withheld because he’s out on bond and still fighting deportation. Mario is now 32; he crossed the border illegally with his parents when he was 5.

In 2017, he was convicted of a misdemeanor and ICE agents picked him up at his home in Ontario, Calif. At the time, Mario was seeing a therapist for depression and taking medication. It took three weeks to get back on antidepressants, he said, and the sessions with the psychologists at Adelanto were only cursory.

“They keep their actual sessions to five to 10 minutes,” he said. “It’s basically like a quick check-in. They just ask you, ‘How are you? Do you have any suicidal thoughts? When is your next court date?’ It’s one of those things that I feel is basically done just to say, ‘All right, we did it.’”

Mario is gay and lived in a room with three other men, including a gay man from Mexico who was seeking asylum. The two became close friends.

“He was persecuted in Mexico because of being gay,” Mario said. Months of detention “and not getting any mental health care really took a toll on him. And that’s when he cut himself. He cut his wrist with a razor blade that we get to shave. And after that he was placed in solitary confinement for about a week.”

Mario said when his friend came back to their room, he was taking some sort of medication.

“After that, all he did was sleep,” Mario said. “When the food was ready I’d go call him: ‘OK, it’s time to eat.’”

Other detainees and immigration lawyers described a similar pattern, of GEO psychiatrists prescribing antipsychotic medications that make people sleep much of the time. It’s one of the reasons people were reluctant to seek help, Mario said. But also, like other detainees, he was worried about being labeled as depressed.

“I couldn’t express whenever I was feeling extremely sad or depressed or anxious because I was afraid that would be used against me in court,” he explained.

Judges cannot use mental health conditions to deny legal status to a detainee, according to immigration attorneys.

Although the GEO Group said any problems detailed in the Disability Rights California report had long been addressed, last month detainees in Adelanto staged a hunger strike. The detainees gave an attorney a handwritten note, which was released by the Inland Coalition for Immigrant Justice, an advocacy group.

Chief among their demands was speedier access to good medical care.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Article source: https://khn.org/news/watchdogs-cite-lax-medical-and-mental-health-treatment-of-ice-detainees/

Special antimicrobial soap used to fight antibiotic-resistant superbugs

Hospitals and nursing homes in California and Illinois are testing a surprisingly simple strategy against the dangerous, antibiotic-resistant superbugs that kill thousands of people each year: washing patients with a special soap.

The efforts — funded with roughly $8 million from the federal government’s Centers for Disease Control and Prevention — are taking place at 50 facilities in those two states.

This novel approach recognizes that superbugs don’t remain isolated in one hospital or nursing home but move quickly through a community, said Dr. John Jernigan, who directs the CDC’s office on health care-acquired infection research.

“No health care facility is an island,” Jernigan said. “We all are in this complicated network.”

At least 2 million people in the U.S. become infected with an antibiotic-resistant bacterium each year, and about 23,000 die from those infections, according to the CDC.

People in hospitals are vulnerable to these bugs, and people in nursing homes are particularly vulnerable. Up to 15% of hospital patients and 65% of nursing home residents harbor drug-resistant organisms, though not all of them will develop an infection, said Dr. Susan Huang, who specializes in infectious diseases at the University of California-Irvine.

“Superbugs are scary and they are unabated,” Huang said. “They don’t go away.”

A nurse at Coventry Court Health Center in Anaheim, Calif., wheels Neva Shinkle to her room to be bathed with a special soap to help fight infections.(Heidi de Marco/KHN ) A nurse at Coventry Court Health Center in Anaheim, Calif., wheels Neva Shinkle to her room to be bathed with a special soap to help fight infections.

Some of the most common bacteria in health care facilities are methicillin-resistant Staphylococcus aureus, or MRSA, and carbapenem-resistant Enterobacteriaceae, or CRE, often called “nightmare bacteria.” E. coli and Klebsiella pneumoniae are two common germs that can fall into this category when they become resistant to last-resort antibiotics known as carbapenems. CRE bacteria cause an estimated 600 deaths each year, according to the CDC.

CREs have “basically spread widely” among health care facilities in the Chicago region, said Dr. Michael Lin, an infectious-diseases specialist at Rush University Medical Center, who is heading the CDC-funded effort there. “If MRSA is a superbug, this is the extreme — the super superbug.”

Containing the dangerous bacteria has been a challenge for hospitals and nursing homes. As part of the CDC effort, doctors and health care workers in Chicago and Southern California are using the antimicrobial soap chlorhexidine, which has been shown to reduce infections when patients bathe with it. Though chlorhexidine is frequently used for bathing in hospital intensive care units and as a mouthwash for dental infections, it is used less commonly for bathing in nursing homes.

In Chicago, researchers are working with 14 nursing homes and long-term acute care hospitals, where staff are screening people for the CRE bacteria at admission and bathing them daily with chlorhexidine.

The Chicago project, which started in 2017 and ends in September, includes a campaign to promote handwashing and increased communication among hospitals about which patients carry the drug-resistant organisms.

The infection-control work was new to many nursing homes, which don’t have the same resources as hospitals, Lin said.

In fact, three-quarters of nursing homes in the U.S. received citations for infection-control problems over a four-year period, according to a Kaiser Health News analysis, and the facilities with repeat citations almost never were fined. Nursing home residents often are sent back to hospitals because of infections.

In California, health officials are closely watching the CRE bacteria, which are less prevalent there than elsewhere in the country, and they are trying to prevent CRE from taking hold, said Dr. Matthew Zahn, medical director of epidemiology at the Orange County Health Care Agency. “We don’t have an infinite amount of time,” he said. “Taking a chance to try to make a difference in CRE’s trajectory now is really important.”

The CDC-funded project in California is based in Orange County, where 36 hospitals and nursing homes are using the antiseptic wash along with an iodine-based nose swab. The goal is to prevent new people from getting drug-resistant bacteria and keep the ones who already have the bacteria on their skin or elsewhere from developing infections, said Huang, who is leading the project.

Certified nursing assistant Cristina Zainos wipes Neva Shinkle's face with chlorhexidine, a special antimicrobial soap.(Heidi de Marco/KHN ) Certified nursing assistant Cristina Zainos wipes Neva Shinkle’s face with chlorhexidine, a special antimicrobial soap.

Huang kicked off the project by studying how patients move among different hospitals and nursing homes in Orange County, and discovered they do so far more than imagined. That prompted a key question: “What can we do to not just protect our patients but to protect them when they start to move all over the place?” she recalled.

Her previous research showed that patients with the MRSA bacteria who used chlorhexidine for bathing and as a mouthwash, and swabbed their noses with a nasal antibiotic, could reduce their risk of developing a MRSA infection by 30%. But all the patients in that study, published in February in the New England Journal of Medicine, already had been discharged from hospitals.

Now the goal is to target patients still in hospitals or nursing homes and extend the work to CRE. The traditional hospitals participating in the new project are focusing on patients in intensive care units and those who already carried drug-resistant bacteria, while the nursing homes and the long-term acute care hospitals perform the cleaning — also called “decolonizing” — on every resident.

One recent morning at Coventry Court Health Center, a nursing home in Anaheim, Calif., 94-year-old Neva Shinkle sat patiently in her wheelchair. Licensed vocational nurse Joana Bartolome swabbed her nose and asked if she remembered what it did.

“It kills germs,” Shinkle responded.

“That’s right — it protects you from infection.”

In a nearby room, senior project coordinator Raveena Singh from UC-Irvine talked with Caridad Coca, 71, who had recently arrived at the facility. She explained that Coca would bathe with the chlorhexidine rather than regular soap. “If you have some kind of open wound or cut, it helps protect you from getting an infection,” Singh said. “And we are not just protecting you, one person. We protect everybody in the nursing home.”

Coca said she had a cousin who had spent months in the hospital after getting MRSA. “Luckily, I’ve never had it,” she said.

Coventry Court administrator Shaun Dahl said he was eager to participate because people were arriving at the nursing home carrying MRSA or other bugs. “They were sick there and they are sick here,” Dahl said.

Results from the Chicago project are pending. Preliminary results of the Orange County project, which ends in May, show that it seems to be working, Huang said. After 18 months, researchers saw a 25% decline in drug-resistant organisms in nursing home residents, 34% in patients of long-term acute care hospitals and 9% in traditional hospital patients. The most dramatic drops were in CRE, though the number of patients with that type of bacteria was smaller.

The preliminary data also shows a promising ripple effect in facilities that aren’t part of the effort, a sign that the project may be starting to make a difference in the county, said Zahn of the Orange County Health Care Agency.

“In our community, we have seen an increase in antimicrobial-resistant infections,” he said. “This offers an opportunity to intervene and bend the curve in the right direction.”

Article source: https://abcnews.go.com/Health/special-antimicrobial-soap-fight-antibiotic-resistant-superbugs-hospitals/story?id=62391590

High Stress Can Lead To Heart Attacks, Sibling Study Finds. Here’s How To Relax : Shots – Health News

The trick, of course, is to find moments of deep relaxation wherever you are, not just on vacation. Laughing with friends can be another way to start breaking the cycle of chronic stress, and help keep your heart healthy, too.

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The trick, of course, is to find moments of deep relaxation wherever you are, not just on vacation. Laughing with friends can be another way to start breaking the cycle of chronic stress, and help keep your heart healthy, too.

stock_colors/Getty Images

Work Stress. Home Stress. Financial Stress.

The toll of chronic stress isn’t limited to emotional suffering. High stress can set the stage for heart disease.

If fact, research shows that those of us who perceive a lot of stress in our lives are at higher risk of heart attacks and other cardiovascular problems over the long term.

This Is Your Stressed-Out Brain On Scarcity

The latest evidence comes from a new study of siblings in Sweden. Researchers identified about 137,000 people who had been diagnosed with stress-related disorders; the diagnoses included post-traumatic stress disorder or acute stress following a traumatic event, such as the death of a loved one or a violent episode. Then, the researchers identified about 171,000 of their brothers and sisters who had similar upbringings and genes — but no anxiety disorder.

Next, they compared the siblings’ rates of cardiovascular disease, including heart attacks, cardiac arrest and blood clots, over a number of years.

The Swedes who had a stress disorder, it turns out, had significantly higher rates of heart problems compared to their siblings.

“We saw [about] a 60 percent increased risk of having any cardiovascular events,” within the first year after being diagnosed, says researcher Unnur A Valdimarsdóttir of the Karolinska Institute, and a professor of epidemiology at the University of Iceland. Over, the longer term, the increased risk was about 30 percent, Valdimarsdóttir says.

Forest Bathing: A Retreat To Nature Can Boost Immunity And Mood

The findings, published in the current issue of the medical journal BMJ, “are quite consistent with other studies,” says Simon Bacon, of Concordia University, who studies the impact of lifestyle on chronic diseases. He points to other studies that show depression, anxiety and stress increase the risk of cardiovascular events. He’s written an editorial that is published alongside the study.

So, when is stress just a normal part of life — something we all just need to deal with — and when does it become so problematic that it sets the stage for disease? Part of the answer here depends on how we respond to stress, the scientists say, and on our own internal perceptions about how much stress we’re feeling.

We’ve all experienced the fight-or-flight stress response.

“Imagine you’re walking down the street and someone jumps out and gives you a scare,” says Bacon. What happens? Your heart rate increases and your blood pressure climbs. “You have that immediate activation,” Bacon says. And, in the short term, this temporary response is good. It gives you what you need to flee or take action.

But, the problem comes if you start to experience these stress response ‘activations’ even when there’s not an imminent threat.

“When people have stress disorders, these systems are being activated at all the wrong times,” Bacon says. For instance, with PTSD, “you can get very exaggerated stress responses just thinking about something that happened.”

Dialing Back Stress With A Bubble Bath, Beach Trip And Bees

People who experience chronic stress seem to be at highest risk of health problems.

“Over the long term, repeated, persistent [stress] responses will activate the immune system and contribute to inflammation,” says Dr. Ernesto Schiffrin, a physician and professor of medicine at McGill University. He says inflammation can set the stage for atherosclerosis, also known as hardening of the arteries. Arteries are the blood vessels that carry blood to your heart and body. When the arteries narrow, this limits blood flow — increasing the likelihood of a heart attack, stroke or other cardiovascular event.

So, since we can’t wave a magic wand and make stress disappear, what are the best coping options? There’s no magic bullet, but day-to-day habits can help tamp down stress.

Schiffrin says he gives his patients this advice: Eat in a healthy way, attempt to have good relationships, have a good attitude, spend time in nature, and exercise. “I think exercise is critical,” Schiffrin says. So, let’s take a closer look at each of these.

  • Exercise When researchers analyzed CDC survey data from more than a million adults in the U.S., they found that people who exercised reported fewer days of bad mental health compared to those who didn’t exercise. And, as we’ve reported, there was an extra ‘boost’ in mental health linked to playing team sports. But, whether you choose a simple walk, forest-bathing, or a group activity, who doesn’t feel a little better after moving their body?
  • Cultivate Friendships Loneliness is an epidemic. And, as we’ve reported, a recent survey found 2 in 5 respondents reported lacking companionship or said they felt isolated from others. Yet, spending time with friends can really boost our moods. No matter your stage of life, signing up for a group activity or volunteering are good options for getting and staying engaged in the community around you.
  • Learn Meditation Or Relaxation Techniques Mindfulness meditation has been shown to tamp down the stress response, and even help reduce blood pressure among people who can maintain the habit. As we’ve reported, one study found that meditation helped 40 out of 60 patients reduce their blood pressure enough to reduce some of their medications.
  • Eat Well There is indeed a link between food and mood. As we’ve reported, a diet full of refined carbohydrates and sugar (the sort you’ll find in packaged snacks and sodas) can lead to a metabolic roller coaster, that can influence your mood, too. On the other hand, a Mediterranean-style diet — rich in fruits, vegetables, whole grains and fish — can leave you feeling nourished.
  • Seek Help For Anxiety Disorders These day-to-day habits may help reduce the amount of stress you feel, but for people with stress disorders such as PTSD it may be best to reach out to a professional for help. “People should treat their mental health issues,” says Bacon. You don’t have to grin-and-bare it, he says. Mental health professionals have lots of tools.

“You don’t want to put yourself in a position where you could make your health worse by not doing anything,” Bacon says.

Article source: https://www.npr.org/sections/health-shots/2019/04/14/711921685/high-stress-drives-up-your-risk-of-a-heart-attack-heres-how-to-chill-out