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Got Dense Breasts? That Can Depend On Who Is Reading The Mammogram

Mon, 07/18/2016 - 5:01pm

Breasts deemed "dense" in a mammogram tend to have less fatty tissue and more connective tissue, breast ducts and glands, doctors say. About 40 percent of women between the ages of 40 and 74 have dense breasts.

Lester Lefkowitz/Getty Images

If you're a woman who gets screening mammograms, you may have received a letter telling you that your scan was clear, but that you have dense breasts, a risk factor for breast cancer. About half of U.S. states require providers to notify women if they fall into that category.

But what you may not know is that gauging breast density isn't a clear-cut process. Researchers reporting in Annals of Internal Medicine Monday found that density assessments varied widely from one radiologist to another. That means you shouldn't let one finding freak you out too much, nor should you assume something's wrong if your reported density changes from year to year.

"Women and providers should keep in mind that density is a subjective measure," says Brian Sprague, a cancer epidemiologist at the University of Vermont and an author of the study. And, he says, breast density is only one factor contributing to a woman's individual risk of getting breast cancer.

Shots - Health News Letters Telling Women About Breast Density Are Often Too Darn Dense

About 40 percent of women between 40 and 74 years old have dense breasts — meaning they have more breast tissue (that is, ducts and glands) and connective tissue and less fatty tissue than women whose breasts aren't dense. You can't know your status by how the breasts feel; it only shows up on a mammogram.

Dense breasts make it harder for radiologists to detect possible abnormalities on a mammogram, and the presence of the tissue itself is an independent risk factor for breast cancer.

The researchers looked at 216,783 mammograms from more than 145,000 women, interpreted by 83 radiologists in Pennsylvania, Vermont, New Hampshire and Massachusetts. The average proportion of mammograms that fell into the "extremely dense" or "heterogeneously dense" categories was 38.7 percent. But the proportion of mammograms assigned to those two categories by individual radiologists ranged from 6.3 percent to 84.5 percent.

Even when adjusting for each patient's age, race and body mass index — since, after all, the patient population in Philadelphia isn't same as in rural Vermont — the variation continued, the authors say.

And among women who had consecutive mammograms read by different radiologists, 17.2 percent got different assessments of whether they fell into the dense or nondense category.

The findings aren't too surprising, says Dr. Priscilla Slanetz, a radiologist at Beth Israel Deaconess Medical Center. "There's agreement usually in the extremes, but a lot of variation in the middle," she says.

Shots - Health News Letters About Dense Breasts Can Lead To More Questions Than Answers

The guidelines for assessing density have also changed since the study was conducted, Slanetz points out, though it's not yet clear how that will affect the percentage of women assessed as having dense breasts.

At a policy level, the researchers say, the results mean that authors of state legislation requiring that women be notified of breast density — and in some cases, offered extra screening using other methods — need to be aware that this variation exists. If all women classified as having dense breasts are referred for an ultrasound based on that factor alone (as they are in some states), that could make for a lot of unnecessary tests and false positive results without an offsetting benefit.

Slanetz's advice for women is to use the density report as a jumping-off point for a broader discussion about their individual breast cancer risk. Authors of a large study published last year said that density alone shouldn't be the only criterion for getting extra screening. Nor should women whose breasts aren't dense assume that they have a low risk of breast cancer.

That personal discussion with a doctor or other health care provider should cover risk factors such as personal history of breast abnormalities and family history of breast cancer, as well as density, Slanetz says.

She also recommends that women with dense breasts seek out digital mammography, which improves detection of cancers.

Ultrasound, digital breast tomosynthesis and MRI have all been suggested as additional screening options for women with dense breasts. But the U.S. Preventive Services Task Force says there's not yet enough evidence to know whether they should be used for screening.

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: @katherinehobson

Copyright 2016 NPR. To see more, visit NPR.
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A Case Of Zika Apparently Spread From A Patient To A Family Caregiver

Mon, 07/18/2016 - 4:14pm
A Case Of Zika Apparently Spread From A Patient To A Family Caregiver Listen · 1:47 1:47 Toggle more options
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July 18, 20164:14 PM ET Heard on All Things Considered

Zika virus particles (colored purple in this scan) infecting cells. Each particle is about 40 nanometers in diameter.

CDC/Smith Collection/Gado/Getty Images

It's been thought that the Zika virus spreads only through mosquito bites or sexual contact. But someone in Utah appears to have caught Zika another way — while caring for an elderly family member infected with the virus.

"The new case in Utah is a surprise, showing that we still have more to learn about Zika," Erin Staples, a medical epidemiologist at the federal Centers for Disease Control and Prevention, reported Monday.

Health officials stressed to reporters in a press briefing that mosquitoes remain the main way that Zika spreads. And there is no evidence at this point that the virus can be spread from one person to another "by sneezing or coughing, routine touching, kissing, hugging or sharing utensils," Dr. Satish Pillai, the CDC's incident manager, told reporters.

"However, there's a lot we don't know about Zika virus, and we are still doing a lot of investigation into whether Zika can be spread from person to person through contact with a sick person," Pillai said.

"From what we have seen, with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, nonsexual spread from one person to another does not appear to be common," Staples said.

The family caregiver who became infected quickly recovered and is being interviewed, along with other family members, by federal and state investigators to try to determine the route of viral transmission in this case.

Health care workers involved with the care of the elderly patient who is believed to have spread the virus are also being tested for Zika, the CDC said. And investigators are testing mosquitoes in the area, although there's no sign so far that any local insects are carrying the virus.

The elderly person caught Zika while traveling to a country where the virus is known to be spreading, according to state and federal health agencies. That patient died in June of unknown causes, the health officials said.

Tests have already shown that the deceased elderly patient had "uniquely high amounts of virus" in the bloodstream, according to a CDC statement. The level of virus was more than 100,000 times higher than seen in other samples of infected people, according to the CDC.

The significance of those high levels of virus remains unclear, but officials told reporters that could have been an important factor in how the virus spread.

In a written statement, the Utah Department of Health said the infected caregiver in the family "has not recently traveled to an area with Zika and has not had sex with someone who is infected with Zika or who has traveled to an area with Zika."

"Our knowledge of this virus continues to evolve and our investigation is expected to help us better understand how this individual became infected," Dr. Angela Dunn, the Utah deputy state epidemiologist, said.

There is "no evidence of any risk of Zika virus transmission among the general public," she added.

The Zika virus can cause serious birth defects when pregnant women get infected. The virus can also cause neurological complications in adults in rare cases.

Mosquitoes have spread the virus widely throughout Latin America and the Caribbean.

No known cases of mosquito-borne Zika virus infections have been reported in the United States. Zika has spread through sexual contact in the United States in a small number of cases. Last week, the CDC reported the first known case in which a woman spread the virus to a man through sexual contact.

Copyright 2016 NPR. To see more, visit NPR.
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Rise And Fall Of Theranos In A Biotech Cartoon

Mon, 07/18/2016 - 11:44am
// Require.js is on the page (new Seamus) if (typeof requirejs !== 'undefined') { // Create a local require.js namespace var require_kqed_theranos_20160615 = requirejs.config({ context: 'kqed-theranos-20160615', paths: { 'pym': 'http://apps.npr.org/dailygraphics/graphics/kqed-theranos-20160615/js/lib/pym', 'CarebotTracker': '//apps.npr.org/dailygraphics/graphics/kqed-theranos-20160615/js/lib/carebot-tracker' }, shim: { 'pym': { exports: 'pym' } } }); // Load pym into locale namespace require_kqed_theranos_20160615(['require', 'pym', 'CarebotTracker'], function (require, Pym, CarebotTracker) { // Create pym parent var pymParent = new Pym.Parent( 'responsive-embed-kqed-theranos-20160615', 'http://apps.npr.org/dailygraphics/graphics/kqed-theranos-20160615/child.html', {} ); // Unbind events when the page changes document.addEventListener('npr:pageUnload', function (e) { // Unbind *this* event once its run once e.target.removeEventListener(e.type, arguments.callee); // Pym versions with "remove" if (typeof pymParent.remove == 'function') { pymParent.remove(); // Pym version without "remove" } else { // Unbind pym events window.removeEventListener('message', pymParent._processMessage); window.removeEventListener('resize', pymParent._onResize); } // Explicitly unload pym library require_kqed_theranos_20160615.undef('pym'); require_kqed_theranos_20160615 = null; }) // Add Carebot linger time tracker var lingerTracker = new CarebotTracker.VisibilityTracker('responsive-embed-kqed-theranos-20160615', function(result) { pymParent.sendMessage('on-screen', result.bucket); }); // Add Carebot scroll depth tracker // var scrollTracker = new CarebotTracker.ScrollTracker('storytext', function(percent, seconds) { // pymParent.sendMessage('scroll-depth', JSON.stringify({ // percent: percent, // seconds: seconds // })); // }); }); // Require.js is not on the page, but jQuery is (old Seamus) } else if (typeof $ !== 'undefined' && typeof $.getScript === 'function') { // Load pym $.getScript('http://apps.npr.org/dailygraphics/graphics/kqed-theranos-20160615/js/lib/pym.js').done(function () { // Wait for page load $(function () { // Create pym parent var pymParent = new pym.Parent( 'responsive-embed-kqed-theranos-20160615', 'http://apps.npr.org/dailygraphics/graphics/kqed-theranos-20160615/child.html', {} ); // Load carebot and add tracker // Separate from pym so that any failures do not affect loading // the actual graphic. $.getScript('http://apps.npr.org/dailygraphics/graphics/kqed-theranos-20160615/js/lib/carebot-tracker.js').done(function () { // Add Carebot tracker var tracker = new CarebotTracker.VisibilityTracker('responsive-embed-kqed-theranos-20160615', function(result) { pymParent.sendMessage('on-screen', result.bucket); }); // Add Carebot scroll depth tracker // Uncomment on one graphic per story // var scrollTracker = new CarebotTracker.ScrollTracker('storytext', function(percent, seconds) { // pymParent.sendMessage('scroll-depth', JSON.stringify({ // percent: percent, // seconds: seconds // })); // }); }); }); }); // Neither require.js nor jQuery are on the page } else { console.error('Could not load kqed-theranos-20160615! Neither require.js nor jQuery are on the page.'); }

Sources

  • Everything You Need to Know About the Theranos Story So Far (Wired)
  • This Woman Invented a Way to Run 30 Lab Tests on Only One Drop of Blood (Wired)
  • Youngest Self-Made Female Billionaire Elizabeth Holmes in Harsh Spotlight Amid Theranos' Criminal Probe (ABC News)
  • Under Fire, Theranos CEO Stifled Bad News (The Wall Street Journal)
  • Craving Growth, Walgreens Dismissed Its Doubts About Theranos (The Wall Street Journal)
  • Now no doctor's note needed for blood test in Arizona (USA Today)
  • Elizabeth Holmes presentation: Lab testing reinvented (TEDMED 2014)
  • This CEO is out for blood (Forbes)
  • From $4.5 Billion To Nothing: Forbes Revises Estimated Net Worth Of Theranos Founder Elizabeth Holmes (Forbes)
  • Theranos phenomenon: promises and fallacies (Clinical Chemistry and Laboratory Medicine)
  • OK, Theranos: Here's the Data The World Needs to See (Wired)
  • Statement on CMS findings (Theranos)
  • Theranos' board: Plenty of political connections, little relevant experience (Fortune)
  • Hot Startup Theranos Has Struggled With Its Blood-Test Technology (The Wall Street Journal)
  • Theranos CEO fires back at WSJ: I was shocked (CNBC)
  • Elizabeth Holmes Discusses Theranos at WSJDLive 2015 (WSJ Video)
  • Theranos Facts (Theranos)
  • The Secret Culprit in the Theranos Mess (Vanity Fair)
  • Proposed imposition of sanctions against Theranos (Centers for Medicare & Medicaid Services (CMS)
  • Statement of deficiencies at Newark, California lab (Centers for Medicare & Medicaid Services)
  • Statement regarding Newark, California lab survey (Theranos)
  • Theranos Announces Leading Medical and Laboratory Experts Join Scientific and Medical Advisory Board (Theranos)
  • Theranos Voids Two Years of Edison Blood-Test Results (The Wall Street Journal)
  • Imposition of sanctions (Centers for Medicare & Medicaid Services)
  • Theranos Statement on CMS Findings (Theranos)
  • Inside the Hollywood Frenzy Around Jennifer Lawrence's Theranos Movie (Vanity Fair)
  • The Theranos Scandal is Just the Beginning (Fast Company)
  • Theranos is Wrong: We Don't Need More Blood Tests (FiveThirtyEight)
  • Lessons for Theranos: Patients Matter More Than Disruption (San Francisco Business Times)

This story was produced by KQED's Future of You blog.

Copyright 2016 KQED Public Media. To see more, visit KQED Public Media.
Categories: NPR Blogs

Wellness Programs Take Aim At Workplace Stress

Mon, 07/18/2016 - 4:48am
Wellness Programs Take Aim At Workplace Stress Listen · 2:41 2:41 Toggle more options
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July 18, 20164:48 AM ET Heard on Morning Edition Katherine Streeter for NPR

Stress has long been shown to increase the risk of heart disease, obesity, diabetes and a number of mental health problems.

And a recent poll finds that a substantial number of working adults say stress is a critical health issue they face at work. The poll was conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

So what are employers doing about it? Fifty-one percent of the people in our poll said their workplace has a formal wellness or health improvement program.

Such plans might include weight management, diet and nutrition, exercise, gym discounts, quit-smoking programs, assistance with alcohol or drug rehabilitation or disease-management programs for diseases like asthma or diabetes.

Many programs also focus on stress reduction.

The downside? Less than half the people polled — 40 percent — say they participate in the programs offered by their workplace.

Still, these programs can go a long way toward creating an environment that promotes health and reduces stress — thereby helping a company's bottom line.

"There's a recognition that the cost of burnout — either in the form of lower productivity or, in extreme cases, the loss of employees — is more costly" than taking steps to reduce stress, says Diane Domeyer, executive director of The Creative Group, a staffing firm.

Those stress-curbing steps can include things like planning ahead and hiring temporary workers to fill in the gaps when regular employees take time off for stress-relieving exercise or vacation, she says.

Wellness programs can help, too. They're often aimed at improving specific health factors and offer ways to help employees lose weight, exercise more, improve diet and even diminish back pain. This may include employing people who can do back exams in the workplace and even offer physical therapy or financial advice.

Dr. Tim Church, a preventive medicine specialist and chief medical officer at ACAP Health Consulting, helps companies set up wellness programs. Most companies he deals with are concerned about health costs and see wellness as a relatively easy fix.

"Health care costs to a company are now a major issue, whereas it used to be an afterthought," he says. "As health care costs continue to skyrocket, it's the American employers who are taking the brunt of these costs."

Employers are now including meditation and yoga classes in wellness programs to reduce stress, he says. They're also trying "water challenges" to get employees to drink more water. Some companies even bring in a massage therapist every week or so, according to Church.

Beyond formal wellness programs, companies should also pay attention to stress-inducing conditions like workloads and paid time off, says John Quelch, a professor of business administration at the Harvard Business School.

"The sheer overload that comes from downsizing and outsourcing and asking someone to do two jobs, when previously they had to do one" is something companies must consider if they're interested in reducing worker stress, Quelch told a forum on the workplace and health, held last week at the Harvard Chan School.

Among people in NPR's survey who work 50-plus hours a week, 49 percent said their workload made it too hard to take a vacation. And 42 percent said they don't take all the paid vacation they earn because there wouldn't be enough people to cover their work if they did.

Not taking all your vacation leave is an unfortunate mistake, says psychologist Matthew J. Grawitch of Saint Louis University, who studies stress in the workplace.

"When workers come back from vacation they have more energy, they tend to be more replenished and feel more engaged in their work," Grawitch says.

Companies have to make changes that actively encourage employees to take their vacation, he says, and to take advantage of wellness programs.

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

Cardiac Rehab Saves Lives. So Why Don't More Heart Patients Sign Up?

Mon, 07/18/2016 - 4:21am
Cardiac Rehab Saves Lives. So Why Don't More Heart Patients Sign Up? Listen · 3:50 3:50 Toggle more options
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July 18, 20164:21 AM ET Heard on Morning Edition

From

Exercise physiologist Courtney Conners checks Mario Oikonomides' vital signs before his cardiac rehab workout at the University of Virginia Health System clinic.

Francis Ying/Kaiser Health News

When Mario Oikonomides was 38 years old he had a massive heart attack. About a month later, after he'd recuperated from the emergency, his doctors sent him to a cardiac rehabilitation program, where he learned about the role physical activity can play in reducing cardiac risk.

"I never exercised before," Oikonomides says. "I became addicted to exercising." The program, overseen by a medical team, also checked up on his medications, provided nutrition counseling and offered other help and coaching in the fraught weeks and months after his hospitalization.

Oikonomides is 69 now and lives in Charlottesville, Va. When he recently needed bypass surgery, long decades after that heart attack, he again signed up for a rehabilitation program as soon as he could.

"I bought myself 30 years of healthy life as a result of cardiac rehab," he says.

But, despite many years of research showing that joining a cardiac rehabilitation program can help heart patients heal faster and even live longer, Oikonomides is among a minority of patients who take advantage of such programs; fewer than a third do.

Why is rehab such a hard sell? Blame it on a number of factors, doctors say.

Some patients have to travel a long way to the nearest program; work schedules keep others from joining. Uninsured patients often can't afford it. And even those with insurance can be stopped short by copayments that can be $20, $40 — or even $50 a class.

"The number one barrier is the cost of the copay, which is frustrating," says Dr. Ellen Keeley, a cardiologist at the University of Virginia Health System.

These days, Medicare and most private insurers cover cardiac rehab for patients who have had heart attacks, coronary bypass surgery, or who have had stents implanted or received a diagnosis of heart failure or any of several other conditions. Most plans cover two or three hour-long visits per week — up to 36 sessions. With most programs encouraging patients to participate two or three days a week, the cost of copayments can add up fast.

Courtney Conners is an exercise physiologist at U.Va. who meets with patients after a heart attack. The U.Va. clinic, started by Keeley about a year ago, contacts patients before they are discharged and brings them back to the clinic a week or 10 days later to meet one-on-one with a nutritionist, pharmacist, cardiologist and exercise physiologist to develop a tailored rehab program.

"There's a little hesitance, where they're like, 'I don't really want to come. I don't know if I want to go three days a week,'" Conners says of the exercise program. "And then their wife, or one of their family members will push them, and then they'll agree to sign up."

Charles Greiner gets his heart rate up — with supervision — at the U.Va. cardiac rehabilitation gym in Charlottesville, Va.

Francis Ying/Kaiser Health News

Right now, there actually aren't enough rehab programs in the U.S. to accommodate all the patients who are eligible, advocates say. A recent study in the Journal of Cardiopulmonary Rehabilitation and Prevention surveyed 812 existing cardiac rehab programs across the nation and found that even if they were expanded modestly and operated at capacity, the existing programs could serve only 47 percent of qualifying patients.

Still, advocates are hopeful that cardiac rehab may start to gain more traction, now that hospitals have an extra incentive to encourage patients to sign up. Because of provisions in the Affordable Care Act, hospitals now face financial penalties if too many of their cardiac patients need to be readmitted soon after discharge — and enrolling patients in rehab helps keep those numbers down, the evidence shows.

For example, getting patients into cardiac rehab programs cut hospital re-admissions by 31 percent in one Canadian study, according to a review of the literature by the American Hospital Association, saving $8.5 million a year; a study in Vermont pegged the savings at about $900 per patient.

Kathryn Shiflett, a hospital phlebotomist and one of Keeley's patients, is just 33 and has two young kids. A week after her heart attack she was at the U.Va. clinic looking for information about a rehab program. She's eager to get well. But she's not used to exercise and she's a bit nervous about cardiac rehab.

After being reassured that her vital signs would be monitored closely as she exercised, Shiflett hinted at the real barrier: She lives an hour away and is about to start a new job. Cardiac rehab classes happen Mondays, Wednesdays and Fridays, with sessions at 8 a.m., 10 a.m. and 3 p.m.

Just a week after her heart attack, Kathyrn Shiflett meets with Dr. Ellen Keeley, a U.Va. cardiologist, to learn more about the next steps in healing.

Francis Ying/Kaiser Health News

"I don't know if I can get there by then," Shiflett says. "My job goes from 4:30 in the morning until 3."

Oikonomides says there was no question that he would do whatever it took to participate in rehab after his bypass surgery this winter. Cardiac rehab sparked his love of exercise, he says — and that has helped keep him out of the hospital for decades.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
Categories: NPR Blogs

Don't Do What I Do: How Getting Out Of Sync Can Help Relationships

Sat, 07/16/2016 - 7:00am

Source: Nicole Xu for NPR

"Whatever! Just leave me alone!"

Tammy stomps her feet up the stairs to the bedroom. A few moments later she slams the door, leaving for work. Jack is exasperated, angry and hurt. He wanted to rush outside and demand that Tammy treat him with respect. He imagined giving her the silent treatment until she apologized. But he knew this would prolong the fight and compound the resentment.

He goes upstairs, tidies their room and does her laundry. He arranges some flowers on their nightstand and goes to work.

Tammy gets home ragged from a long day, sneers at Jack briefly over the edge of her phone and goes upstairs knowing that her laundry needs to be done before work tomorrow morning. After a few moments she comes down the stairs sheepishly, with a gentleness on her face. "Did you do my laundry?"

"Yes," he says.

"And the flowers?"

"I know how stressful work has been. I feel bad about how things went this morning, and I thought they might cheer you up."

"They did. I am sorry."

"Me too."

What Jack did in this fictional scenario was difficult and counterintuitive. It could feel like giving up too much and setting yourself up for being taken advantage of. Why should he have to do something nice for Tammy? She was rude and she owed him an apology.

But it worked. He lost the battle in order to win the war. And in the end the couple joined around the fact that the stresses of life are the enemy, and they are on the same team.

The typical course of action would be for Tammy's cold behavior to lead to Jack being cold, which would in turn lead to even colder behavior by Tammy, and so on. Psychologists call this pattern complementarity, and there are two varieties. The first is that warmth begets warmth whereas coldness begets coldness, as in the case of Jack's initial impulse to give Tammy the silent treatment.

The second is that dominance begets submission whereas submission begets dominance. For instance, some clients submissively say to their therapists: "Doc, I just don't know what to do. I feel like I have tried everything and I am out of ideas. I sure hope you can help." The therapist might respond with complementarity: "I understand. I have some experience with clients like you and I think I can help. Let's start with some assessments to get a better idea about what is going on."

Alternatively, a dominant client might open with: "My problem is depression. I have been depressed before, and what I really need is someone who will listen — to give me a place to talk about my problems without trying to do too much." The complementary therapist might say, "It sounds like you have done a lot of thinking about this, and I am interested in learning more about your situation. I hope I can help."

Complementarity is generally natural and easy. If someone is nice to you, you tend to be nice back. If they're not nice, then why should you be? If someone seems to know what they are doing, it is natural to follow. And when you are in charge, it is easiest if others do what you say.

Noncomplementary behavior is more difficult, but sometimes it is the best choice. Jack's warm response to Tammy's coldness led to her apology, which is what he really wanted and would have been unlikely to receive with the silent treatment.

Research suggests that complementary behavior by therapists is good for building an alliance, which turns out to be really important for helping clients feel better. However, noncomplementary behavior is linked with clients' behavior change.

The submissive client may feel more comfortable with a therapist who tells him what to do. But if he is to learn how to be more assertive, he needs a therapist who will occasionally say: "You know, this is a time when I don't have an answer — you are going to have to figure it out for yourself." The client may become anxious and insecure, but ultimately may also learn to practice a new approach to solving life's problems.

Similarly, the dominant client might need a therapist who will sometimes say: "So you have always had the answers, but at the same time you are here because your solutions have not been working. Friends tell you that you are too bossy and critical, and your automatic response is that they need to be tougher. But I think sometimes they are right, and by shutting them down you are also shutting them out of your life. Then you don't get the support you need, and feel lonely and depressed."

This is a threatening thing for a dominant client to hear, but again, it is the kind of response that may help her see things a different way and change her behavior so that she is more likely to get her needs met.

Noncomplementarity is uncomfortable, can threaten relationships, and should be used with care. If you are always warm to a cold person, you can become a pushover. Meeting dominance with dominance can result in a fight, whereas being submissive with a submissive person can lead to inaction and boredom. Strategic interpersonal behavior in any form can feel manipulative and inauthentic.

However, in psychotherapy, the idea is that occasional, high-impact noncomplementary moments can have a positive impact in the context of a trusting relationship, and this principle generalizes to other relationships as well.

Christopher J. Hopwood is an associate professor of psychology at Michigan State University who researches noncomplementary behavior. NPR's Invisibilia podcast and show explores real-life experiments in noncomplementarity, including a Danish city where police embraced young Muslim residents who were becoming radicalized and a dinner party that was suddenly interrupted by a stranger.

Copyright 2016 NPR. To see more, visit NPR.
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First Case Reported Of A Woman Infecting A Man With Zika Through Sex

Fri, 07/15/2016 - 12:09pm

The Centers for Disease Control and Prevention is updating its guidelines on preventing transmission of Zika virus via sexual activity.

Stephanie Lynn/Flickr Flash/Getty Images

Doctors have known for some time that a man can spread the Zika virus to a woman through sex. Now officials have documented the first case in which a woman apparently infected a man through unprotected sexual intercourse.

The case occurred in New York City when a woman in her 20s returned from a trip to a country where Zika is spreading, according to a report released Friday by the federal Centers for Disease Control and Prevention.

The woman, who was not identified, and a male partner had sex without a condom the day she returned home, according to the report.

After the woman developed Zika symptoms, she went to her doctor. Tests showed she was infected with the Zika virus. Her partner, who is also in his 20s, subsequently got sick and tested positive for the virus. He had not traveled outside the United States nor did he have other risk factors for Zika, such as having been bitten by a mosquito.

"The hypothesis is that this was transmitted sexually, and I think that's probably a pretty good case," John Brooks, a medical epidemiologist who is in charge of studying the sexual transmission of Zika for the CDC, told Shots in an interview. "This the first case that we're aware of, anywhere."

The report did not identify the country where the woman had traveled. Both she and her partner recovered, Brooks says. The woman was not pregnant.

Most people who get infected with Zika do not get sick, or they develop only a relatively mild illness. But Zika can cause serious birth defects when pregnant women get infected. And the virus can cause neurological complications in adults in rare cases.

Based on this case, the CDC is revising its recommendations for how people can protect themselves from getting infected with the Zika virus through sexual contact.

Currently the CDC recommends that pregnant women whose male sexual partner has traveled or lived in a place where Zika is spreading use a barrier method of contraception, such as a condom, or refrain from sex during the pregnancy. The CDC now recommends that pregnant women whose sexual partners are female take the same precautions.

Goats and Soda Zika Epidemic May Have Peaked But Will Threaten U.S. For Years

In addition, the CDC plans to update its recommendation for sexually active couples in which the woman is not pregnant. Currently, the CDC recommends that men who have traveled to a place where Zika is spreading and develop symptoms should use condoms or abstain from sex for at least six months. If they don't have symptoms, they should take precautions for at least eight weeks.

Brooks says the CDC plans to provide similar advice to women about "what they might want to consider doing to reduce the risk that they may expose someone to Zika or transmit it to someone else."

He noted that mosquitoes remain a major way the Zika virus is spread. No cases of Zika transmission through mosquitoes have been reported in the U.S.

It's unclear exactly how women spread Zika to men, but the virus has been detected in the vaginal fluid of at least one woman and in nonhuman primates.

Brooks noted that the male partner involved in the New York case was not circumcised. Uncircumcised men tend to be at greater risk for sexually transmitted diseases. In addition, the woman involved in the case started her period shortly after they had sex. So there's a chance the virus could have spread through blood.

The report from the New York Department of Health and Mental Hygiene was published in the CDC's Morbidity and Mortality Weekly Report.

Copyright 2016 NPR. To see more, visit NPR.
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She Offered The Robber A Glass Of Wine, And That Flipped The Script

Fri, 07/15/2016 - 7:48am
Manual Cinema/NPR

This week's Invisibilia podcast and show explore what happens when people flip the script, responding to situations in ways that are completely unexpected. We tend to respond to aggression with aggression, kindness with kindness. Usually that works just fine. But sometimes turning 180 degrees can change the world. Think Mahatma Gandhi or Martin Luther King Jr.

In this Invisibilia excerpt on NPR's Morning Edition, we tell the tale of a mellow Washington, D.C., dinner party that was suddenly interrupted by a man with a gun. "Give me your money," the man said. Or he would start shooting.

The diners tried to persuade him to back off, but the situation was getting increasingly tense. Then a woman named Christina did something simple yet extraordinary. And that changed everything.

Additional Information:

Manual Cinema, a live performance company, re-enacted the dinner scene from this week's Invisibilia episode using projectors, shadow puppets and live music. You can check out the complete behind-the-scenes version of the production here.

Manual Cinema/NPR YouTube

(Check out the video, above, that the performance collective Manual Cinema created for Invisibilia about the dinner-party robber and the unexpected outcome.)

In NPR's health blog, Shots, Invisibilia co-host Hanna Rosin explains what she found when she traveled to Denmark to check out a radical experiment in flipping the script. It involves the local police and dozens of young Muslims who were planning to run off to Syria and join ISIS.

We also asked psychologist Christopher J. Hopwood to explain the science behind what happened at the dinner party. Psychologists call it noncomplementarity — responding in an unexpected way to prompt a positive response. It's used in psychotherapy, and it also can work to make relationships better in your own life.

Copyright 2016 NPR. To see more, visit NPR.
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How A Danish Town Helped Young Muslims Turn Away From ISIS

Fri, 07/15/2016 - 3:05am

One day in 2012, a group of policemen in a Danish town were sitting around in the office when an unusual call came in. This town, called Aarhus, is a clean, orderly place with very little crime. So what the callers were saying really held the cops' attention. They were parents, and they were "just hysterical," recalled Thorleif Link, one of the officers. Their son was missing. They woke up one day and he was gone.

The officers put together whatever clues they had about the missing person: He was a teenager who went to a local high school, and he lived in a largely Muslim immigrant neighborhood just outside town. But before they got any further with their investigation, they got another call, from another set of parents. Their son was missing too.

"Why is this going on?" asked Allan Aarslev, a police superintendent.

After talking to the parents and snooping around the neighborhood, the police figured it out: These young men and women had gone to Syria. They were among the exodus of thousands of European citizens who were drawn to the call put out by ISIS, the Islamist terrorist group, for Muslims worldwide to help build the new Islamic state.

Shots - Health News WATCH: She Offered The Robber A Glass Of Wine, And That Flipped The Script

Link and Aarslev are crime prevention officers. They usually deal with locals who are drawn to right-wing extremism, or gangs. The landscape of global terrorism was completely new to them. But they decided to take it on. And once they did, they wound up creating an unusual — and unusually successful — approach to combating radicalization.

The rest of Europe came down hard on citizens who had traveled to Syria. France shut down mosques it suspected of harboring radicals. The U.K. declared citizens who had gone to help ISIS enemies of the state. Several countries threatened to take away their passports — a move formerly reserved for convicted traitors.

But the Danish police officers took a different approach: They made it clear to citizens of Denmark who had traveled to Syria that they were welcome to come home, and that when they did, they would receive help with going back to school, finding an apartment, meeting with a psychiatrist or a mentor, or whatever they needed to fully integrate back into society.

Their program came to be known as the "Aarhus model." It's been called the "hug a terrorist" model in the media, but this description never sits well with the cops. They see themselves as making an entirely practical decision designed to keep their city safe.

As they see it, coming down hard on young, radicalized Muslims will only make them angrier and more of a danger to society. Helping them is the only chance to keep an eye on them and also to keep the peace in their town.

Allan Aarslev, a police superintendent in Aarhus, became part of the effort to make young Muslims feel like they have a future in Denmark.

Scanpix Denmark/USAScanpix/Sipa

Link and Aarslev were intuiting what scientists who study radicalization are coming to see.

"The original response was to fight [extremism] through military and policing efforts, and they didn't fare too well," says Arie Kruglanski, a social psychologist at the University of Maryland who studies violent extremism. "That kind of response that puts them as suspects and constrains them and promotes discrimination — that is only likely to exacerbate the problem. It's only likely to inflame the sense there's discrimination and motivate young people to act against society."

Their approach has a basis in research on interpersonal relations as well.

Christopher Hopwood, an associate professor of psychology at Michigan State University, studies something called noncomplementary behavior. Complementary behavior is the norm. It means when you act warmly, the person you are with is likely to act warm back. The same is true with hostility. But noncomplementary behavior means doing the unexpected. Someone acts with hostility and you respond warmly. It's an unnatural reaction, and it's a proven way to shake up the dynamic and produce a different outcome from the usual one.

The nonviolent resistance movements of Martin Luther King Jr. and Mahatma Gandhi are the most well-known examples of this tactic. The Aarhus model is another. How did it unfold in real time? Consider the case study of a young man we call "Jamal." Jamal is not his real name, and we don't usually use pseudonyms, but he asked us to not use his name. He doesn't want to be known as a person who almost became a terrorist. He wants a job and a life now. But that didn't seem possible for a while.

Jamal was born in Somalia; his family moved to Denmark because Somalia was in the middle of a civil war. His was the only black family in the neighborhood and the only Muslim family, and his childhood wasn't easy. Kids called him names, asked him if he had the same blood as they did, and teased him. For a long time he just would fight back, but he knew he was disappointing his father.

When he was a little older, Jamal decided to take a different tack. He tried to be the good kid. He studied and made jokes in class, and his stress eased. The teachers liked him, his classmates liked him, and he began to make Danish friends and even to feel more Danish.

Then one day in high school, his teacher organized a debate about Islam. Jamal had just been on the hajj, the pilgrimage to Mecca, with his family, and he was infused with a newfound religious identity. And during the debate one of the girls started saying to the class that Muslims "terrorize" the West, and kill people and stone women. Jamal argued with her and eventually lost his temper, saying, "People like you should never exist."

After that moment, Jamal's life went off the rails. The teacher told the principal, who told the police, who questioned Jamal about being a terrorist. Jamal had to stay home from school and miss his final exams. The police cleared him, but it was too late for him to redo his exams, so he had to redo some of high school. He was furious about it. Soon after the investigation, his mother died, and he blamed her death on the stress caused by the investigation. He began to feel rejected by the West.

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During that year, he ran into a group of fellow Muslims who had experienced some of the same discrimination. One of them had an apartment, and the group spent a lot of time there talking, praying and watching videos of Anwar al-Awlaki, a famous English-speaking imam. The friends talked a lot about jihad and making the trip to Syria. Two of the guys in the apartment began planning their trip.

While he was living in that apartment, Jamal got a call from Link, who had heard about his case. Jamal cursed him out and tried to hang up the phone, but then Link did something Jamal didn't expect: He apologized, for the ordeal his fellow officers had put Jamal through. Hearing a policeman take responsibility for his life getting derailed really moved Jamal. He agreed to come into Link's office.

When Jamal got there, Link introduced him to Erhan Kilic, one of the first official mentors hired by the program. Kilic was a fellow Muslim who had also faced discrimination in Denmark as a child. But he had taken a very different path. He had decided to embrace Denmark as his country. He now had a wife and two daughters and a successful practice as a lawyer. Kilic relayed to Jamal the main message of the Aarhus program: If he chose to, Jamal could also find his place in Denmark.

This is what sets the Aarhus program apart. It didn't use force to stop people from going to Syria but instead fought the roots of radicalization, Kruglanski says. "There are strong correlations between humiliation and the search for an extremist ideology," he says. Organizations like ISIS take advantage of people who, because of racism or religious or political discrimination, have been pushed to the margins of society.

Link and Aarslev's program showed people like Jamal that there was a place for them.

"Aarhus is the first, to my knowledge, to grapple with [extremism] based on sound social psychology evidence and principles," Kruglanski says. What Link and Aarslev were doing was so unexpected that it created an opening for people to think differently about their ideology. "They expect to be treated harshly," Kruglanski says. Instead, they got the opposite. "That kind of shock opens people's minds to maybe they were wrong about their society that they perceived as their enemy. It opens a possible window into rethinking and re-evaluating."

Starting in 2012, 34 people went from Aarhus to Syria. As far as the police know, six were killed and 10 are still over there. Of the 18 who came back home, all showed up in Aarslev and Link's office, as did hundreds of other potential radicals in Aarhus — about 330 in total.

But the program is admired for another accomplishment: Since the initial exodus of young people, very few have left from Aarhus for Syria, even when traffic from the rest of Europe was spiking. Last year, in 2015, it was just one person.

The program is still precarious, though. One terrorist attack in Aarhus could undo much of the work that has been done. But the officers are willing to keep trying. As Link put it, there are still "strong forces" out there tempting young Muslims to leave their lives in the West and join the battle.

And Jamal? He and his mentor met for two years, exploring parts of Aarhus Jamal had never seen. During that time, two of his friends from the apartment did leave for Syria. One was killed by a roadside bomb, and the other, a fellow Somali, is still over there.

Jamal, by contrast, can definitely and confidently say, "I am Danish." Reflecting on his path, he concludes, "I'm lucky I got that phone call from Thorleif."

Hanna Rosin is a host of Invisibilia, NPR's podcast and show on the invisible forces that shape our lives. This episode explores what happens when you flip the script. Alix Spiegel also tells the tale of a D.C. dinner party that almost became a crime scene, with video from the performance collective Manual Cinema. And on Saturday in Shots, psychologist Christopher Hopwood explains how to use the concept of noncomplementarity to make your own relationships better.

With additional reporting by Angus Chen.

Copyright 2016 NPR. To see more, visit NPR.
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Emotional Healing After A Flood Can Take Just As Long As Rebuilding

Thu, 07/14/2016 - 4:28pm
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July 14, 20164:28 PM ET Heard on All Things Considered

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A small memorial marks the former homestead of the Nicely family, who died in the June flooding of White Sulphur Springs, W. Va.

Kara Lofton/West Virginia Public Broadcasting

Most of the front door of Rachel Taylor's little yellow house in White Sulphur Springs, W. Va., is pasted with paw prints where her dog struggled to get inside during the flood last month. He was too big to carry through the rising waters.

Across the street, nestled between two battered houses, an empty lot is marked by a cross with an array of flowers and photos — a small memorial for a family washed away by the torrent.

Taylor's dog survived and is now with some of her family members in Kentucky. But those neighbors across the street, the Nicelys, were swept away when their house collapsed; they have since been confirmed dead.

"When I start feeling overwhelmed with this," Taylor says from her front porch, "I just look across the street at that memorial and I think, there's nothing that we have lost that can't be replaced or mended."

She and her husband spent seven years renovating this 1930s Craftsman house, room by room. They were just about done with renovations when their house flooded a few weeks ago. Today the living room is gutted.

"You know, the first couple of days it was very intense," Taylor says. "It was kind of 'crisis mode.' Maybe that's the way I would describe it, because you didn't really have time to think about it and process it."

But once the full extent of the damage set in, Taylor says, she developed severe nausea and carsickness to the point of not being able to drive.

A number of people, she says, have chalked up her symptoms to nerves. "You know, the stress level. You don't realize your body is just having a response to this."

Taylor worries that the houses in her neighborhood will remain abandoned and that she, her husband and her 14-year-old daughter won't feel safe at home anymore. She plans to rebuild, but says her family will likely sell the house and move.

Rachel Taylor surveys the flood damage from her front porch in White Sulphur Springs, W.Va. Muddy paw prints on the front door still mark her dog's panic as the waters rose. He survived, but others didn't.

Kara Lofton/West Virginia Public Broadcasting

"The words we use when we talk about it are 'I don't know if I have it in me;' 'I'm not sure if I can do it again,' " she says. "Things like that. And then we just say, 'Well, we'll take it one day at a time.' "

Psychologists say this kind of response is normal following natural disasters.

"It's a physical aspect of the stress response — it will affect the body's ability to concentrate, to rest and to be able to function," says Marcie Vaughan, leader of the state-funded West Virginia Community Crisis Response Team. "Cognition is slowed and impaired," she adds.

Vaughan's team offers support, counseling and referrals for further mental health care at local behavioral health centers.

"From the behavioral health perspective, we find we are more in need after the tenth [or] twelfth day," Vaughan says, "just because immediate needs of food, clothing and shelter take precedence."

In the first few days following the flood, Vaughan's team members split their time between helping people replace lost psychiatric medications and looking for signs of mental distress in people at shelters or feeding stations.

"We see fatigue, problems with cognition," she says. "You have individuals who walk into a supply center and they have no idea what they need."

A 2012 study published in the journal Social Psychiatry and Psychiatric Epidemiology found that while most people bounce back a few months after a disaster, if their ongoing stressors aren't addressed — such as a lack of permanent shelter, financial challenges and repeated exposure to the trauma — affected residents will continue to struggle.

In addition to Vaughan's team, church disaster-assistance teams and Hope Animal-Assisted Crisis Response — a support organization that uses trained therapy pets for comfort — stepped in to help.

"As the fatigue sets in and the frustration, we see an increased need for behavioral health intervention," says Vaughan.

Unfortunately, that's just when the work becomes hardest, Vaughan says, and it's often after national organizations and media have lost interest. Very real, tough problems persist, though only local groups and neighbors remain to extend helping hands.

This story is part of NPR's reporting partnership with West Virginia Public Broadcasting and Kaiser Health News.

Copyright 2016 West Virginia Public Broadcasting. To see more, visit West Virginia Public Broadcasting.
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Early Bedtime For Preschoolers Might Help Reduce Obesity Risk Later

Thu, 07/14/2016 - 1:36pm
Isabel Pavia/Getty Images

For parents concerned that their preschoolers may one day gain excess weight, a study published Thursday suggests one strategy for keeping the little ones on track that isn't related to food: Tuck them in earlier.

Scientists reporting online in The Journal of Pediatrics found, in a study of not quite a thousand U.S. children, that preschoolers who got to bed by 8 p.m. were about half as likely as those who turned in after 9 p.m. to develop obesity in their teenage years.

Obesity continues to be a major health issue for children and teens in the United States, and many studies have shown that issues with sleep quality and duration can contribute to that risk, says Sarah Anderson, epidemiologist at the Ohio State University and lead author on the current research. But "there haven't been many studies that have looked at bedtime," Anderson says.

A child's bedtime is an important factor to examine because it's something a parent generally has some control over, says Lisa Medalie, director of the Pediatric Insomnia Program at the University of Chicago Medicine, whereas kids often have a fixed wakeup time because they have to get out the door in time for camp or school.

"Kids can get really fussy when you keep them up too late," Medalie says. "If they get too fussy and get overtired, then it actually makes it harder for them to sleep."

To find out whether preschooler bedtimes might be linked to obesity later in life, Anderson and colleagues looked back at data collected for 977 children across nine states as part of a government-funded research project called the Study of Early Child Care and Youth Development.

Researchers followed these children from birth in 1991 through their adolescent years. They recorded a range of data — everything from a child's height and weight at different ages to a mother's education level and attention to her child's needs as observed through video recordings.

Importantly for Anderson's study, when the children reached about 4.5 years old, researchers included this in the list of questions they asked mothers: "What time does your child go to bed on most weekday evenings?"

It turned out that about 25 percent of the children went to bed at 8 p.m. or earlier, half went to bed between 8 and 9 p.m., and 25 percent went to bed after 9 p.m.

Anderson and her team found that the bedtime category a child fell into was linked to his or her likelihood of being obese. When the preschoolers reached about age 15, 10 percent of the early-to-bed group, 16 percent of the middle group, and 23 percent of the late-to-bed group were obese.

Even after the researchers controlled for other factors like birthweight, socioeconomic status, ethnicity, and the mother's weight, the preschoolers who went to bed late — after 9 p.m. — were still twice as likely to develop obesity in their teens as the early-to-bed group.

"That you can ask one question of a mother of a 4.5-year-old child and it relates to body mass index 10 years later — that's pretty remarkable," says Joseph Buckhalt, a pediatric sleep researcher at Auburn University.

The research hasn't proved that later bedtimes directly cause obesity, only that there seems to be some connection between the two, the sleep scientists agree. Research on this point has only just begun.

And Anderson says she recognizes that it's not always possible to get kids to bed early. Some parents' work schedules "don't allow them to arrive home early enough in the evening to both spend time with the child and have an early bedtime," she notes.

Still, Anderson says, for lots of reasons, "parents might want to consider what it would take for them to have a regular early bedtime routine for their preschool-aged child." And aim for that.

Copyright 2016 NPR. To see more, visit NPR.
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Social Media Abuse Of Nursing Home Residents Often Goes Unchecked

Thu, 07/14/2016 - 8:00am
Maria Fabrizio for NPR

Editor's note: This story contains language that some may find offensive.

When a certified nursing assistant in Hubbard, Iowa, shared a photo online in March of a nursing home resident with his pants around his ankles, his legs and hand covered in feces, the most surprising aspect of state health officials' investigation was this: It wasn't against the law.

The Iowa law designed to protect dependent adults from abuse was last updated in 2008, before many social media apps existed. It bars "sexual exploitation of a dependent adult by a caretaker," which would have applied if the photo showed the resident's genitals. It didn't.

The nurse assistant was fired from Hubbard Care Center after a co-worker reported her to supervisors, but the state was unable to discipline her at all. She remains eligible to work in any nursing home in the state. Government documents did not name her.

"This was something no one expected," says David Werning, a spokesman for the Iowa Department of Inspections and Appeals, of the case. The nurse assistant had used Snapchat to send the photo of the resident, who has dementia, to six colleagues, along with the caption "shit galore," according to government reports.

"What we have is a very disgusting and humiliating situation," Werning says. "But it does not meet the definition of sexual exploitation, and I think that was a surprise to everybody."

Now Iowa officials are working to update the law to address changing technology, he says, "so we won't be caught off-guard again."

The Iowa incident is just one illustration of how regulators and law enforcement officials nationwide are struggling to respond when employees at long-term care facilities violate the privacy of residents by posting photos on social media websites.

In a story published last year, ProPublica identified nearly three dozen of these cases, the majority involving Snapchat, a social media service in which photos appear for a few seconds and then disappear. We've discovered nine more instances since then, including one in which a youth volunteer at a Colorado nursing home shared a selfie on Snapchat that showed a 108-year-old resident urinating. (You can read details of each incident here.)

Following ProPublica's earlier coverage, Sen. Charles Grassley, the Iowa Republican who chairs the Senate Judiciary Committee, sent letters to social media companies and federal agencies asking what they are doing to stop the abuse. He's taken Snapchat, in particular, to task because he says its online tool for reporting suspected abuse requires the affected person to file a complaint — a near impossibility for elderly people with dementia.

"When an individual tries to report a safety concern on behalf of someone else, say, an elderly nursing home resident, the tool produces the message: 'We are unable to take action based on third-party reports,' " Grassley wrote to Snapchat on June 28. "An elderly nursing home resident victim is unlikely to have his or her own Snapchat account or have the knowledge or ability necessary to report abusive snaps on his or her own behalf."

Snapchat's website gives people several avenues to file complaints. But the pathway to report elder abuse isn't straightforward, particularly for those unfamiliar with the app, which is popular among teenagers.

In replies to Grassley, Facebook and Snapchat have said they are doing what they can to deal with abusive pictures and videos that violate their terms of service.

"Although we cannot prevent physical abuse from occurring — whether in a nursing home or schoolyard — Snapchat is fiercely committed to terminating the accounts of Snapchatters who we believe have engaged in abusive behavior," Snapchat's general counsel Chris Handman wrote to the senator.

Facebook, which also owns Instagram, says it removes images depicting sexual violence and generally prohibits nudity. Anyone can report abusive content, the company says.

Grassley's pressure also has regulators re-examining their handling of these cases. In a letter to the senator, Assistant Attorney General Peter J. Kadzik wrote that while the Justice Department has gone after nursing homes for poor care, "we have not yet brought any cases involving allegations of nursing home employees misusing social media or electronic devices to record elder residents in compromising positions. We wholeheartedly agree that such conduct is deeply troubling and unacceptable." The Justice Department said it would share the concern with its Elder Justice Task Forces "to ensure that they are especially attuned to allegations of such conduct."

Some state and local prosecutors have been more aggressive in pursuing such cases under laws that prohibit elder abuse, sexual exploitation and indecency. In Colorado, for example, the volunteer who took a selfie with the 108-year-old resident who was urinating has been charged in juvenile court with invasion of privacy.

The Office for Civil Rights within the U.S. Department of Health and Human Services could take action in such cases as part of enforcing the federal patient privacy law known as HIPAA. But that agency has not penalized any long-term care facility for photos posted online and has yet to release any social media guidance for nursing homes. An official tells ProPublica that guidelines are in the works.

The nursing home industry isn't waiting. Last month, the industry's trade group issued its own suggestions for dealing with such situations, encouraging training and swift responses by these facilities when allegations are brought to light. The group also is holding training events around the country. Dianne De La Mare, vice president of legal affairs at the American Health Care Association, says nursing home companies are "all struggling with this."

"We don't want this stuff to happen anymore. To the greatest degree we can stop it, we want to," she says.

The trade group notes that most instances of abuse have been reported by other staff members — a sign that most workers are diligent and do not tolerate such actions — but that some homes also hire outside companies to monitor social media.

While many facilities ban the use or possession of cellphones by employees when in resident areas, De La Mare says, they've also found such rules impractical to enforce

"A lot of the younger people — your phone is like your wallet," she says. "You would never be without your phone ... It's really difficult for [nursing home officials] to say, 'We understand you're a single mom; you need to keep track of your kids, but that stays in your purse.' It's a challenge, I have to tell you that."

As the Iowa case demonstrates, even nursing homes eager to respond to incidents responsibly face obstacles.

When it learned of the photo of its resident covered in feces, Hubbard Care Center contacted its local sheriff's office. The law enforcement officials did not create a report or press charges; instead they encouraged the nursing home to contact health regulators, says Hardin County Deputy Sheriff Jeffrey Brenneman. The state investigated and initially fined the facility $8,500, which it reduced to $1,000 on appeal. Officials determined there was no evidence the facility knew or should have known that the assistant "might engage in such outrageous actions."

And state officials learned that the law wasn't written with these situations in mind.

Kendall Watkins, a lawyer for the nursing home, calls the incident an "isolated act" to which the facility responded quickly and appropriately.

The nursing home has already updated its policy to define "exploitation" of residents to include "transmission, display, taking of electronic images of the dependent adult by a caretaker in a private or compromised situation (i.e. using the bathroom, changing clothes, personal cares) for a purpose not related to treatment or diagnosis or as part of an ongoing investigation."

Grassley says the incident in his home state troubled him. "It speaks to the lowest instincts of humankind that you never expect people to do," he says. "If you're a worker there, if you were really concerned about the patient, why wouldn't you start immediately cleaning people up?"

Has your medical privacy been compromised? Help ProPublica investigate by filling out a short questionnaire. You can also read other stories in our Policing Patient Privacy series.

Copyright 2016 ProPublica. To see more, visit ProPublica.
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Frustrated You Can't Find A Therapist? They're Frustrated, Too

Thu, 07/14/2016 - 4:59am
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July 14, 20164:59 AM ET Heard on Morning Edition

From

Katherine Streeter for KQED

There are a lot of people suffering from a mental health condition who need therapy. And there are a lot of therapists who want to help them. But both sides believe the insurance companies that are supposed to bring them together are actually keeping them apart.

Insurance companies, for their part, say there's a shortage of therapists.

But it's not that simple. Especially in urban areas, there are lots of therapists. They just don't want to work with the insurance companies.

Take Michael Klein, a psychologist practicing in San Francisco for more than 20 years. He considers it his spiritual calling to help people calm their social anxiety and to help couples stop fighting and build trust.

"With the right kind of support, they blossom," he says.

Klein doesn't accept insurance. In fact, nearly half of therapists in California don't take insurance, according to a recent survey from the California Association of Marriage and Family Therapists. The same is true of psychiatrists. There are two reasons why, Klein says.

"One, because the reimbursement rates don't provide a living wage," Klein says. "You can't own a home and drive a car and survive on what in-network providers pay you."

Most insurance companies pay therapists in their networks between $60 and $80 per session. In the San Francisco area and Los Angeles, therapists say the market rate for therapy is more like $150 to $200 a session.

"The second thing is the paperwork. For an hour of psychotherapy you spend a half-hour on paperwork," Klein says. "I got into this field because I don't like paperwork," he says, laughing.

On that first point — money — insurance companies acknowledge that they may have to raise their rates to attract more therapists, particularly in rural areas. But they also say it's on therapists to compromise.

"I think it's unrealistic to expect either the state of California taxpayers or for health plans to just pay providers whatever they ask to be paid," says Charles Bacchi, CEO of the California Association of Health Plans, a trade group for the insurance industry.

"That's not sustainable," he continues. "So you're either in the system, and you want to be part of our health care system. Or you want to do concierge service outside of it and just pretend our health care system doesn't exist. That's your choice as a provider. Our job is to find providers that are willing to be part of the solution and willing to provide coverage to those of low and moderate income."

That's exactly how San Francisco psychologist Jonathan Horowitz feels. He wants to take insurance, but he has hit roadblock after roadblock. He sent out 10 applications to insurance companies and got nowhere.

"I might knock on Cigna's door and say, 'Hey, are you guys accepting any new therapists in 94105?' " he says, referring to his ZIP code. "And they might say, 'No, we're not doing that. We're totally full.' "

Six different companies told Horowitz their networks were full.

So even though a patient might call seven therapists in her insurance network and not be able to get an appointment, insurance companies are telling new and willing therapists that there's no demand for them.

"I definitely think it's to control costs," Horowitz says. "That's very clear."

He says he tried for a year, and one company finally said yes. Sort of. Horowitz never got a formal notice saying his clinic was admitted to the network.

"It was just like, 'Oh wait, it looks like we're suddenly getting a couple referrals from them. I wonder if we're in their directory,' " he explains.

They were. Sort of. The clinic was listed in the directory. But the therapists who work at the clinic weren't approved yet, meaning there was no one who was allowed to see the clients calling the clinic.

So Horowitz tried to call the insurance company to clear things up. He tried many, many times. I sat with him during a recent attempt to navigate the automated phone system:

Insurance company automated attendant: First I'll need your provider identification number. If you need a moment, say, hold on.

Horowitz: Hold on.

Sound familiar? Turns out therapists get the automated run around as much as patients do. Horowitz persevered.

Insurance company: OK, please say or enter your PIN.

Horowitz: My PIN? Is this my PIN? (He enters a few numbers.)

Insurance company: I'm sorry I couldn't find an account using the info you gave me. Do you already belong to the network?

Horowitz: I think so?

Insurance company: Sorry, yes or no.

Horowitz: Um, I don't know ... yes?

Insurance company: All right. And have you already requested a credentialing application?

Horowitz: Yes.

Insurance company: Sorry, could you repeat that?

These experiences didn't bode well. "Honestly, I got a really bad feeling about it," he says.

Horowitz figured, if this is what it's like just finding out if he's in the network, how's it going to be when he has a problem with a claim?

"I could just see that getting out of hand really quickly," he says. "So at that point we just said, do we really even want to do this?"

Furthermore, he says, the reimbursement rate was even lower than he expected, and the billing was so complicated that he was going to have to hire someone to do it. He says he couldn't afford that.

"We made the decision that we're just going to cancel the contract and continue to go with cash," he says.

Easier said than done. Horowitz hasn't been able to get through to anyone on the phone to cancel the contract. In the meantime, prospective patients are finding his name on the directory and are calling for appointments. Horowitz says he just has to say no.

This story is part of NPR's reporting partnership with KQED and Kaiser Health News.

Copyright 2016 KQED Public Media. To see more, visit KQED Public Media.
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A Mouse Watches Film Noir And Offers Clues To Human Consciousness

Wed, 07/13/2016 - 2:12pm
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July 13, 20162:12 PM ET Heard on All Things Considered

Lucky laboratory mice got to watch scenes from Orson Welles' classic Touch of Evil, starring Janet Leigh and Charlton Heston.

Keystone/Getty Images

Letting mice watch Orson Welles movies may help scientists explain human consciousness.

At least that's one premise of the Allen Brain Observatory, which launched Wednesday and lets anyone with an Internet connection study a mouse brain as it responds to visual information.

"Think of it as a telescope, but a telescope that is looking at the brain," says Christof Koch, chief scientific officer of the Allen Institute for Brain Science, which created the observatory.

Senior scientist Jerome Lecoq and research associate Kate Roll of the Allen Institute inspect one of the microscopes used to record cellular activity in the visual cortex of mice as they watch movies.

Allen Institute

The hope is that thousands of scientists and would-be scientists will look through that telescope and help solve one of the great mysteries of human consciousness, Koch says.

"You look out at the world and there's a picture in your head," he says. "You see faces, you see your wife, you see something on TV." But how does the brain create those images from the chaotic stream of visual information it receives? "That's the mystery," Koch says.

There's no easy way to study a person's brain as it makes sense of visual information. So the observatory has been gathering huge amounts of data on mice, which have a visual system that is very similar to the one found in people.

The data come from mice that run on a wheel as still images and movies appear on a screen in front of them. For the mice, it's a lot like watching TV on a treadmill at the gym.

But these mice have been genetically altered in a way that allows a computer to monitor the activity of about 18,000 neurons as they respond to different images. "We can look at those neurons and from that decode literally what goes through the mind of the mouse," Koch says.

A snapshot of the mouse visual cortex at the cellular level, captured by two-photon microscopy.

Allen Institute

Those neurons were pretty active when the mice watched the first few minutes of Orson Welles' film noir classic Touch of Evil. The film is good for mouse experiments because "It's black and white and it has nice contrasts and it has a long shot without having many interruptions," Koch says.

At one point, the camera follows a couple through the streets of a Mexican border town. As a mouse watches the action, its brain activity changes in response to the images. For example, brain cells that respond to vertical lines start firing as the couple moves past a building with vertical columns.

That response is just one tiny part of the brain system that allows a mouse to create an internal map of its world. Other experiments show which brain cells fire when a mouse recognizes another animal, like a butterfly.

By making all of this data publicly available, scientists around the world can test their own ideas about the nature of perception and experience and even consciousness, Koch says. "And we expect like in astronomy or other fields of science that they themselves will uncover things in our data that we never suspected."

Future versions of the observatory will explore nonvisual areas of the mouse brain, Koch says, including those involved in making decisions.

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

Congress Approves Bill To Address Addiction As A Health Problem

Wed, 07/13/2016 - 10:51am

A woman lobbying Congress holds two versions of naloxone which can be used to reverse an opioid overdose.

Al Drago/CQ-Roll Call Inc.

The Senate on Wednesday overwhelmingly approved a bill intended to change the way police and health care workers treat people struggling with opioid addictions.

The bill, which had previously passed the House, will now be sent to President Obama. He has indicated that he will sign it, despite concerns that it doesn't provide enough funding.

The bill is an amalgam of more than a dozen proposals passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create prescription drug monitoring programs — it doesn't have much money to put them in place.

President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn't include all that money. It provides about half that much.

"It's clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments," Sen. Patty Murray, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.

But Sen. Lamar Alexander, R-Tenn., argued that the money for treatment has been rising for three years.

"Our friends on the other side say, you have to fund it. We are funding it," he said in a statement on the Senate floor Friday. "And they helped fund it. We've increased funding for opioids already by 542 percent."

Still, Democrats supported support the bill even without the additional money.

And that's a good thing, says Linda Rosenberg, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.

For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.

"Treatment capacity is really a crisis. There just isn't enough," Rosenberg tells Shots. "But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that's a very big deal."

She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.

The legislation also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that will allow police departments to send people with addiction problems to treatment rather than to jail.

In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.

Rosenberg says these measures help change the definition of addiction from a crime to a health problem.

"It's a health care issue and not a moral failing issue," she says. That's a big reversal from the "war on drugs" campaigns of a few decades ago.

And the legislation allows more people to have access to naloxone, the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.

The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of Adapt Pharma, which sells Narcan, a nasal spray version of naloxone.

"This bill addresses getting Narcan out into the community, outside of emergency and first responders," Kelly says. "The big thing here is this will fund recovery."

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

Workplaces Can Be Particularly Stressful For Disabled Americans, Poll Finds

Wed, 07/13/2016 - 4:56am
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July 13, 20164:56 AM ET Heard on Morning Edition

Jason Olsen, a 39-year-old policy adviser for the Department of Labor, uses the Washington, D.C., Metro to commute to work three times a week. On the other days of the week, Olsen telecommutes from home to avoid the challenge of taking the Metro.

Ruby Wallau/NPR

More than 4 in 10 working Americans say their job affects their overall health, with stress being cited most often as having a negative impact.

That's according to a new survey about the workplace and health from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

While it may not sound so surprising that work affects health, when we looked more closely, we found one group was particularly affected by stress on the job: the disabled.

More than 60 percent of people with a disability in our poll say their job has a bad impact on their stress level.

Shots - Health News Work Can Be A Stressful And Dangerous Place For Many

Jason Olsen says he's not surprised by the poll's findings. As I meet him at his home in Gaithersburg, Md., we start trading commuter complaints. Traffic was terrible getting here, I say.

But his story wins out.

"The other day I had to wait 45 minutes to finally get a train where I could get myself and the wheelchair onto the train," he says. Navigating Washington's Metro system is always a challenge, he says.

And then there was the time when someone ran their luggage over his foot, breaking it in multiple places.

But because a car accident left Olsen paralyzed from mid-chest down, he didn't realize his foot had been broken.

Another time — a couple of weeks before our meeting — he suddenly fell ill at work.

"Three hours later, I'm in the ER, and two hours later I'm in the ICU," he tells me. "Some of the stuff, you know, when you don't have the sensation, your body doesn't give a lot of warning signs."

Warning signs, in this case, that might have signaled that a cut on his foot had turned into a septic infection. He was ultimately hospitalized for two weeks.

Our workplace and health survey found that 62 percent of people with disabilities say their job adds to their stress level, compared with 41 percent of the nondisabled.

The Workplace And Your Health

How does work affect your health? What can be done to make for healthier workplaces? Stories in this series include:

  • For many, the workplace is a dangerous, stressful place.
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  • Most people say they go to work when they're sick. And some really shouldn't.
  • Take that vacation, really. It will make you happier and more productive.

Perhaps more stark is that over a third (35 percent) of disabled workers say their job has a bad impact on their overall health. That's more than double the rate for their nondisabled peers (15 percent).

Olsen, who works on disability policy for the federal government, says it often isn't the work that's stressful, but the time, energy and physical toll it takes to get to the office, sit in a chair for hours, and manage the other demands of living with a disability.

Those demands can require specialized equipment and extra time and care.

For example, because he uses a catheter and other equipment, going to the bathroom can take an hour.

And when he falls ill, it also affects his wife B.J.'s work schedule as an emergency room nurse, adding to the stress.

"I think it's a double-edged sword," she tells me. "I want him to go and do work and stuff like that, but then because of his physical problems, it makes it harder to work."

(Top left) Olsen re-enters his van to drive to an alternative Metro entrance after learning that one of the elevators is not working. (Top right) Olsen often leaves for work early to avoid crowded cars during rush hour. (Bottom) Olsen greets Metro station employee C.A. Phang at the Shady Grove Metro station.

Ruby Wallau/NPR

Jason Olsen's main sources of stress relief, he says, are his son, Gunnar, and baby daughter, Scottie. They keep him motivated.

"Your option is to sacrifice some of your own self-care and health or to live in destitution," he says. "For me, that's not a choice."

On balance, the income, independence and social contact that work provides are good for people with disabilities, says Cheryl Bates-Harris, an advocacy specialist with the National Disability Rights Network.

"We have study after study that shows that for people with psychiatric disabilities, work is part of recovery, and it helps them," she says. But she can also see how it adds stress.

"If you're worried about whether your performance is going to be acceptable, whether they're going to keep you beyond your probationary period, whether there's going to be opportunity for advancement, God forbid that you could request some kind of reasonable accommodation, I imagine that could be pretty stressful for people," Bates-Harris says.

When considering whether to hire a disabled worker, employers worry that accommodating disabilities might cost a pretty penny. In fact, the average cost is only about $500 per person, Bates-Harris she says.

Judy Owens says that persistent misconception is one reason she started Opportunity Works five years ago, helping more than 70 people with disabilities find jobs. She says it can be so hard to find jobs, some people might stick with a bad job.

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"You might have five other friends with disabilities who don't have jobs at all, so you just kind of deal with the bad environment you're in, because at least you have a job," Owens says.

That was not the case for James Schwonek, who left his previous job in IT after his boss fell ill.

"That actually prompted me to go find a different job," he tells me, "because I didn't have the arranged accommodation that was there previously."

The accommodations in his case were basic: His boss took care to face him when talking, so Schwonek could read his lips. Without the boss around, however, the workplace seemed less welcoming. Co-workers ridiculed him, he says, for trying to teach them basic sign language.

His experience appears to be fairly common. According to our survey, just over a third of disabled workers say their workplace policies helped them. But more than half (55 percent) rated their workplace fair or poor in terms of providing a healthy work environment, as compared with 21 percent of the nondisabled.

Still, that's progress, says Clay Bradley. He's a 51-year-old man who was born missing part of each limb.

He recalls the era before the Americans with Disabilities Act, when buses often didn't come with ramps.

"Now buses automatically have ramps in them," he says. "When I was using buses in the '90s or in the '80s, half of them would have ramps and then half of them wouldn't. So you'd have to schedule your trips for a bus that was going to have a ramp on it."

Bradley, who works in customer service at a health insurance firm, says other than a ramp, he requires no special equipment.

"I use both arms and I can touch the keys individually; I make mistakes but I've used the computer so long, I correct them very quickly, so my typing speed is about 35 words per minute," he says.

And once he's at work, he says, work is just as stressful for him as the next person.

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

Red Tape Leaves Some Low-Income Toddlers Without Health Insurance

Tue, 07/12/2016 - 2:52pm

Toddlers need consistent care from a pediatrician to make sure, among other things, that they are hitting developmental milestones and their vaccinations are up-to-date.

Tetra Images/Getty Images

Many babies born to mothers who are covered by Medicaid are automatically eligible for that health insurance coverage during their first year of life. In a handful of states, the same is true for babies born to women covered by the Children's Health Insurance Program.

Yet, this approach is routinely undermined by another federal policy that requires babies' eligibility for these programs to be re-evaluated on their first birthday. Although they're likely still eligible for coverage, many of these toddlers don't get it because of a tangle of red tape.

People often cycle in and out of Medicaid and CHIP, state/federal health programs for low-income residents, as their income or family circumstances change. Such churning is a long-recognized problem. The requirement that people renew their coverage annually may also cause hiccups.

"Many people lose Medicaid coverage for procedural reasons," says Shelby Gonzales, a senior health policy analyst at the Center on Budget and Policy Priorities. "But there are all sorts of things that are unique about babies turning 1" that present extra challenges.

"You hate any baby to lose coverage," says Jill Hanken, a lawyer with the Virginia Poverty Law Center who has worked on this issue. "A 1-year-old needs to have consistency with their health care and visits with the pediatrician." Regular well-baby visits ensure kids are developing properly and get scheduled vaccines, among other things.

One potential snag in retaining toddlers' coverage is that their first-year review is pegged to their date of birth, which is generally different from the annual renewal date for other family members' coverage.

In other instances, states that don't seek babies' Social Security numbers until they turn 1 may have a tougher time getting the income and other data they need to process the renewal. And some states mistakenly ask for documentation proving the baby's citizenship, which is not required if Medicaid or CHIP paid for the birth.

Antiquated computer systems sometimes automatically drop babies after their first birthday unless a renewal has been processed. This can be a problem in states that are behind in renewals, which is not uncommon, Gonzales says; some states have scrambled to implement the many requirements of the health law.

It's hard to quantify the extent of the problem nationally. An analysis of data from the 2014 American Community Survey of 700,000 children found that children between the ages of 1 and 2 were less likely than infants to be covered by Medicaid or CHIP. That suggests "some children may be losing Medicaid/CHIP coverage at their first birthday," says Genevieve Kenney, a co-director and senior fellow at the Urban Institute's Health Policy Center.

The experience of the state of Connecticut offers a window on the problem. Connecticut Voices for Children, a policy research and advocacy organization, has tracked the issue closely for several years. In 2008 and 2009, 42 percent of babies who had been considered automatically eligible for Medicaid at birth lost their coverage at the end of the month they turned 1. That's compared with roughly 6 percent of babies who were in other Medicaid coverage groups, such as those whose mothers had employer-sponsored insurance.

By 2013, when Connecticut Voices revisited coverage gaps, Medicaid and CHIP coverage retention when infants turned 1 had improved significantly. Still, nearly 23 percent of babies with guaranteed coverage for their first year were uninsured after their first birthday. That was true for less than 2 percent of other babies in the state.

During that time the state had revised confusing notices to families that, for example, announced that coverage was ending for infants because, "You are not the right age to be eligible for this program." Advocates also played a role in improving the troubling statistics by working to alert pediatricians and community services providers about the problem.

Though coverage for 1-year-olds has improved, "the problem still persists," says Mary Alice Lee, senior policy fellow at Connecticut Voices for Children. Advocates hope that a new eligibility management system, scheduled to roll out next year, will make a difference.

Elsewhere, advocates in Virginia are also awaiting a computer system fix so that infants who were guaranteed Medicaid coverage for the first year aren't automatically canceled after their birthday. In the meantime, Hanken says, the state changed its policy so that the determination of a newborn's Medicaid eligibility at 1 year of age is a streamlined renewal, instead of a totally new application for coverage.

"We're about halfway to a solution," Hanken says.

Outdated technology is no excuse for states not addressing this longstanding problem, says Tricia Brooks, a senior fellow at Georgetown University's Center for Children and Families.

These newborns are easily identified, Brooks says, so "if nothing else, [state officials] could go in on a manual basis and trigger a review."

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter:@mandrews110.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
Categories: NPR Blogs

Overworked Americans Aren't Taking The Vacation They've Earned

Tue, 07/12/2016 - 1:40pm
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July 12, 20161:40 PM ET Heard on All Things Considered Jeannie Phan for NPR

A majority of Americans say they're stressed at work. And it's clear the burden of stress has negative effects on health, including an increase in heart disease, liver disease and gastrointestinal problems.

Still, though it's been known for years that periodically disengaging from one's everyday routine can reduce stress, most Americans don't take advantage of their days off. A recent poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health finds about half of Americans who work 50-plus hours a week say they don't take all or most of the vacation they've earned.

And among respondents who actually take vacations, "30 percent say they do a significant amount of work while on vacation," says Robert Blendon, a professor and health policy analyst at the Harvard T.H. Chan School of Public Health who directed the survey. "So they're taking their stress along with them wherever they go."

Take 27-year-old Julie Hagopian, for example. She lives in Alexandria, Va., works in digital marketing for a large educational company, and says she adores her job. But it consumes at least 60 hours of her time each week, she says, and includes plenty of stress. The biggest problem, Hagopian says: There's no "off switch."

"I'm on call all the time — to moderate, create content, curate everything," she says. "So, generally speaking, even when on vacation, I'm checking email and moderating social feeds."

When it comes to taking the classic one to two weeks of vacation — forget it, she says. That would require burdening her colleagues with her workload, and they already have too much to do.

So, instead, she takes a few days here and there, but always stays connected via phone calls or online.

For 33-year-old Adam Rowan, who lives in Dolores, Colo., staying "connected" isn't a big issue, he says, because he just doesn't take vacation. Ever.

"It's just not my thing," he says with a chuckle, "which probably sounds strange. But I'd prefer to be at work, getting things done."

Rowan works in information technology for a large outdoor retail company. Because many of his colleagues in IT got their start in their early 20s, Rowan says he feels like he has a lot of catching up to do. He skips vacation to keep learning more, he says — "just to get a foot in the game."

In our poll, 35 percent of people who work 50 or more hours a week say they also skip vacations because they want to get ahead at work. Like Hagopian, 42 percent say there wouldn't be enough people to pick up their workload if they took days off. And many, like Hagopian and Rowan, say their office doesn't have many people with the same expertise who could serve as backup.

"If I leave and something breaks and somebody who doesn't know how to fix it tries to fix it, it could get a lot worse," Rowan says.

Rowan is hardly alone in his dedication to the job. Today, Americans take far less vacation time than they did a few decades ago, says psychologist Matthew J. Grawitch of Saint Louis University, who studies stress in the workplace. Research shows that, on average, Americans now take 16.2 days of vacation a year, compared with nearly three weeks of vacation in 2000.

That's an unfortunate trend, he says; not only can time off help alleviate stress, it can also be personally rejuvenating and motivate people to be more productive once they return to the job.

Recent research suggests employee health and well-being improve even during short vacations. That has led scientists studying workplace stress to urge people to take shorter vacations throughout the year if they feel they can't manage a week or two all at once.

At least some employers concur. Diane Domeyer, executive director of The Creative Group, a staffing firm, recently surveyed more than 400 advertising and marketing executives and found that 39 percent say they believe their employees would be more productive if they took more time off.

But Grawitch says it's one thing for employers to recognize the value of vacation and another to make it happen.

"It has to involve thinking through how to restructure work, utilize technology more effectively, [and] to coordinate vacation times so work is still being accomplished — and not by the person who is on vacation," Grawitch says.

Of course, that can require more investment in staffing from employers. Domeyer says an increasing number of companies are choosing to make that sort of investment because they recognize the relatively high cost of burnout — either in the form of lower productivity or in the loss of employees.

If you're one of those people who go on vacation and just can't disconnect completely, Domeyer suggests you resist the temptation to answer email immediately. A too-quick response suggests you are available to do work, she says.

Instead consider using a "delayed delivery" function in your emailed responses, she suggests. That gets the note off your plate, but doesn't deliver it until the day you return — from vacation.

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

HHS Report Says Obamacare Plans Are Cheaper Than They Look

Tue, 07/12/2016 - 12:43pm

A guide works on the federal enrollment website as she helps a Delaware resident sign up for coverage under the Affordable Care Act in 2014.

Andrew Harrer/Bloomberg via Getty Images

Obamacare health plans have been getting a bad rap this year. Critics say the premiums are too high, the out-of-pocket costs are out of control, and the requirements and red tape are too thick.

But now the Obama administration is pushing back.

A study released Tuesday by the Centers for Medicare and Medicaid Services argues that the cost-sharing isn't nearly as heavy as previous analyses have shown, because most consumers get subsidies that limit their deductibles and copayments.

"This comprehensive analysis makes clear that two key misconceptions about the market are incorrect," said Christen Linke Young, principal deputy director of the Center for Consumer Information and Insurance Oversight at CMS.

She said those misconceptions are that deductibles are very high and that out-of-pocket costs for consumers are out of control.

The median deductible that consumers actually pay for Obamacare health plans is $850 this year, $50 less than last year, the CMS report shows. A deductible is the amount of health costs a person must cover before insurance kicks in.

The CMS report contrasts with a Kaiser Family Foundation analysis from November 2015 that shows the average deductible for a midlevel health plan, including prescription drugs, is $3,064. That survey didn't take into account the financial assistance that about 60 percent of Obamacare customers get to cover health costs.

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"This shows that the marketplace is more attractive to lower-income people," says John Holahan, a fellow in health policy at the Urban Institute in Washington.

He said for people with higher incomes, health plans sold on the government run exchanges are often still out of reach because of high premiums and out-of-pocket costs. The report found that 17 percent of people are paying deductibles of more than $5,000 per year.

People whose incomes are 250 percent of the federal poverty level or below qualify for "cost reduction subsidies" under the Affordable Care Act. These subsidies are designed to protect lower-income consumers from unexpected high costs after they buy insurance.

Young says that level can reach families whose incomes are as high as $60,000 a year.

"We're really not talking about the lowest-income enrollees," she said on a conference call with reporters.

The CMS report also argues that the health plans are less expensive than the public perception because many services come free to patients even before they meet their deductible. The plans cover annual checkups and vaccines for children and cancer screenings for adults with no copayments. Most also cover primary care visits for adults, most prescription drugs and some specialist visits — with a copay, but before a patient meets a deductible.

"They are able to get the basic services they need without even thinking about the deductible," Young said.

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

Parents Can Help Reduce Pain And Anxiety From Vaccinations

Tue, 07/12/2016 - 10:45am

If you're worried, they're worried. Staying calm is one of many techniques parents can use to reduce pain and anxiety about shots.

Fuse/Getty Images

Now that the nasal spray FluMist is no longer considered an effective vaccine against influenza, parents will have to resort to the old, unpopular standby for their kids: a shot.

It's not unusual for a child to have as many as 20 vaccinations by age 5 — all typically administered by injection. The pain of those shots can sometimes be a barrier to getting kids vaccinated, but several studies have shown that the pokes don't have to be so painful or petrifying, and parents can actually play a big role in soothing the sting.

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"There is a whole body of research on children's pain management that people aren't aware of," Christine Chambers, a clinical psychologist and professor whose lab is based at the Centre for Pediatric Pain Research in Halifax, Nova Scotia, tells Shots. "Parents assume that everything possible is already being done — that if there was something more, it would be offered."

She says a vicious circle can sometimes arise: When parents are asked why they aren't using pain management techniques, they say their doctors are not suggesting them. When pediatricians are asked why they're not discussing those pain control options, they say parents aren't asking.

"In theory, every health professional would be offering these strategies, but we know physicians aren't very well trained when it comes to pain," says Chambers.

Chambers is trying to spread awareness of vaccine pain-management techniques via blogs, videos and social media sites. Together with Erica Ehm, publisher of YummyMummyClub, a Canadian online forum for moms, Chambers has launched a social-media campaign called "It Doesn't Have to Hurt," which aims to quickly give parents science-backed information on how to help kids better cope with vaccination pain.

Parents need to be honest with their kids about the fact that they're going to get a shot, says Chambers. But telling them too far in advance gives them more time to worry.

Rebecca Pillai Riddell, research chair of pain and mental health at Toronto's York University, suggests telling your child on the morning of the shot. "When they're waking up, getting dressed and eating breakfast, talk about what's coming up. Make it about the next event: 'We're going to go for ice cream afterward.' It helps them focus beyond the vaccination," she says.

When it's time to actually get the vaccination, the most important thing parents can do is remain calm themselves. This can be difficult, as research has shown that nearly a quarter of adults fear needles. When parents are anxious, kids pick up on that right away.

According to a study co-authored by Riddell and published earlier this year in the journal Pain, it is the parent's behavior rather than the actual pain level of the shot that increases a child's anxiety in the vaccination room.

And worse, says Riddell, babies who show distress before a vaccination exhibit more post-needle pain, which is measured by signs such as facial expressions, crying, heart rate and blood pressure.

"When kids are riled up, it makes them more reactive," she says.

Too many verbal assurances have repeatedly been shown in studies to cause higher distress, says Riddell. "When things are OK, parents don't go walking down the street reminding kids that things are OK," she says.

A child's position during the shot can also help set the tone of the experience. Chambers says physicians or nurses can prompt parents to hold kids in a way that's more like being hugged and less like being restrained. Letting your child remain upright establishes a sense of control and decreases fear.

In babies, skin-to-skin contact, and breastfeeding or pacifiers have been shown in multiple studies to stabilize heart rates, improve oxygen levels and decrease crying during painful medical procedures.

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Parents can also try using an over-the-counter topical skin-numbing cream on their kids, making sure to give it time to take effect (this varies depending on which anesthetic you are using.)

Sugar water can provide some relief from pain, though possibly more because it's a pleasure that compensates for the pain rather than an analgesic that relieves it. Health professionals recommend giving a child sugar water before the shot and, if receiving multiple shots, throughout the entire process.

The order in which vaccinations are given may also help with pain levels. One study found, for example, that starting with the least painful shot produced a lesser pain response in infants than starting with the most painful one.

Older kids can also try the "cough trick." Coughing once before and once during routine vaccinations helped reduce painful reactions among children receiving their prekindergarten vaccines as well as in those getting shots before middle school, according to a 2010 study published in the journal Pediatrics. Coughing provides a distraction, and the sensory stimuli of the sound and feeling may compete with the pain.

Immediately after the shot, try distraction, suggests Riddell. Let your child play with a favorite handheld video game, watch a cartoon, hug a stuffed animal or sing a song. Blowing a few bubbles might also be helpful, since they're both distracting and relaxing, says Chambers.

Finally, don't dwell on the shot once it's over. "It's best to emphasize what went well, and then move to the next thing," she says.

Laurel Dalrymple is a freelance health and science writer based in Fairfax, Va. She's on Twitter: @ldal

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs