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A Push In California To Train More Latino And Black Nurses

Fri, 11/13/2015 - 11:10am

Diana Venegas, a nursing student at Samuel Merritt University, in Oakland, Calif., takes a patient's blood pressure at a recent health fair at Allen Temple Baptist Church.

Adizah Eghan/KQED

Allen Temple Baptist Church is buzzing with chatter and upbeat music. On this warm Saturday morning in East Oakland, Calf., the church is hosting its annual holistic health fair.

Students from the nursing program at Oakland's Samuel Merritt University, are dressed in blue scrubs, hustling to give eye exams and check blood pressure.

A couple tables down, Samuel Merritt's chief diversity officer, Shirley Strong, hopes to talk with prospective students. The private university has one of the three biggest nursing programs in California, and is committed to reducing health disparities by recruiting more students of color.

"The work of diversity at Samuel Merritt involves recruiting faculty, staff and students of color particularly," Strong says, "especially "African-American/black and Latino/Hispanic students, because they're the ones underrepresented in our community."

Last May, Samuel Merritt University's nursing program graduated its second-largest class of African-American and Latino students — 10 African-Americans and 28 Latinos.

"What we'd like to do is train more [registered nurses] and more case managers and more nurse practitioners," Strong says. "People who are really in decision-making roles in hospitals."

Black And Latino Registered Nurses Needed

The majority of the state's registered nurses are white or Asian-American. While 39 percent of California's population is Latino, just 8 percent of the state's nurses are. Six percent of the state's population is black, but just 4 percent of nurses are.

"Clearly we are lacking African-American and Latina nurses," says David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at UCLA's medical school. Having nurses who more closely represent the state's diversity will "make for better patient care [and] better language communication," he says. Studies show that many Latinos in California lack access to preventive care, and African-Americans experience higher rates of heart disease and shorter life expectancy than whites.

Shanda Williams grew up in Oakland, where there's great need for health providers who understand the community, she says. Williams was inspired to become a nurse after noticing her grandmother's lack of candor at visits to the doctor.

Adizah Eghan/KQED

These disparities are what motivated Samuel Merritt grad Shanda Williams to become a registered nurse.

Williams grew up in Oakland, where there's a great need, she says, for providers who understand the community. She's seen this firsthand.

"I would go to the doctor's office with my grandmother," Williams says, "and she would basically lie to all of her doctors about everything that she was doing."

Williams says her grandmother told the doctor she was eating fruits and vegetables and cutting out fried foods. Williams knew that wasn't true.

"It sparked a conversation," she says. But her grandmother dismissed Williams' suggestion that she be more candid with her medical team. " 'They don't understand the way we eat," the older woman told her granddaughter. "This is part of my identity.' "

Williams says this moment stuck with her. The doctor had neglected some key questions.

"There was never really a time when her doctor would ask her ... 'Well, why do you eat that way?' or 'Can we find a compromise?' or anything like that," Williams says. "Those questions never came up."

Helping Others Achieve

Now Williams wants to extend what she's learned to others. She's a tutor in Samuel Merritt's academic success program, which is specifically geared toward Latino and African-American nursing students. Today she's working with junior Leslie Hernandez. The two sit in one of Samuel Merritt's basement classrooms, going over neuropharmacology.

Hernandez says she sees a lot of Latino classmates in nursing school, but it's not the same when she accompanies family members to the hospital, or when she's out working in the clinic as part of her schooling.

She well remembers the moment she realized the need for more Latino and Spanish-speaking health professionals. She was working in the psychiatric unit of a hospital. Doctors and nurses deemed a particular patient "noncompliant" because she didn't talk.

But Hernandez was able to communicate just fine with the patient — in Spanish.

"She was speaking in Spanish, and she felt like nobody could understand her," Hernandez recounts.

The patient told Hernandez that she had suicidal thoughts, and Hernandez was able to alert the doctor.

Addressing Barriers Faced by Low-Income Students

Competition for slots in California's public school nursing programs is especially fierce. It can be very hard to get all the classes you need to graduate in four years, and students of color, who may be more likely to have financial pressures to complete school quickly, are underrepresented.

Inadequate financial support is a barrier in other ways, too, Strong says. While lower-income students can take advantage of financial aid to cover tuition at either a public or private school, they are often derailed by other, unexpected expenses.

A sudden need for hundreds of dollars for a car repair or an emergency dental problem, for example, can force students to drop out, Strong says. Many come from families that lack the ready cash to help in an emergency.

To aid these students, Strong says Samuel Merritt is working to create a special fund, "so that when a student has a problem, we just write the check from the emergency fund." That way, he says, students can "stay attentive, and on course to graduate."

Strong says the best preparation for a career in health care starts in high school — or even sooner. "The key really is that they have to take science courses and the math courses early on, so when they get to college they are prepared to step into these various programs," she says.

Students who haven't taken those early preparatory classes spend a lot of time playing catch-up in college, and many find it just too overwhelming to tackle.

Samuel Merritt is partnering with pathway programs such as the Health Academy at Oakland Technical High School, and Berkeley Technology Academy. The goal is to give more students who are interested in the health care field the preparation they need.

California's Board of Registered Nursing forecasts that Latino population growth in the state will continue to outpace the number of Latino registered nurses unless more effort is made to encourage enrollment and graduation of Latinos from RN programs.

While the number of African-American nurses is climbing faster, it's can't happen fast enough for Shanda Williams. She wants to open a clinic with some of her classmates.

"Working in my community is what also helped keep me motivated in school," she says; she thinks other students of color feel the same way, wanting to make positive changes in the towns and neighborhoods they grew up in.

Williams wants patients like her grandmother to seek care from people they trust, doctors and nurses who can say, "I'm from the same neighborhood you come from."

This story ran first on KQED's blog State of Health.

Copyright 2015 KQED Public Media. To see more, visit
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To Prevent Addiction In Adults, Help Teens Learn How To Cope

Thu, 11/12/2015 - 3:56pm

Madison Square Boys & Girl Club, which operates four clubs in Brooklyn and the Bronx, reaches about 200 teenagers with an substance abuse prevention curriculum called Empowerment.

Robert Stolarik for NPR

Addiction is a pediatric disease," says Dr. John Knight, founder and director of the Center for Adolescent Substance Abuse Research at Boston Children's Hospital. "When adults entering addiction treatment are asked when they first began drinking or using drugs, the answer is almost always the same: They started when they were young — teenagers," said Knight.

Smoking, drinking and some forms of drug use among teens have declined in the U.S. in recent years, but an estimated 2.2 million adolescents — 8.8 percent of youth aged 12 to 17 years old — are currently using an illicit drug, according to a 2014 Behavioral Health Barometer prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA).

Drug use changes brain development, and when substances are used during adolescence, young people are much more likely to become addicted, Knight said. "When people start using at younger ages, the changes in brain structure and function are very, very pronounced," he explained. "If we could only get kids to postpone their first drink or their first use of drugs, we could greatly diminish the prevalence of addiction in the U.S."

And in some places, teenagers may be using more, sooner. "In the last several years, it seems like the kids that we see in services are far sicker than in the past," said Sara Ellsworth, clinical supervisor at True North Student Assistance and Treatment Services in Olympia, Wash.

Last year, True North served nearly 700 students in 44 mostly rural school districts. Increasingly, she said, kids who come for help have a history of victimization or significant trauma, such as domestic violence, physical or sexual abuse, parental incarceration or substance abuse, rape or homicide. More than half also had at least one mental health disorder.

Despite some improvements in the national youth substance abuse numbers, Ellsworth has witnessed a disturbing new pattern: kids who start using alcohol or marijuana at ever younger ages as a form of self-medication, who quickly escalate to more dangerous drugs, and who wind up using multiple substances in extreme amounts. "Maybe the average kid is using less and doing better, but the kids who are falling through the cracks are spiraling down, really fast," she said.

About 10 percent of Americans will develop a substance-use disorder at some point in their lives and need therapeutic services, according to Rob Vincent, a SAMHSA public health analyst. But those services are hard to come by, especially for youth.

"Once a child 12 to 17 years old is identified as needing treatment, only 1 in 20 of those adolescents is actually getting treatment. That is not a good number," said Vincent.

Yolanda Roberson, who directs the Empowerment program, teaches a class at a Boys and Girls Club in the Bronx. The classes are funded by the state of New York.

Robert Stolarik for NPR

So public health officials and researchers are making the case for prevention instead. Dealing with drug and alcohol abuse after the fact is a costly, impractical approach, so public health officials and researchers are making the case for early detection and intervention instead.

The leading prevention strategy, dubbed SBIRT — Screening, Brief Intervention and Referral to Treatment — is deployed in schools, afterschool programs and most widely, in primary and public health care.

Most pediatricians routinely screen patients for substance problems during annual visits. That's a big change from just 20 years ago, when the American Academy of Pediatrics found that fewer than half of pediatricians reported they were screening adolescents for substance use. By 2013, that percentage had risen to more than 80 percent, according to Dr. Sharon Levy, director of the adolescent substance abuse program at Boston Children's Hospital.

"I interpret that as a real shift in culture, from one in which there was controversy over whether drug use was a legitimate topic for pediatricians to address to one in which it's now part of the standard of care," Levy said. She sees the pediatrician's office as an ideal place to discuss substance abuse. "It's a unique setting in which an adolescent gets to have a confidential conversation" with an adult who is not their parent.

Doctors use one of a variety of screening tools, including one, called CRAFFT, that was developed by Knight. It asks six questions, including: "Have you ever ridden in a car driven by someone (including yourself) who was "high" or had been using alcohol or drugs?"

In many doctors' offices, the survey is now computerized or given as a questionnaire before the medical visit, so doctor and patient can discuss the results. (You can take the CRAFFT screening test here; it's available in 13 languages, including Khmer and Haitian Creole.)

Other screening tools widely in use are called frequency-based screens. Those tools use multiple-choice questions which ask teenagers how often they have used alcohol or marijuana to predict their risk of developing an addiction.

If screening turns up troubling behavior, the second step is brief intervention. In the doctor's office, that could be a five-minute conversation with the two elements that Knight says comprise a good brief intervention: science and stories. "What they want from doctors is, 'Tell us what the science is, don't tell us what to do; give us the information and trust us to make the right decisions.' "

The intervener can also be a therapist, counselor or youth-development worker. They often use what's called "motivational interviewing." That's the approach used by Elizabeth D'Amico, a licensed clinical psychologist and senior behavioral scientist at RAND Corporation, who developed CHOICE, a voluntary afterschool prevention and intervention program in California.

"Motivational interviewing is about guiding someone to make a healthy choice," D'Amico said, "versus saying, 'Okay, you have a problem and you need to change.' "

Counselors have to acknowledge there are reasons why young people use alcohol or drugs, D'Amico said. "You lose all your credibility if you just say, 'It's bad for you, stop.' "

Instead, motivational interviewing is more collaborative, said D'Amico. For example, if a teen says he drinks to relax, the counselor can help him to think of other, healthier ways to relieve stress. Studies have found a modest benefit in the program, with some students delaying drinking.

The third step of a prevention strategy, referral to treatment, connects youth who need more care with specialty treatment. Levy said most teenagers with a drug or alcohol problem don't need a residential program, or even an intensive outpatient program. Instead, they'll do fine working one-on-one with a counselor, she said.

In Washington, Ellsworth at True North Student Assistance and Treatment Services says that students served by the prevention programming have done better. In the last academic year, students said their use of marijuana and cocaine declined by half after participating in the program, and alcohol use declined by one-third. Participants also had better grades and fewer behavior problems at school.

Students in the Empowerment program talk about myths surrounding substance abuse. The program emphasizes healthy lifestyles.

Robert Stolarik for NPR

Even the computerized CRAFFT screening, with a few minutes of counseling by a pediatrician, has been shown to deter substance use, according to a study led by Knight and published in the journal Pediatrics in 2002. "The intervention resulted in 40 percent less substance use three months after the visit, and 12 months later there was still 25 percent less use, without any reinforcement. That's pretty powerful," said Knight.

Prevention is a cost-effective proposition, according to the National Institute on Drug Abuse (NIDA), with every dollar invested in keeping kids off drugs saving from $4 in health-care costs to $7 in law enforcement and other criminal justice costs. According to NIDA, research-based prevention programs can significantly reduce early use of tobacco, alcohol and illicit drugs.

Yet according to Knight, "of all the money that is spent by the federal government on the so-called war on drugs, only 5 percent goes to prevention." That's a short-sighted approach, he said. "The evidence is compelling that addiction is a pediatric disease, and if we don't prevent it during the teen years, we're really missing the boat."

Additional Information: Brothers and sisters

Hurt. Grief. Anger. Three sisters and one brother reflect on their dead siblings' drug addictions.

Elaine Korry writes about healthcare and social policy from the San Francisco Bay area. This story was produced by Youth Today, the national news source for youth-service professionals, including child welfare and juvenile justice, youth development and out-of-school-time programming.

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More Babies In The U.S. Are Dying Because Of Congenital Syphilis

Thu, 11/12/2015 - 1:34pm

The bacterium that causes syphilis is spread through sexual contact. It's easily cured with antibiotics, but can be hard to diagnose.

CDC/Phanie/Science Source

The number of babies born with syphilis has shot up, and it's taking a toll.

Of the 458 babies born last year with syphilis, 33 were stillborn or died shortly after birth. From 2012 to 2014, there's been a 38 percent increase in cases of congenital syphilis in the U.S. The spike reverses a previously falling trend in the rates of babies with syphilis from 2008 to 2012, according to a report released Thursday in Morbidity and Mortality Weekly Report.

As rates of new syphilis infections rise and fall, rates of fetal and congenital syphilis tend to follow suit, says Virginia Bowen, an epidemiologist at the Centers for Disease Control and Prevention and lead author on the study. If a pregnant woman carries the bacteria, syphilis can infect the unborn fetus. When that happens, a lot of things can go awry.

"Up to 40 percent of babies will die in utero or shortly after delivery," Bowen says. "Or they might have severe illness like blindness or deafness or other types of damage."

It's hard to know the reason behind the recent surge in syphilis cases, Bowen says. "The only thing I can say is syphilis is going up right now across the board," she says. "From '13 to '14, we are seeing syphilis going up everywhere, including among the women, and we don't have the answers as to why."

The rising rates in congenital syphilis might betray a larger problem among health care for women and pregnant women, Bowen says. "There are a lot of barriers to getting into the door at the prenatal care provider. That could be related to insurance status, stigma or discrimination." If women aren't getting adequate prenatal care, then they can't be screened for syphilis.

Access to care can be particularly hard for certain populations, says Dr. Martha Rac, a maternal-fetal medicine physician at Ben Taub Hospital and Baylor College of Medicine in Houston who was not involved with the study.

"African-American women are more disproportionately affected by syphilis than any other race," she says. And 57 percent of children with congenital syphilis were born to African-American women.

Lack of prenatal care is probably the greatest contributor to the upturn in congenital syphilis, Rac says. "It seems to be the common theme that women having congenitally infected babies overwhelmingly have, if any, late, poor prenatal care. That is a big area which can be targeted from a public health standpoint."

Some states have been harder-hit than others. California went from 35 cases in 2012 to 99 in 2014, while Texas continued to see a slight decline in the overall number of babies born with syphilis. "In April, I designated Fresno County as an area of high syphilis, so providers are required to screen for syphilis three times during pregnancy," says Dr. Ken Bird, health officer for the Fresno County Department of Public Health.

There are states that have free health coverage for pregnant women. "In California, every pregnant female has coverage for prenatal care [through the Medi-Cal program]. Many don't realize that, and they're not sure how to access that care," Bird says. Other states may cover prenatal visits through state Children's Health Insurance Programs.

Syphilis is a difficult disease to diagnose, Bowen says. Many people become asymptomatic after the first lesions or rashes appear, but can still pass the infection on to their unborn children. But as long as the infection is caught early enough, a simple course of antibiotics is enough to ensure a healthy baby. "Of the 458 cases we had last year, every single one of them is considered preventable," she says.

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Depressed? Look For Help From A Human, Not A Computer

Thu, 11/12/2015 - 10:24am

For it to work, you have to do it. And doing can be difficult when depressed.


Almost 8 percent of Americans 12 and older dealt with depression at some point between 2009 and 2012. With that many of us feeling blue, wouldn't it be nice if we could simply hop on the computer in our pajamas, without any of the stigma of asking for help, and find real relief?

Online programs to fight depression are already commercially available, and while they sound efficient and cost-saving, a study out of the U.K. reports that they're not effective, primarily because depressed patients aren't likely to engage with them or stick with them.

The study, which was published in The BMJ on Wednesday, looked at computer-assisted cognitive behavioral therapy and found that it was no more effective in treating depression than the usual care patients receive from a primary care doctor.

Traditional cognitive behavioral therapy (CBT) is considered an effective form of talk therapy for depression, helping people challenge negative thoughts and change the way they think in order to change their mood and behaviors. Online CBT programs have been gaining popularity, with the allure of providing low-cost help wherever someone has access to a computer.

A team of researchers from the University of York conducted a randomized control trial with 691 depressed patients from 83 physician practices across England. The patients were split into three groups: one group received only usual care from a physician while the other two groups received usual care from a physician plus one of two computerized CBT programs, either "Beating the Blues" or "MoodGYM." Participants were balanced across the three groups for age, sex, educational background, severity and duration of depression, and use of antidepressants.

After four months, the patients using the computerized CBT programs, or cCBT, had no improvement in depression levels over the patients who were only getting usual care from their doctors. "Uptake and use of cCBT was low, despite regular telephone support," the study authors wrote. Almost a quarter of participants dropped out within four months, and patients noted the "difficulty in repeatedly logging on to computer systems when they are clinically depressed."

"It's an important, cautionary note that we shouldn't get too carried away with the idea that a computer system can replace doctors and therapists," says Christopher Dowrick, a professor of primary medical care at the University of Liverpool, who wrote an accompanying editorial. "We do still need the human touch or the human interaction, particularly when people are depressed."

The lack of patient engagement in this study means these programs aren't the panacea that busy doctors and cost-conscious health care officials might be hoping for, Dowrick wrote in the editorial. Yet it's important to note that the study was conducted in a primary care setting, he says, because many other studies on cCBT that show some benefit have been conducted in psychological settings, where patients might be more motivated to engage with these kinds of online programs.

Despite the unenthusiastic findings of the study, Dowrick says that do-it-yourself treatments like cCBT can still be effective. But they're more likely to succeed when people have relatively mild symptoms of depression or are in a recovery stage – the participants in this study were mostly in the category of moderate to severe depression, he says. Computerized CBT is also more likely to succeed, he adds, if the patients are open to seeking help on a computer and when they have a "reasonable amount" of guidance as they go through the program, preferably from a therapist. In this study, he says, participants each totaled roughly six minutes of telephone support and guidance.

Being depressed can mean feeling "lost in your own little small, negative, dark world," Dowrick says. Having a person, instead of a computer, reach out to you is particularly important in combating that sense of isolation. "When you're emotionally vulnerable, you're even more in need of a caring human being," he says.

Copyright 2015 Kaiser Health News. To see more, visit
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Surge In Use Of 'Synthetic Marijuana' Still One Step Ahead Of The Law

Wed, 11/11/2015 - 5:24pm
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The drug sold as K2, spike, spice or "synthetic marijuana" may look like dried marijuana leaves. But it's really any of a combination of chemicals created in a lab that are then sprayed on dried plant material.

Spencer Platt/Getty Images

A street drug made of various chemicals sprayed on tea leaves, grass clippings and other plant material continues to send thousands of people suffering from psychotic episodes and seizures to emergency rooms around the country.

In 2015, calls to poison control regarding the drug already have almost doubled, compared to last year's total, and health professionals and lawmakers are struggling to keep up with the problem.

Some call the drug K2, or spice. It's also widely known as "synthetic marijuana," because the key chemicals in the spray are often man-made versions of cannabinoids, a family of psychoactive substances found in marijuana.

But the ingredients and concentrations used in this street drug vary widely, and it can be very different from marijuana in its effects.

Edwin Santana, 52, entered a detox program at Syracuse Behavioral Healthcare to help break his heroin addiction and daily habit of smoking the synthetic drug known as spike.

Hansi Lo Wang/NPR

At a drug rehabilitation center a short drive north of Syracuse University, where 52-year-old Edwin Santana has come for treatment, they call the drug "spike."

Santana, who was born in the Bronx, is a few weeks into his detox program at Syracuse Behavioral Healthcare. A longtime heroin user, he became homeless after multiple run-ins with the law. Then, he says, a couple years ago he developed a problem with spike.

"It was getting out of hand," Santana says. "I was starting to smoke every day. And you know, spike is a drug I respect, because you don't know what you're getting."

The drug also inspires fear in him.

"Not a little bit of fear. A lot of fear," he adds.

It's hard to guess what will happen after you smoke or ingest spike, users and drug enforcement officials say, because the chemists who make it are constantly changing the main ingredients — tweaking a cannabinoid's chemical structure, or mixing it with other substances entirely, which can change its effects.

"You get stuck when you're on spike," Santana says. "And it makes you do all kinds of crazy things, man. I've seen people roll around on the floor and stuff like that." Smoking the drug landed him in the hospital.

Angel Stanley, a psychiatric nurse at the rehab center, ticks off the symptoms she's seen in patients who have smoked spike: "Auditory hallucinations, visual hallucinations, disorganized thinking, delusional thinking. Paranoia is a big one."

Many of these patients, she says, expected that smoking spike would be just like smoking regular pot, because the drug was sold as "synthetic marijuana." The drug first became popular with teens, who were looking for a new way to get high for just a few dollars.

But now, Stanley says, she's seeing older users, too.

"They've gone from using some marijuana in the past, a little bit of alcohol use over the years, and now all of a sudden, they're in their 50s and they're addicted to spike," she says.

Often users are also homeless.

"A lot of people who use it, their reality is pretty bleak, so they use spike to escape that reality," explains Matthew, who asked that we not use his last name. He just finished an inpatient program at Syracuse Behavioral Healthcare to help him stop using spike and cocaine, and doesn't want future employers to find out about his past.

"The main thing with spike," Matthew explains, "is this: It is the cheapest, most effective high in Syracuse right now. Is it the most enjoyable high? Probably not. But it's the cheapest, hands down."

The question facing workers at rehab centers and emergency rooms is how to effectively treat users of a drug that's essentially an unknown mixture.

"We know how to treat an alcoholic," says Jeremy Klemanski, who heads Syracuse Behavioral Healthcare. "We know how to treat an opiate patient. We know how to treat somebody's who's using cocaine. But, when we say we know how to treat somebody who is using synthetics — to a certain extent we do."

Health professionals faced with such a patient are usually flying blind, Klemanski says. Some types of spike can be detected in drug tests, but not all.

"Until we get to a point where the treatment system has as sophisticated testing as the labs that are inventing and creating these things, we'll struggle," he says.

Lawmakers are paying attention. The federal government has permanently banned more than a dozen types of synthetic cannabinoids.

But packets of "spike" and "K2" and "spice" are still sold in many mom-and-pop convenience stores, because they contain versions of cannabinoids not covered by the ban, says Matt Strait of the Drug Enforcement Administration.

"They are in a legal grey area," Strait explains, "because they're not specifically named in the statute."

That keeps makers and dealers of spike one step ahead of state and federal laws. Congress is weighing how to streamline the process of regulating new versions. Meanwhile, the Drug Enforcement Administration has been investigating and temporarily banning some new forms of the drug.

But back in Syracuse, some health professionals and spike users say the government can't move fast enough to keep up with new varieties hitting the streets.

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10 Percent Of Older People Have Been Victims Of Abuse

Wed, 11/11/2015 - 5:04pm

Nursing home residents can be at risk, but so are people living at home with a spouse or adult children.


Abuse of older people, which can take the form of sexual or emotional abuse, physical violence and financial manipulation, affects at least 10 percent of older Americans, according to a review article published Thursday in the New England Journal of Medicine.

That figure, researchers note, is likely an underestimate, since it's based on self-reported cases and its victims often suffer from dementia or are otherwise isolated from people who might notice something is wrong. But the estimate drives home how pervasive the problem is and how familiar its victims might be.

Elder abuse can happen to residents in nursing homes or those living with family members. The "young old" are more vulnerable because they're apt to be living with a spouse or adult children, the two groups most likely to be abusers.

If unchecked, elder abuse increases risk of death and can result in long-term harm — putting its victims in the hospital and emergency room and increasing their odds of physical and mental illness.

And because the abuse can take various forms and the issues involved are complex, there is rarely a single, easy solution. Instead, with this review of research from the past decade, the authors conclude that multidisciplinary strategies offer the most effective responses.

For example, if someone is being physically harmed, he or she could need help from a primary care doctor. But once this initial problem is recognized, it might become clear that the victim also needs a new place to live, which would make the assistance of housing authorities key. Or if someone is scamming the older person or withholding his or her money, getting help at the bank also makes sense.

"These cases do not resolve magically — often these play out over months or years," said Mark Lachs, the paper's lead author and director for the Center of Aging Research and Clinical Care at Cornell University. When trying to bring a variety of services to a victim or family, he says, it helps to have them all connected to each other.

Lachs is also the medical director for the New York City Elder Abuse Center, which uses an integrated approach when treating victims of elder abuse. It has also been trying to help doctors in other cities develop similar programs.

There isn't any data tracking how common these kinds of formal alliances are, said Robert Blancato, the national coordinator for the Elder Justice Coalition, an advocacy group focused on preventing abuse of older people. Anecdotally, though, he's seen many doctors and other service providers across the country using this multidisciplinary strategy. "When they stick to it and do it," he said, "they can show results."

Doctors can't fix elder abuse by themselves. But they are often an important first line of defense. So if they do notice something is wrong, knowing about other community resources is key to resolving the issue.

"The odds are better that somewhere in that group of people in the [multidisciplinary] team, someone may have the ability to work closer with the elderly person and find out what the situation is," Blancato said.

But recognizing signs of elder abuse and coordinating a response isn't easy, Lachs said.

"Fragmentation of care is a huge problem," he said. "I've seen situations where patients have been victims of abuse at home, they go to a hospital [and] there's understandably a pressure to get people out of the hospital. They might go to an environment for rehab where the receiving providers don't have an understanding that the family member is physically, emotionally or fiscally abusive because of that fragmentation."

Though it may seem unrelated, Lachs said, financial abuse — scamming the older person or mishandling his or her funds — can often accompany medically significant harm. Victims then may not be able to buy medication or get enough to eat, which can exacerbate other health problems.

And if abuse goes untreated long enough, he added, patients can end up using expensive medical care they otherwise wouldn't have needed.

Copyright 2015 Kaiser Health News. To see more, visit
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Budget Switch For Maryland Hospitals Is Starting To Pay Off

Wed, 11/11/2015 - 5:02pm

Maryland hospitals, including Johns Hopkins Hospital in Baltimore, are part of a payment experiment that provides new incentives to keep people in good health.

Patrick Semansky/AP

Results are in from the first year of a bold change to the way hospitals get paid in Maryland, and so far the experiment seems to be working.

We recently reported on the unique system the state is trying to rein in health care costs. Maryland phased out fee-for-service payments to hospitals in favor of a fixed pot of money each year.

A report in the latest New England Journal of Medicine says the experiment saved an estimated $116 million in 2014, the first year it was in operation.

The state of Maryland and the Centers for Medicare and Medicaid Services struck an agreement that ended payments to hospitals for each procedure, each emergency room visit and each overnight stay. Instead, Maryland hospitals receive a set amount of money — called a global budget – for the whole year, regardless of how many patients they treat.

In essence, Maryland flipped financial incentives for hospitals. In the past, more patients meant more revenue. Now, with revenue fixed for the year, hospitals benefit when patients are healthy and stay out of the hospital.

Many Maryland hospitals have hired care coordinators to follow up with patients once they've gone home, to make sure they're taking their medications, following up with their primary care doctors and so on.

As part of the deal, Maryland promised to cut costs and improve care. There are targets to hit, including saving Medicare $330 million over five years and reducing preventable health problems, such as bed sores and transfusions with the wrong type of blood, by 30 percent.

Maryland also agreed to bring its hospital readmission rates for Medicare patients, which were among the highest in the country, down to the national average.

Preliminary data for 2014 show that while Medicare per capita hospital costs rose nationally by just over 1 percent, they dropped in Maryland by a little more than 1 percent. The savings in the state amounted to $116 million.

Meanwhile, hospitals also reduced the potentially preventable conditions by 26 percent. The state's readmission rate came down, but remains higher than the national average.

John Colmers, who as chair of Maryland's Health Services Cost Review Commission worked to negotiate this deal on behalf of the state, calls these results a good start. He's one of authors of the report, along with other key figures behind the deal.

"We're not going to rest on our laurels, but we're pleased with the work that hospitals, physicians and others have done," he says. "Ultimately the goal here is to provide the best care to patients in the most appropriate settings."

Even with the early successes, there are still significant challenges to overcome. The article points out that Maryland's most recent patient-experience scores are among the worst in the country.

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Musicians Struggle To Buy Insurance In A City That Thrives On Music

Wed, 11/11/2015 - 2:35pm
Listen to the Story 3:48
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Kalu James moved to Austin, Texas, eight years ago, but bought health insurance for the first time this year. Twenty percent of the city's musicians live below the federal poverty line.

Veronica Zaragovia/KUT

It looks like Kalu James is living the life as a musician. He's standing under a neon sign, ready to play guitar at Austin's famous Continental Club. And when he's not here, he's hustling to pay his bills.

"Being a full-time musician means you have three other side jobs, you know?" he says.

James moved to Austin about eight years ago and got health insurance for the first time this year. He pays $22 a month, after the $200 subsidy he gets through the Affordable Care Act. Even that is a lot, because he earns only $15,000 a year. He gets help paying his monthly premium through a local nonprofit.

"We still have to worry about counting the quarters and the pennies when we leave these venues," he says. Health insurance doesn't come easily.

Austin thrives on its reputation as the live music capital of the world and is making far more than quarters and pennies from music. The city estimates the commercial music industry pumps $1.6 billion into the local economy every year.

But Austin has a lot of people like James struggling to afford life here.

"A lot of people didn't understand just how dire that situation is," says Nikki Rowling, the founder and CEO of the Titan Music Group. "We have hard data that shows it."

The Titan Music Group recently conducted a large survey and several focus groups of musicians in Austin; it produced the Austin Music Census for the city. The census found that 20 percent of Austin musicians live below the federal poverty level. More than 50 percent qualify for federal housing subsidies, and nearly 19 percent lack health insurance.

A lot of Austin musicians rely on the Health Alliance for Austin Musicians for help.

"Close to 60 percent of our membership doesn't even qualify for the subsidies that are given through the Affordable Care Act," says Reenie Collins, the alliance's executive director. And Texas didn't expand Medicaid, which would have helped those musicians below the poverty line.

Her organization helps in two ways. This year, HAAM gave Kalu James and about 300 others money to afford their premiums for plans bought on the exchange. It also coordinates low-cost health care for about 2,000 members every year. It partners with doctors and hospitals to give these musicians medical, dental, vision, hearing and mental health care.

Backstage at the Moody Theater, dobro player Tom Caven is getting ready to go onstage.

"Travel anywhere in the United States," Caven says, "you tell them you're from Austin, [and] they almost always say, 'Austin City Limits,' you know? This is very much the identity. And if we lost that, we'd just be another up-and-coming city with no personality."

Caven is an executive at the Seton hospital network, an organization that partners with HAAM. He is also a physician and treated musicians in Austin for almost 20 years. Caven's band, The Stray Bullets, is performing at a local "battle of the bands" to raise money for HAAM.

"Some people feel like you just ought to work hard enough to have health insurance," he says. "But working in a safety-net hospital, like I do, you see people that come in. They're working really hard — working sometimes two and three jobs to support their family."

Dr. Tom Craven (second from right) plays dobro and guitar with The Stray Bullets. He also treated Austin musicians for 20 years and is now an executive at the Seton hospital network in the city.

Veronica Zaragovia/KUT

Thanks to fundraisers and other private donations, HAAM's Collins plans to triple the number of musicians who will get help with their premiums next year. She's also a passionate advocate of Medicaid expansion, which would help many musicians in Austin.

"Many, many people think, 'Oh, HAAM's not needed anymore.' Well, that's not really true," she says, "because Texas did not expand Medicaid."

While more people have become insured since the rollout of the exchanges, Texas still has the highest uninsured rate in the country — about 17 percent.

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

Copyright 2015 KUT-FM. To see more, visit
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House Calls For The Homebound Make A Comeback

Wed, 11/11/2015 - 10:56am

Misha Friedman for NPR

Credit: NPR; Photographs by Misha Friedman for NPR

Dr. Roberta Miller hits the road at 8 a.m. to see her patients.

Many are too old or sick to go to the doctor. So the doctor comes to them.

She's put 250,000 miles on her Honda minivan going to their homes in upstate New York. Home visits make a different kind of care possible.

"You can evaluate the person as a whole," says Miller, who has been a home care physician in Schenectady, N.Y., for more than 20 years. "You see everything that influences their health and well-being: the environment, the surrounding people, the support system, whether they had or didn't have food."

Miller spends about an hour at each house call. Conversation with patients and their family members flows so naturally that it's easy to miss that she's also checking vital signs, gently stretching a hand, noting which pill bottles are empty.

Although Miller's practice may harken back to the country doctor of decades past, it could be the future of medicine. In 2013, about 2.6 million Medicare claims were filed for patient home visits and house calls. That's up from 2.3 million visits in 2009 and 1.4 million visits in 1999, according to Medicare statistics.

The trend is expected to accelerate as baby boomers grow older. One in 20 people over the age of 65 is homebound in the U.S., according to a study published in July in JAMA Internal Medicine.

"That's just the nature of the population we treat," Miller says. "They're extremely ill. Homebound patients often have up to 12 or 13 problems, not just one."

And they're often invisible. These people could be living just down the block, and you'd never know it. Many of them never leave their homes.

Miller's patients include a 55-year-old woman with ALS who can communicate only with her eyes, a 27-year-old former quarterback left quadriplegic and in a coma after surgery on an Achilles tendon, a 92-year-old woman cared for by her daughter, and a severely depressed man who lives alone.

After the Affordable Care Act took effect in 2014, Miller saw a spike in new patient requests after Medicare reimbursements increased for people who are disabled or 65 and older.

"Now we can afford to see them and take care of them. Because they haven't had medical care, they have multiple medical needs and psychosocial needs," she says. "It has given us access to a group of people, but more importantly, they have access to us."

But reimbursements declined in 2015 because of sequestration. And now Medicaid reimbursements rates are starting to fall as well.

Editor's note: This is an abbreviated version of a story that ran on Sunday, Nov. 8.

Misha Friedman for NPR

Photographer Misha Friedman says he tries "looking beyond the facts, searching for causes, and asking complex and difficult questions." His work has been featured by many media organizations, including NPR, The New Yorker, Sports Illustrated, Der Spiegel and GQ.

Freelance writer Nadia Whitehead contributed to this report.

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Women In Their 40s Get Some Help With The Mammogram Decision

Wed, 11/11/2015 - 8:42am

The online tool called Breast Screening Decisions explains the risks of screening vs. waiting, and also asks how a woman feels about the options.

Meredith Rizzo/NPR

Expert groups differ on when and how often women should have mammograms. So many groups now say that a woman in her 40s should talk to her doctor about the pros and cons of mammography as well as her individual risk in order to make the decision that's right for her.

Except that none of my 40-something friends I've spoken with have had that kind of conversation with a physician. Instead they've heard: "You're 40, here's a prescription for a mammogram." End of discussion.

Next year I'm determined to actually talk over the screening decision with my doctor rather than slink out the door with my questions unanswered. An online decision tool that launched earlier this year may make that conversation easier.

The online tool, called Breast Screening Decisions, grew out of a blog post written by Margaret Polaneczky, a gynecologist at Weill Cornell Medical College, back in 2009. That's when the U.S. Preventive Services Task Force first recommended that average-risk women in their 40s shouldn't be automatically be screened for breast cancer. (The task force is currently updating those recommendations, though the draft released earlier this year sticks to that same basic message.)

"I found myself really wondering how I'd address this in my practice," says Polaneczky. So she dug into the data used by the USPSTF and wrote about the controversy. In short, mammograms starting at 40 do save lives across a population of women, but not many, and at the cost of false positive results and the overdiagnosis of breast cancers that never would have threatened a woman's life if left undetected.

Polaneczky got good feedback on her explanation and wanted to help women and their physicians sort all this out with some kind of evidence-based screening decision aid. "I wanted women to decide not as a gut reaction to a horror story they've heard, either pro or con," she says.

There are plenty of online tools to calculate risk, but Polaneczky wanted to also give an estimate of the effects of screening and help women think about their own values.

She collaborated with Elena Elkin, a health outcomes researcher at Memorial Sloan Kettering Cancer Center. "We wanted this to be based on the best available evidence on mammography, and to use the best ways to communicate with people about risk," says Elkin. The tool is based on the data the USPSTF used to formulate its 2009 recommendations, which is a mix of information from large registries, analyses of the many studies done of mammography and predictive models.

The tool gives a woman in her 40s (it's not meant for older or younger women) an individual breast cancer risk assessment by asking questions about ethnicity, age at first menstrual period, personal history of breast abnormalities and family medical history, among other factors. Then it uses easy-to-understand infographics to show what is likely to happen across a population of similar-risk women if they have regular mammograms.

For example, after providing my own information, I learned I was at low to average risk of breast cancer, with a five-year risk of developing the disease at 0.9 percent. Or put another way, nine of 1,000 women like me will develop breast cancer in that time period.

I learned that if 1,000 low-to-average-risk women of my age have a mammogram, 900 will get a normal result, though one of them will actually have breast cancer that is missed by the test. The other 100 will have an abnormal mammogram that requires further testing or biopsies, but only two of them will actually have breast cancer.

What I found most illuminating were the scenarios for starting mammograms at different ages and intervals. If 1,000 women of my age and risk profile have annual mammograms starting at 40, over a lifetime, 22 will die of breast cancer. On the other end of the spectrum, if those women start mammography at age 50 and are screened every other year, 25 will die of breast cancer. That's not a big difference — unless of course, you or someone you care about is among those three additional deaths.

My tour of the tool ended with a series of questions intended to clarify what's important to me. For example, am I willing to do anything to detect breast cancer as early as possible? How worried am I about the harms of screening? (The tool provides information about unnecessary biopsies or overdiagnosis, but doesn't quantify them because the exact numbers are controversial, says Elkin.)

Those values questions are important, say the tool's creators. "Some women will say, 'My mother had a breast biopsy and developed an abscess, and I never want an unnecessary biopsy,' " says Polaneczky. "Another will say, 'My mother had breast cancer at 45 and I will do anything to catch it early.' "

Unpublished data show that most initial users of the tool came away with an accurate gauge of their risk and of the benefits and limitations of screening. Deanna Attai, assistant clinical professor of surgery at UCLA's David Geffen School of Medicine, says she recommends the decision aid to her patients. Given a doctor's limited time, it's nice to have something women can complete on their own, then bring in for discussion, says Attai, who is also the president of the American Society of Breast Surgeons. (The group recently revised its own mammography consensus statement.)

Shots - Health News OK, When Am I Supposed To Get A Mammogram?

Doctors know they're supposed to having this kind of conversation with their patients, says Christine Gunn, a research assistant professor at the Boston University School of Medicine. But "how that looks in practice hasn't been spelled out," and clinicians tell her they don't always know what to do, she says. Her own research has shown that just 31 percent of women under 50 feel they are being given a choice to undergo screening.

The creators of the decision aid say their aim isn't to drive women toward or away from mammography, but to help them make an informed choice. "The mere fact that there's inconsistency should tell us that not even the experts agree on the best thing for an individual to do," says Elkin. When a woman makes her choice, "we should respect that," she says.

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

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Pitching Health Care In Baltimore's Red Light District

Tue, 11/10/2015 - 3:59pm
Listen to the Story 11:18
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Nathan Fields talks to passersby about how to use a naloxone auto-injector to treat an opioid overdose.

Meredith Rizzo/NPR

Every Thursday night you can find Nathan Fields making the rounds of Baltimore's red light district, known to locals as The Block.

An outreach worker with the Baltimore City Health Department, Fields, 55, is a welcome sight outside strip clubs like Circus, Club Harem and Jewel Box.

In the early evening before the clubs get busy, he talks with dancers, bouncers and anyone else passing by about preventing drug overdoses and how to stop the spread of HIV and other sexually transmitted diseases.

Later on, he'll drop into the clubs to check on the dancers who aren't able to come outside, finding out what they might need.

Fields has credibility on The Block that people higher up in the health department don't. "I watch him walk down any street in Baltimore city, and people come up to him, and they know that he is there to serve them," says his boss, Health Commissioner Dr. Leana Wen.

The needle exchange van parks on the corner of a block that is home to numerous strip clubs.

Meredith Rizzo/NPR

It wasn't always so easy.

Seven years ago, Fields was working with the city's needle exchange program. After a spate of drug overdoses at the strip clubs, the health department brought its needle exchange van to The Block one night a week.

There were hardly any takers at first. People were skeptical.

"They were under the impression that we were giving their information to the police," Fields says. "So that's when I came on board. You know, I'm a great negotiator. Donald Trump can't beat me out."

Fields started with the bouncers. Though a Baltimore native, Fields is a huge fan of the New England Patriots and would often show up in head-to-toe Pats gear. The Baltimore Ravens-loving bouncers hated his get-up, and the football rivalry broke the ice.

Seven years ago, Fields began outreach work with Baltimore's needle exchange program on The Block.

Meredith Rizzo/NPR

Eventually, the sports talk turned more personal. Fields learned that some of the men had girlfriends dancing in the clubs who needed help – everything from condoms to drug treatment. Some women needed copies of birth certificates and other forms of ID in order to get into treatment.

Fields leaned on colleagues in the health department to get the problems solved.

Soon, the clubs doors opened for him. Once inside, Fields saw people needed even more.

"We went into one club, and there were three girls in different stages of pregnancy that were still dancing," he recalls. "We started running it up the chain: 'Hey, we need health care down here — reproductive health care.' "

So in addition to the needle exchange van, the city brought a second van to The Block, one with an exam table and a nurse. Now, every Thursday night, health workers offer needles for exchange, training in the anti-overdose drug naloxone, HIV tests, reproductive health exams, pregnancy tests, flu shots and more other basic health care services.

(Left) A Baltimore City health worker demonstrates how to use a naloxone auto-injector. (Right) Inside the needle exchange van, bundles of used needles are held in a container for disposal.

Meredith Rizzo/NPR

Fields treats each person coming into the vans like family. He remembers babies and boyfriends and other small details of people's lives.

"The Block is like living," he says. "These relationships, you've got to keep them flourishing."

Quietly, Fields also hands out pamphlets with information about drug treatment. Every so often, he'll mention a new option and encourage someone to check it out. But, it's a soft sell. He doesn't want to drive people away.

"I don't beat a person over the head," he says. "I never badger anybody for fear of them looking at me like, 'Oh, he's an elitist. He forgot where he came from.' I could never forget where I come from."

Nathan Fields (center) with his sons Hassan Fields (left) and Malik Fields on Friday, May 22. Hassan was shot and killed that weekend.

Courtesy of Nathan Fields

For nearly 20 years, Fields was a heroin addict. He sold drugs to support his habit and did time in the Baltimore City jail. "I was a predator to my community," he says.

After getting clean in the mid-1990s, he got a job as a recovery counselor. In 2004, he went to work with the Baltimore City Health Department. "The job just gives me a sense that I'm helping to build back what I tore down," he says. "You know, every time I can get somebody to even thinking different or even consider going into treatment, I feel as though I had a successful day."

In spite of those small victories, it's been a particularly difficult year for Baltimore and for Nathan Fields.

Over Memorial Day weekend, the outbreak of violence following the death of Freddie Gray claimed the life of his youngest child, 20-year-old Hassan Fields. He was shot and killed on the west side of Baltimore. His death remains an open case.

Nathan Fields struggles to understand how this could happen to him, given all he's done for the community. He had thoughts of reverting to the person he once was. Then, he came to a quieter place.

"The Block is like living," outreach worker Nathan Fields says. "These relationships, you've got to keep them flourishing."

Meredith Rizzo/NPR

"I'm sorry. I can't let this destroy me," he says. "I can't let this turn what my thoughts are about human nature — some good people with some bad people. I believe the bad people have a little bit of good in them too. It's just got to come out."

Thinking about Hassan's death has led him to reflect on his own past.

"I just have to look back on myself and say, I've caused pain. No, I've never done anything as violent as that, but I've got to keep working. I can cherish his memory, I sit down, I look at his picture and think about it, and it just makes me work harder."

NPR and All Things Considered will continue reporting from Baltimore in the coming months, checking in with Leana Wen and her team. Stay tuned for future stories.

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Some Hospital Systems Want To Care For You And Sell You Insurance

Tue, 11/10/2015 - 12:27pm

Geisinger Health System, based in Danville, Pa., offers both insurance and patient care.

Bradley C. Bower/Reuters/Landov

In addition to treating what ails you, a number of health care systems aim to sell you health insurance to pay for it.

Some of the most competitively priced policies on health insurance marketplaces are offered by the providers of health care, but it remains to be seen how many health systems will succeed over the long haul as insurers.

It's not surprising that health systems might get into the insurance business. Doing so funnels more patients to a health system's hospitals and doctors. And it makes sense that combining clinical and claims data under one roof could lead to better coordinated, more cost-efficient patient care.

A number of well-regarded health systems have long sponsored insurance plans, including Kaiser Permanente, headquartered in Oakland, Calif., Geisinger Health System in central Pennsylvania and Intermountain Healthcare in Utah. (Kaiser Health News, an independent service of the nonprofit Kaiser Family Foundation, is not affiliated with the health insurance company Kaiser Permanente.)

Yet even though health care systems can gain insurance know-how by partnering with or acquiring an insurer or third-party administrator to handle claims, compliance and customer service, putting it all together can be challenging.

"They're inexperienced," says Gunjan Khanna, a partner in the health care practice at McKinsey & Co. who co-authored a paper on this type of plan, when talking about newer entrants in this market. "The viability of that business and the ability to manage that is a question." For example, it may take years to develop the necessary skills in managing financial risk and coordinating patient care beyond the hospital or clinic, among other things.

Health plans sponsored by providers are still rare. In 2014, 13 percent of health care systems in the United States offered plans that covered 18 million members, or about 8 percent of all people with insurance, according to McKinsey. Most of the people covered by provider-led plans are in Medicaid managed care or Medicare Advantage plans.

A growing number of provider-led plans are available on the health insurance marketplaces. When the marketplaces opened in 2014, there were 64 provider-led plans; next year there will be 72, according to McKinsey. In 2016, 19 percent of the new carriers on the exchanges will be provider-led plans.

The provider-led marketplace plans are priced very competitively, says John Holahan, a fellow at the Urban Institute's Health Policy Center. In a number of rating areas, the plans will be the lowest priced at the silver level in 2016, according to a forthcoming analysis of 63 rating regions in 21 states, Holahan says. The lowest priced silver plans include those sponsored by New York's North Shore-LIJ Health System, Oregon's Providence Health and Services and Inova Health System in Virginia.

Network coverage in these plans varies. Some cover only services within the health system, while others offer broader access.

Consumers have generally been willing to accept narrower networks of hospitals and doctors in exchange for lower premiums.

"The exchanges have pushed the concept of narrow networks front and center," says Khanna. Consumers confronting that might want to "consider a provider health plan, because it's based around a network of providers and at heart a network is built around a health care system."

Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation. Email questions: Michelle Andrews is on Twitter: @mandrews110

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More Women Opt For IUD, Contraceptive Implant For Birth Control

Tue, 11/10/2015 - 12:03am

Birth control pills are 99 percent effective in preventing pregnancy, research shows — but only if you remember to take them as prescribed. Rod-shaped implants, T-shaped IUDs and vaginal rings are other options.

BSIP/Science Source

Contraceptive implants and IUDs are very effective in preventing pregnancy — nearly 100 percent, statistics show. A new federal survey finds many more women are making this choice than did a decade ago.

Federal researchers analyzed data from a national health survey that included birth control practices among women of childbearing age. The survey found that while use of the pill, condoms and female sterilization all dipped between 2002 and 2013, the number of women using long-acting contraception more than quadrupled. These days, 11.6 percent of U.S. women — 4.4 million — rely on either an intrauterine device or a contraceptive implant to prevent pregnancy.

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IUDs come in two types. One is made of plastic and copper. The other kind, made of plastic, releases a progestin hormone.

The contraceptive implant works by releasing progestin delivered via a small, flexible tube inserted under the skin, usually in the woman's upper arm.

Both IUDs and implants are reliable for years without intervention or replacement, doctors say, and that's key to their efficacy and popularity. The implant prevents pregnancy for three years and the IUDs for three to 12 years, depending on the type, says Megan Kavanaugh, senior research scientist at the Guttmacher Institute. The pill is also highly effective, when taken as prescribed every day, she says, but you have to remember to take it.

Kavanaugh says the methods are endorsed as good options by medical associations, and more and more providers are being trained in how to insert them, which may have contributed to the uptick in use. Also, in plans established under the Affordable Care Act, insurance companies are required to cover birth control methods, including inserting IUDs and implants, she says. And that could increase their popularity.

As part of her own research on why women choose one method of birth control over another, Kavanaugh interviewed teenagers and young 20-somethings. Many, she says, told her, "I have so much on my plate — and I can't remember to take a pill every day." For this age group in particular, Kavanaugh says, these long-lasting methods are very reasonable options. They're the most effective methods available, she adds, "similar to sterilization" in effectiveness.

Unlike sterilization, the IUD and implant are both reversible and can be stopped at any time — also an important consideration for many people.

"We just want to have as broad a mix as possible for all women," Kavanaugh says, "so they can choose the birth control method that works best for them."

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Aggressive Lowering Of Blood Pressure Carries Risks As Well As Benefits

Mon, 11/09/2015 - 4:19pm

For people 50 and older at a high risk for heart disease or stroke, an aggressive approach to treatment has advantages. But there are risks, too.


In early September, the National Institutes of Health halted a study that aimed to figure out the right blood pressure goal for people with hypertension and other risks for heart disease and stroke.

The accepted target has been to get patients' systolic pressure (the first number in the pair used to gauge blood pressure) below 140. This study tested whether lowering systolic pressure below 120 would be a better idea.

A year before the study of more than 9,000 people age 50 and older was scheduled to end, the results already showed a big difference in health between patients whose doctors aimed to get below 120 rather than 140. Fewer people died in the more aggressively treated group, too. (People with diabetes, a risk factor for cardiovascular disease, were excluded from the study, called SPRINT for short.)

Reducing systolic blood pressure below 120 reduced heart attacks, heart failure and strokes by nearly a third and the risk of death by almost a quarter, a press release announcing the decision said.

But the details were missing. What about side effects? How big a difference, in absolute terms, did the more intensive approach make?

On Monday, the detailed results were presented at the American Heart Association annual scientific meeting in Orlando, Fla., and published online by the New England Journal of Medicine.

For people in the group whose blood pressure goal was lower than 120, the annual rate for a serious cardiovascular event — including a heart attack, stroke, heart failure or death from cardiovascular causes— was 1.65 percent. For the group whose blood pressure target was less than 140, the rate was 2.19 percent, 0.54 higher than the more aggressive approach.

In relative terms, the group that got treated more aggressively did 25 percent better than the one that was treated according to the traditional goal.

"It's a great study that provides evidence that some people should consider a lower target blood pressure than has been previously recommended," Yale cardiologist Harlan Krumholz and occasional Shots contributor said in an email. "But there are lots of caveats and people should not panic if their blood pressure is above 120."

For instance, there was a greater risk of side effects from treatment for people who received the intensive treatment, some of them serious. Among the problems were blood pressure that was too low (3.4 percent for the intensive group vs. 2.0 percent for standard treatment), fainting (3.5 percent vs. 2.4 percent) and acute kidney injury or failure (4.4 percent vs. 2.6 percent).

The NIH's September press release didn't include information about side effects.

"The thing about risk factors like hypertension is that not everyone who gets treated gets a benefit," Krumholz cautioned. "It is about whether you lower risks enough to make it worth it — and whether the adverse effects are not important enough to you to deter you."

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Menopause: A Gold Mine For Marketers, Fewer Payoffs For Women

Mon, 11/09/2015 - 3:13pm
Listen to the Story 5:24
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Diane Bigda/Getty Images/Illustration Works

Over the years, many of us women have heard or used lots of euphemisms to describe menstruation:

My Friend.

The Curse.

Aunt Flo.

The Crimson Tide. (Yeah, sorry, Alabama, but that preceded you.)

But code words for menopause? Not so much. Menopause was a process that was shrouded in mystery, myth and misinformation. Somehow, the reversal of menstruation, tied as it was to women's aging, was viewed as just shameful. Icky.

Which is strange, considering that women make up 51 percent of the earth's population. And that barring something extraordinary, they will all go through menopause.

Despite that — crickets.

There have been a few notable exceptions. Menopause showed up on hit sitcoms All in the Family and The Cosby Show. There was a cheeky off-Broadway production, Menopause — the Musical!

And a few female comedians like Karen Mills and Chonda Pierce have decided to talk about menopause out loud. In public.

In general, they did a better job of lampooning the process than their male peers. Maybe because they knew what they were talking about. (Or maybe women are just funnier?)


But it took a World War II hero who just happened to be the former majority leader of the United States Senate to move the meno-conversation further along.

"You know, it's a little embarrassing to talk about ED," Bob Dole confessed to TV viewers way back in 1988. "But it's so important to men and their partners that I decided to talk about it publicly."

That ad for Viagra, often referred to as the Little Blue Pill, helped to remove the stigma from erectile dysfunction and cracked the door open for more people to have honest conversations about how their aging bodies worked. It did wonders for men with ED. It's taking a lot longer for a public conversation about menopause.

For one thing, we're still learning about it. When Dr. Wulf Utian, a founder of the North American Menopause Society, started to research menopause back in 1967 at the University of South Africa, he said there was one line about menopause in his medical textbooks. One.

"It said, 'Menopause is physiological amenorrhea' — which means it's the normal loss of periods and there's nothing else to say about it," Utian remembers.

But menopause is more than the just reverse of menstruation. It's actually a systemic change to the body: In addition to those infamous hot flashes, many women experience what they describe as "brain fog" — forgetfulness or disorientation. Most find they're gaining weight, especially around the middle. There may be mood swings. Libido can plunge, and even when it doesn't, vaginal dryness can make it painful.


Fun stuff.

But a lot of women now experiencing menopause are part of the second-wave feminists who helped launch the sexual revolution. Their bible was Our Bodies, Ourselves, the groundbreaking handbook by the Boston Women's Health Collective that urged women to research, question and press for answers: "if this doesn't work, what about that? What are the side effects?"

And they want some of this stuff fixed. Which is why you're starting to see more ads for menopause-related products, many of them for conditions you didn't know had names. That drop of urine that escapes many women during a laugh or sneeze is now being labeled LBL — Light Bladder Leakage. And yep, there are multiple products sold for that, including pads, a tamponlike product called Poise Impressa and prescription medications.

Dr. Hilda Hutcherson remembers her mother and friends whispering among themselves about their menopause symptoms at girls-only gatherings. But those were private conversations with good friends.

Fast-forward to now: Hutcherson, an OB/GYN who teaches at Columbia University's College of Medicine in New York, and her girlfriends don't relegate The Talk to a closed-door room. "My girlfriends and I talk about it all the time," Hutcherson says. "We compare notes: How are you dealing with your hot flashes, and how are you dealing with your desire? It's so much easier to talk about all of those things now."


Partly because Dole's Viagra confessional broke the ice. And partly because, Hutcherson says, women of her generation assume they can — and should — be partners with their doctors in their health care. They did it with birth control. And now they want to do it with menopause. So they're researching, comparing notes and pressing their doctors about how to deal with some of the more uncomfortable aspects of menopause.

"Women are saying, 'I don't have to live with it. I see the commercials on TV, I'm reading about it in the magazines and online, and I know that I don't have to accept this, that there are things that can make my sex life, and my life in general, better,' " Hutcherson says.

Those commercials can be a two-edged sword, though.

Dr. Janet Pregler, director of the Iris Cantor UCLA Women's Health Center, thinks that a more open attitude about menopause is a great thing, but menopause marketing can be complicated. On one hand, if it raises awareness and gets women who think they have a problem to go in to be checked out, that's good. Especially if there is something that can mitigate their discomfort.

"Many of these things [being advertised] are important, and do give relief to a small number of women," Pregler says. "The issue has been, obviously ... that health care industry is an industry, and there's been this sense of 'OK, well let's sell this to as many people as we can.' "

Which, she says, leads some women who are managing their menopause just fine to wonder if they're missing something.

"I've actually had patients come in and say, 'I think there's something wrong with me — I'm not having terrible menopause symptoms, and aren't I supposed to have those?' " Pregler says.

One would certainly think so, given the proliferation of ads for everything from hot flashes to waist-level weight gain (sometimes sardonically labeled the menopot), to dryness that makes intimacy painful, maybe even impossible. There's a supposed remedy for every complaint.

And therein lies the problem, says Utian. Companies have realized that there is big money to be made from a baby boomer demographic in full menopausal flush. In many instances, he says, we're looking at "multibillion-dollar markets." So there are lots and lots of ads that target women in menopause — some legitimate, he says, most not.

In September, the North American Menopause Society issued a report on what works and what doesn't for hot flashes and other symptoms. Aside from hormone therapy, the doctors said there's evidence of benefit for just two treatments — cognitive behavioral therapy and clinical hypnosis. They also said that SSRI antidepressants may help, but over-the-counter and herbal remedies do not.

Utian says the former reluctance to mention menopause has given way to a very different attitude. "Instead of women whispering the word 'menopause,' " as they did a couple of generations earlier, "the word is everywhere now." And as a result, "there's a whole cohort of organizations and snake oil salesmen and so on all trying to climb in on the bandwagon."

The challenge for women in menopause is how to separate the snake oil from what really works, safely and reliably.

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It's Never Too Soon To Plan Your 'Driving Retirement'

Mon, 11/09/2015 - 4:36am
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At 72, Robert McSherry says he's not yet ready to quit driving or ready to plan how he'll get around when that time arrives. But he's happy to get the insurance discount that comes with taking a driver safety class.

John Daley/Colorado Public Radio

Harriet Kelly has one word to describe the day she stopped driving four years ago: miserable.

"It's no fun when you give up driving," she says. "I just have to say that."

Kelly, who lives in Denver, says she was in her 80s when she noticed her eyesight declining. She got anxious driving on the highway, so decided to stop before her kids made the move for her.

"I just told them I'd stop driving on my birthday — my 90th birthday — and I did. And I was mad at myself because I did it," she says, laughing. "I thought I was still pretty good!"

Kelly is now 94. She says her last traffic accident was in the 1960s. But, she says, "I think it's just better to make up your own mind than have your kids go through trying to tell you, and end up with arguments and threats and everybody gets mad."

Her daughter Leslie Kelly says she's grateful she and her siblings didn't have to have that tough conversation. Still, she knows it's been tough for her mom.

Harriet Kelly of Denver says she hasn't had even a fender bender since the 1960s. Still, she noticed in her 80s that her eyesight was starting to decline. She made a plan to stop driving at 90 — and did just that.

John Daley/Colorado Public Radio

"It really cut down on her ability to feel independent," says Leslie. Harriet chimes in, "It certainly did!"

But Harriet Kelly is a great example of someone who planned for her "driving retirement," says Dr. Emmy Betz, an emergency medicine specialist who does research at the University of Colorado School of Medicine on the safety of older drivers.

"Retirement is something that happens to all of us," Betz says. "Maybe we even look forward to it. You prepare for it, you make financial plans, you think about what you're going to do."

But most seniors don't do that when it comes to driving, she says.

"It's sort of the elephant in the room that no one wants to talk about, but it's an issue that's coming for most of us and our family members and so denial isn't probably the most helpful option," she says.

"Transportation is a huge issue that we need to address," says Jayla Sanchez-Warren, director of the Area Agency on Aging for the Denver Regional Council of Governments. For seniors, she says, a lack of transportation also "contributes to so many other things — like poor health care outcomes, isolation and depression."

A recent report by researchers at Columbia University and the AAA Foundation for Traffic Safety found that older adults who give up driving are nearly twice as likely to suffer depression as those who stay behind the wheel.

In my family, we've had to have that conversation twice. When my dad talked to my grandmother, she hid another set of keys, and drove secretly until they found out. Then, 30 years later, "hell" and "no" were just two of the choice words that erupted from my dad when his Alzheimer's diagnosis led us to insist that he stop driving.

Betz urges families to plan ahead, talk about it years before it happens and map out transportation alternatives.

"Imagine if I told you to give me your keys," she says. "And you can no longer drive, starting right now. I mean, what would you do? It's totally unrealistic that we think that that's an OK thing to do to older people."

It will become an issue for lots of us and our families. Nationally, until 2030, roughly 10,000 baby boomers will turn 65 each day, according to the Pew Research Center.

In many cases, drivers age 50 and older can get a discount on their car insurance by taking a driver safety class.

At a senior center in a suburb of Denver, Chris Loffredo teaches just such a class. She asks the 20 attendees to think about everything from how medications might affect them to how new technologies in cars may help them. And, she wants them to strategize.

"You have to know when to give up your keys!" she tells them.

But not a hand goes up when the group is asked if they're ready to talk about that. After the class, retirees Ralph Bunge, who is 72, and his wife, Paula, who is 67, say they're not ready.

"The conversation wouldn't be as difficult as doing it would be," laughs Ralph. Paula agrees.

Driver safety classes, like this one offered by AARP in Aurora, Colo., include discussion of ways to minimize blind spots and the effects of medication on driving, along with a review of road rules.

John Daley/Colorado Public Radio

"We're just not really at a place where we imagine that that decision is going to be made any time soon," she says.

Robert McSherry, who is 72 and retired, says for now he's in denial.

"One thinks, well, that you'll live forever," McSherry says.

Harriet Kelly says she's made adjustments since giving up the keys four years ago. She now hires a companion or calls Uber to take her on errands. She also gets rides from friends, but adds that there are "fewer and fewer people that I'll drive with in their 80s."

In fact, scientific studies show that if older drivers present a danger, it's mostly to themselves and their passengers, Betz says. Fatal crash rates are higher for older drivers, she says, but that's mostly because they don't heal as well after a crash.

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

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Hormones May Help Younger Women With Menopause Symptoms

Mon, 11/09/2015 - 4:35am
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For Linnea Duvall, a marriage and family therapist who lives and works in Santa Monica, Calif., the symptoms of menopause started when she turned 50. She felt more irritable and a smidge heavier, and she started waking up two to three times a night.

And then she had a hot flash.

"It felt like a nuclear bomb went off right behind my belly button," she says. "The radiation went out to my fingertips, the tops of my toes, the top of my head and the ends of my hair."

But Duvall would not consider hormone therapy to control the flashes. She was terrified. She says she can sum up her fear in two words: "breast cancer."

To understand why she feels this way, we have to look back a few decades to a time when many postmenopausal women were taking hormones to treat symptoms. At the time, hormones were thought of as something of an elixir of youth that could also prevent chronic disease. So women took hormones indefinitely. But a huge study in 2002 changed everything.

Known as the Women's Health Initiative, it found that taking estrogen plus progestin hormone replacement therapy actually increased a woman's risk of heart disease and breast cancer. The study had a huge effect. Within months the number of women taking hormones in the U.S. dropped by almost half. Today, only about 10 percent of women ages 50 and over are on hormone therapy.

That was a huge overreaction, according to Dr. Wulf Utian, director of the North American Menopause Society, particularly in light of more recent findings. A more detailed analysis of the Women's Health Initiative data found that age really made a difference in heart disease risk. For women who started hormone therapy between the ages of 50 and 59, there was a protective benefit, says Dr. JoAnn Manson, one of the lead investigators of the study and a professor of medicine at the Harvard T.H. Chan School of Public Health.

Women who take hormones earlier after the onset of menopause may experience less plaque, blood vessel blockage and atherosclerosis, Manson says, and possibly even a reduced risk of heart attack. But for women over the age of 60, the benefit seems to disappear. This is probably because older women already have plaque buildup, Manson says.

Researchers in Denmark also found that age makes a difference. They looked at 1,000 healthy women between the ages of 45 and 58. The women who took hormones experienced significantly reduced risk of mortality, heart failure and heart attack.

Today, menopausal women are young in the scale of things, says Dr. Utian, noting that menopause typically starts between age 45 and 60. If women start hormones within a few years of menopause or even a few years before, he says, there are numerous benefits beyond controlling hot flashes. These benefits include reduced risk of bone fractures, reduced risk of diabetes and, for many women, an overall boost in their quality of life — meaning better sleep, maintenance of libido and more comfortable sex.

"In my opinion, the best recommendation would be for some form of hormone therapy," says Utian.

But here's the worry. Studies do confirm an increased risk of breast cancer among women taking hormones, regardless of age. Manson says any risk is worrisome, but it's important to put this risk in perspective and understand that it is actually small.

"For every 1,000 women per year not using hormone therapy, about three would develop breast cancer," Manson says. "And among every 1,000 women using hormone therapy, about four of them would develop breast cancer, so that's about one extra case of breast cancer per 1,000 women per year on hormone therapy."

This is where things get tricky. There is no consensus in the medical community on whether the symptom relief is worth the extra risk. Different doctors interpret risk differently. And if you're a breast oncologist like Dr. Rowan Chlebowski at Harbor UCLA Medical Center, any risk is too much.

"It's a disease that I see every day," Chlebowsi says. "So I think that's something to be avoided."

Chlebowski adds that hormone therapy also makes it more difficult to read mammograms, since hormones make the breast denser. If mammograms are more difficult to read, it's harder to diagnose breast cancer in its earliest stage when it's most treatable.

So bottom line — this really is an individual decision between a woman and her doctor, a decision based on how much risk a woman can tolerate in favor of symptom control and other potential benefits. Researcher Joann Manson says if a woman chooses hormone therapy, then the lowest possible dose for the shortest amount of time is probably safe for most women.

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Confusion And High Costs Still Hamper Obamacare Enrollment

Sat, 11/07/2015 - 6:21am
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Vernon Thomas, a part-time music producer, is trying to decide whether it's worth it to sign up for health insurance.

Fred Mogul/WNYC

Recording and mixing music are Vernon Thomas' passions, but being CEO and producer of Mantree Records isn't his day job.

He's an HIV outreach worker for a county health department outside Newark, N.J. He took what was to be a full-time job in May because the gig came with health insurance — and he has HIV himself.

But then the county made it a part-time job, and Thomas lost health coverage before it even started. "Benefits are more important than the money you're making," he says.

The Affordable Care Act's third open enrollment season started Nov. 1, and federal officials are hoping to reach about a million uninsured people nationwide before it closes on Jan. 31.

Newark has an estimated 112,000 uninsured people, including Thomas, around one-third of the city's population. Newark is one of five areas – along with Houston, Dallas, Chicago and Miami – where the federal government is focusing enrollment efforts.

Altogether, Washington will spend more than $100 million dollars on marketing and enrollment nationwide.

Why has Thomas stayed on the sidelines for Obamacare's first two years? He values insurance and regular health care, but he says he didn't fully understand what the law had to offer him. He's still trying to make up his mind about signing up for coverage this time around.

He has been getting HIV medications, care of the federal government's AIDS Drug Assistance Program. It doesn't cover anything else, though, and Thomas says he'd like more medical care, particularly a regular doctor who could keep an eye on issues that worry him.

"Prostate cancer runs in my family on both sides," Thomas says. "My mother and her mother and her brother all had diabetes. My mother had hypertension also. Fortunately, I have low blood pressure. But now they're saying I have high cholesterol."

Thomas' part-time job doesn't pay a lot, yet he makes too much to get free health care from Medicaid. He's eligible to buy a plan on the exchange, but he says it's too expensive because the cost of living in Newark is high for him.

So he has gone without coverage and kept his fingers crossed. "I try not to think about it — getting sick," he says.

Thomas didn't know the health law's benefits for people in his income bracket. He qualifies for subsidies that would bring his premium down to $100 or less and also cost-sharing support that would pick up much of the deductible and other out-of-pocket expenses.

Brian McGovern, head of the North Jersey Community Research Initiative, says overcoming misconceptions about Obamacare has been one of his staff's biggest jobs. "It's always been about trust with some of our patients," he says.

Susan Nash, a partner at the McDermott Will & Emery law firm in Chicago, says that health insurance is still too expensive for millions of people living paycheck-to-paycheck.

"These individuals are having difficulty affording food and housing, and so it's a calculus: 'Do I need health insurance? Do I think I'm going to have a catastrophic event or have some large health care expenditures this year?' " Nash says.

The government says about 8 in 10 of these eligible but uninsured people qualify for subsidies. But some of them will get only a little help from the government — and others will get none at all.

Middle-income people can spend hundreds of dollars a month on a high deductible, if they need significant care. And they wouldn't qualify for the same help with out-of-pocket expenses that Vernon Thomas would. That means they often spend additional hundreds of dollars before coverage actually kicks in.

Still, under the law, most people have to get insurance – or face a tax penalty next year of either 2.5 percent of income or $695 per adult and $347.50 per child under 18, with a maximum of $2,085. Even if people have a sense of these fines, they still might not worry about it. The fines don't actually hit until Tax Day, 2017. And for many of people, that's just too far away – and just too abstract.

This story is part of a reporting partnership that includes WNYC, NPR and Kaiser Health News.

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Surgery Helps Some Obese Teens In Battle To Get Fit

Fri, 11/06/2015 - 3:11pm
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Physical exercise, diet and supportive counseling are the first steps of any weight-loss program. But sometimes that's not enough to take large amounts of weight off, and keep it off, doctors say.


Surgery to reduce the stomach's size is often seen as a last resort for severely obese teenagers, partly because there has been little information on the procedure's long-term effects on young people.

But a study published online Friday in the New England Journal of Medicine tracked teens for three years and suggests that bariatric surgery as part of a weight-reduction plan was not only safe, but increased their heart health and the quality of their lives.

Dr. Thomas Inge, a surgeon at Cincinnati Children's Hospital Medical Center, led the study of 242 severely obese adolescents who underwent the surgery.

The young people were between 13 and 19 years old and averaged 325 pounds at the start of the study, Inge says. Surgery helped them lose nearly a third of their original body weight and maintain that loss for three years. Even more importantly, Inge says, the development of obesity-linked disease was stopped in its tracks.

Of teens who had Type 2 diabetes when they underwent the surgery, "95 percent of them had no sign of diabetes at three years," Inge says. Most participants in the study also dramatically reduced their blood pressure after surgery, and had improved kidney function and less blood fat.

The hope is that these sorts of improvements in physical markers will ultimately translate to fewer strokes, heart attacks and other disabilities down the road, he says. Previous research has suggested that only about 2 percent of severely obese teens are able to lose weight and keep it off without surgery.

Adults who have weight-loss surgery also see reductions in diabetes, blood pressure and blood fat, Inge says. But the improvements aren't as dramatic — perhaps, he says, because it's easier to tame a disease that hasn't already had years to do damage.

The teens also experienced a big jump in their confidence.

"I think it's one thing to talk about what this does to their blood pressure and diabetes," Inge says. "It's a whole other thing, when you're in the patients' shoes, to be able to talk about how they feel after the operation."

The answer, he says, was unmistakably good — so good that some kids made a few other bold changes in their appearance, taking deliberate steps to stand out instead of trying to hide.

"It's very much the routine to see them expressing themselves and saying, 'Here's me with green hair color, pink hair color," Inge says. "It's telling the world, 'This is the new me, and I like it!' And, 'Here we are!' "

The surgery isn't without side effects and these, too, showed up in the study. In addition to the risks of any surgery, bariatric surgery alters how the body digests food — so most of the teens also had to start taking vitamin and iron supplements after the procedure. And about 13 percent wound up needing additional abdominal surgery — most commonly gall bladder removal.

These teenagers and others need continued follow-up to be certain that benefits outweigh risks as the years go on, Inge says. But at least now, teens — and their parents and doctors — are starting to get a little more solid information to help guide choices about treatment.

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Did The Language You Speak Evolve Because Of The Heat?

Fri, 11/06/2015 - 11:51am

English bursts with consonants. We have words that string one after another, like angst, diphthong and catchphrase. But other languages keep more vowels and open sounds. And that variability might be because they evolved in different habitats.

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Consonant-heavy syllables don't carry very well in places like windy mountain ranges or dense rainforests, researchers say. "If you have a lot of tree cover, for example, [sound] will reflect off the surface of leaves and trunks. That will break up the coherence of the transmitted sound," says Ian Maddieson, a linguist at the University of New Mexico.

That can be a real problem for complicated consonant-rich sounds like "spl" in "splice" because of the series of high-frequency noises. In this case, there's a hiss, a sudden stop and then a pop. Where a simple, steady vowel sound like "e" or "a" can cut through thick foliage or the cacophony of wildlife, these consonant-heavy sounds tend to get scrambled.

Hot climates might wreck a word's coherence as well, since sunny days create pockets of warm air that can punch into a sound wave. "You disrupt the way it was originally produced, and it becomes much harder to recognize what sound it was," Maddieson says. "In a more open, temperate landscape, prairies in the Midwest of the United States [or in Georgia] for example, you wouldn't have that. So the sound would be transmitted with fewer modifications."

A sample of Georgian from the UCLA Phonetics Lab

Other scientists have noticed that habitats can affect the way different bird species sing. "Say you're a bird in a forest, and some guy's going 'Stree! Stree! Stree!' But because of the environment, what you hear is 'Ree! Ree! Ree!' " says Tecumseh Fitch, a linguist at the University of Vienna in Austria who was not involved in the study. "Well, because you're learning the song, you'll sing 'Ree! Ree! Ree!' "

Since bird species living in rain forests tend to sing songs with fewer consonant-like sounds, Maddieson thought maybe the same would apply to human languages. Over time, people living in different climates would adapt their speech to communicate more efficiently.

In a presentation on Wednesday at the Acoustical Society of America fall meeting, Maddieson showed that consonant-thick languages like Georgian are more likely to develop in open, temperate environments. Meanwhile, consonant-light languages like Hawaiian are more likely to be found in lush, hot ecologies.

A sample from Oiwi TV, Hawaiian language news

A vowel sound like "e" can still sound clear through the dense vegetation in Hawaii.

Daniel Ramirez/Flickr

Fitch says it's a tantalizing hypothesis, but still unproven. People who live nearby are usually related, so their languages could be too. Hawaiian and Maori are light on consonants and developed in hot, tropical climates, but they also both came from an ancestor Eastern Polynesian language. That could confound the results of Maddieson's study. Until that's sorted out, Fitch says, it's hard to know how strong the data are.

And the environmental effect only accounts for some of the variation in birdsongs. That's probably true for our tongues too. "There are many reasons why some languages have more vowels or more consonants, and this is just one of them," Fitch says.

Other researchers say this is just the beginning of a line of research into how nature rules our speech. "This is the first of its kind, and there are several others coming now. It's becoming increasingly clear that the way we speak is shaped by external forces," says Sean Roberts, a researcher at the Max Planck Institute for Psycholinguistics in the Netherlands who was not involved in the study.

In his own work, Roberts found that arid, desertlike places are less likely to have tonal languages like Mandarin or Vietnamese. And he once analyzed a decades' worth of Larry King transcripts. "I carried the proportion of consonants to vowels that he was using and matched that to the actual humidity on the day he recorded those things," Roberts says. The longtime TV pundit used a few more consonants on dry days.

And the language you're reading now evolved in a cold, gloomy climate prone to light mist and drizzle. Fitch says: "English is quite a consonant-heavy language, and of course it didn't develop in a rain forest."

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