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Covid-sniffing dogs can help detect infections in K-12 schools, new study suggests | CNN

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CNN
 — 

Elementary students lined up behind a white curtain in the middle of a grand gymnasium at their school in northern California. They stood still as a dog handler walked a yellow Labrador along the other side of the curtain.

Hidden from the children’s view, the 2-year-old female pup sniffed each child’s shoes from beneath that curtain barrier. After each sniff, the dog looked back up at the handler. Then the handler brought the dog to the next tiny pair of feet beneath the curtain, and the dog curiously brought her snout close to those toes, then a young girl’s lavender tennis shoes and then another child’s white high-tops.

The dog was smelling for what are called volatile organic compounds that are known to be associated with Covid-19 infections.

While watching the Covid-sniffing dog in action, Dr. Carol Glaser saw her vision come to life.

Months prior, Glaser and her team were implementing the school’s Covid-19 testing program, using antigen nasal swab tests. Around that same time, Glaser heard about reports of dogs being used to screen for Covid-19 infections in sports venues, airports and other public settings.

That’s when Glaser had her “aha” moment – incorporating canines into Covid-19 testing programs at schools, nursing homes or other public facilities could help save time, personnel, possibly even costs, and “would be a lot more fun,” she said.

“I thought if we had dogs in schools to screen the students it would be so much faster and less burdensome for schools,” said Glaser, assistant deputy director in Central Laboratory Services and medical officer for infectious disease laboratories at the California Department of Public Health.

“Remember when an antigen test is done at school, as opposed to home, there’s a whole bunch of rules and regulations that run under that. It’s not as simple as just handing those things out at school and having the kids do them,” said Glaser, who oversaw antigen testing programs at some California public schools.

For now, Glaser and her colleagues described in a new study the lessons they learned from the Covid-19 dog screening pilot program that they launched in some California K-12 public schools.

In their research, published Monday in the journal JAMA Pediatrics, they wrote that the goal was to use dogs for screening and only use antigen tests on people whom the dogs screened as positive – ultimately reducing the volume of antigen tests performed by about 85%.

They wrote that their study supports the “use of dogs for efficient and noninvasive” Covid-19 screening and “could be used for other pathogens.”

The dogs used in the pilot program – two yellow Labradors named Rizzo and Scarlett – trained for a couple of months in a laboratory, sniffing donated socks that were worn by people who either had Covid-19 or didn’t. The dogs alerted their handlers when they detected socks that had traces of the disease – and received a reward of either Cheerios or liver treats.

“The one thing we do know for sure is when you’re collecting a sample off of a human being, you want to go where the most scent is produced. That is the head, the pits, the groin and the feet. Given those options, I went with feet,” said Carol Edwards, an author of the study and executive director of the nonprofit Early Alert Canines, which trains medical alert service dogs, including Rizzo and Scarlett.

“We collected some socks from people willing to donate socks, and we taught the dogs, by smelling the socks, which ones were the Covid socks and they picked it up very quickly,” Edwards said. “Then we moved into the schools and started sniffing the kids at the ankles.”

Last year, from April to May, the dogs visited 27 schools across California to screen for Covid-19 in the real world. They completed more than 3,500 screenings.

Rizzo acted as an energized worker, performing tasks with eagerness, Edwards said, while Scarlett tended to have more of a mellow and easygoing personality.

The screening process involves people – who voluntarily opted in to participate – standing 6 feet apart while the dogs, led by handlers, sniff each person’s ankles and feet. The dogs are trained to sit as a way of alerting their handlers that they detect a potential Covid-19 infection.

To protect each person’s privacy, sometimes the people face away from the dogs and toward a wall or behind a curtain, so that they can’t see the dogs or when a dog sits. If the dog sits in between two people, the handler will verbally ask the dog, “Show me?” And the dog will move its snout to point toward the correct person.

“Our dogs can come in, they can screen 100 kids in a half hour, and then only the ones the dog alerts on have to actually do a test,” Edwards said. “There’s no invasive nasal swab unless the dog happens to indicate on you.”

The researchers found that the dogs accurately alerted their handlers to 85 infections and ruled out 3,411 infections, resulting in an overall accuracy of 90%.

However, the dogs inaccurately alerted their handlers to infections in 383 instances and missed 18 infections, which means the dogs demonstrated 83% sensitivity and 90% specificity when it came to detecting Covid-19 infections in the study.

“Once we stepped into the schools, we saw a drop in their specificity and sensitivity due to the change,” Edwards said, referring to the distractions that children in a school setting can bring. However, Edward said, accuracy improved as the dogs spent more times in schools.

In comparison, Covid-19 BinaxNOW antigen tests have been shown in one real-world study to demonstrate 93.3% sensitivity and 99.9% specificity. That study was conducted in San Francisco and published in 2021 in The Journal of Infectious Diseases.

“We never said the dogs will replace the antigen. This was a time for us to learn how they compared,” Glaser said. “We will always plan on doing some amount of backup testing, but the idea would be that the actual antigen testing would be a fraction of what it would currently be because of the dogs.”

“To run these antigen testing programs at school, it’s taking a lot of school personnel resources, test cards as well as biohazard waste. So, I have no doubt in the long-run once it can be perfected, dogs will be cheaper, but I don’t have a great cost comparison,” she said.

This isn’t the first time that dogs’ abilities to detect traces of Covid-19 infections in real-time have been studied in the scientific literature.

“What we have learned in this work is that the dogs in general are capable of discriminating samples from individuals testing,” said Dr. Cindy Otto, professor and director of the Penn Vet Working Dog Center at the University of Pennsylvania, who was not involved in the new study.

Regarding the new research, Otto said, “On the surface their results are encouraging and with the appropriate selection of dogs, rigorous training and impeccable quality control, there is the potential for dogs to be incorporated in threat monitoring.”

Now that Glaser and her colleagues have published research about their Covid-19 dog screening pilot program, she is eager to implement the approach in nursing home settings.

“Honestly, schools aren’t that interested in testing anymore. The outbreaks just aren’t what they used to be, but what we have done is we’ve transitioned to nursing homes, because there is a tremendous need in nursing homes,” Glaser said, adding that many residents may prefer to undergo screening with a dog than with uncomfortable nasal swabs. “What would you rather have: A swab in your nose or something that just maybe tickles your ankle at most for testing?”

Covid-sniffing dogs Scarlett and Rizzo at a skilled nursing home in California.

In skilled nursing homes, the dogs visit each resident’s room to sniff their feet, calmly smelling for Covid-19 volatile organic compounds as the resident lies in bed or sits in a chair.

“Thinking about where dogs would be deployed, I do really think nursing homes and residential care facilities and even schools – if they were ever to have a big outbreak – would be the natural next fit for this,” Glaser said.

“We think we’ll probably end up primarily using them in nursing homes,” she said. “But we’re still doing a little bit of both – there was a school that asked us to come back last week.”

The pilot program within California public schools also has left Edwards with hope for future opportunities in which canines can help detect disease in humans.

“I really do think it’s the tip of the iceberg. This is the door swinging wide open, and now we need to collaborate with those in the science world and figure out where we can take this,” Edwards said.

“There’s been a lot of chatter, even in the very beginning of this project, talking about what other diseases they could do. We’ve talked about TB, we’ve talked about flu A and B, possibly for this next flu season, seeing if we can get the dogs to alert on that,” she said, as volatile organic compounds are also produced by people with influenza. “It’s just a matter of being able to figure out how to collect samples, how to train the dogs, and then to be safe and effective around those diseases too.”

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The cost of senior care is rising while caregivers are ‘drowning’ without help | CNN

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CNN
 — 

For most of her life, Tammy La Barbera has been taking care of someone other than herself. First, it was her two children. Then, it was her brother and father, who both died after being diagnosed with cancer. Now, Tammy is taking care of her 90-year-old mother, Ada, who was diagnosed with dementia five years ago.

In recent months, Ada’s condition deteriorated so quickly that Tammy resigned from her job as an event manager to become a full-time caregiver.

“I don’t have help here, and I know it’s going to get worse,” she said.

Tammy, 53, struggles to provide her mother with the care she needs and would like to place her in a memory care facility equipped to handle the mood swings and outbursts that her mother has due to her condition. But Tammy says she doesn’t expect to ever have enough money to pay for that care.

Recently, she said, she looked into an assisted living facility near her home in Murrieta, California. She says placing her mother at the facility – or others like it – would cost between $7,000 and $10,000 a month out-of-pocket.

Across the country, millions of caregivers like Tammy are looking after a loved one – a relative or a friend. About 53 million US adults are caregivers, according to a 2020 report from AARP.

Sixty-three percent of US caregivers who look after adults said the person they were looking after needed care because of “long-term physical conditions,” the report says.

Since her mother’s diagnosis, Tammy’s life has been turned upside-down.

Ada cannot bathe herself or cook for herself. Most days, she doesn’t even remember who her daughter is.

“All her daily duties are done by me,” Tammy said, caring for her mother all day is like being a prisoner in her own home.

Sooner or later, she said, she will have to move her mother to a long-term care facility and do whatever she can to pay for it.

“I know that I’m reaching a crossroads with my mom’s care, and I’m trying to do this as long as I can,” Tammy said. “But I know the way things are going, and if she’s progressing pretty rapidly, I’m not going to have a choice.”

Ada La Barbera was a teacher for 20 years, so she gets a pension check each month. Tammy puts that money, along with her mother’s monthly Social Security checks, toward bills.

It’s just over $3,300 a month, and along with Tammy’s dwindling savings, it’s barely enough to keep them afloat, Tammy says. She can barely afford her rent.

It’s because of her financial struggles that Tammy has been putting off long-term care for her mother.

Where Tammy and Ada live in California, a home health aide would cost about $137 for one hour of care, according to an online calculator from AARP.

“When you’re on a fixed income, you can’t afford that,” Tammy said. “So I don’t have the luxury to do that.”

A long-term care facility is even more expensive. On average, it costs $10,830 a month to stay at a nursing home and $5,806 per month for an assisted living facility, according to the nonprofit National Investment Center for Senior Housing and Care.

Then there is memory care, where Tammy says her mother belongs.

Memory care facilities are the fastest-growing sector of the senior housing market, according to the National Investment Center. On average, memory care costs just over $7,500 a month, center COO Chuck Harry says.

These facilities offer more hands-on care for people with dementia. They can include special features like locked units that prevent wandering patients from leaving the facility unattended and enclosed outdoor spaces where patients can move about safely.

A nurse comes to see Ada at home every other week. During that 40-minute visit, Ada’s vitals are checked, and her medications are adjusted. Those visits are covered by Medicare, Tammy says.

Medicare is a medical health insurance program that is for people 65 years or older. But Medicare does not cover the cost of a long-term care facility.

And although Ada and Tammy are on a fixed income, Ada doesn’t qualify for other federal safety net programs like Medicaid because Tammy says they are not considered low-income.

For middle-income families, Medicaid goes into effect only after a family has gone through the process of “spending down” their assets until they qualify for the program.

“That is usually the path of anyone going into a nursing home for the long term: spending your own money – which is all out of pocket – and then reaching a Medicaid level of eligibility,” said Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, noting that each state has its own Medicaid program and process.

Until a family qualifies for Medicaid, the program will only cover the medical costs of a stay at a long-term facility, not room and board.

Caroline Pearson, the lead author of a landmark 2019 demographic study called “The Forgotten Middle,” says most middle-income Americans find themselves in a position where they are too “wealthy” to receive Medicaid coverage for long-term care services but too “poor” to afford the out-of-pocket costs of that care.

So why does putting a loved one in a nursing home or an assisted living facility cost so much? Providing long-term care services is expensive, Pearson says, adding that the senior housing industry requires a large workforce of nurses and staff to support it. That is also expensive.

Additionally, as seniors sell their homes and move into these facilities, long-term care facilitators are essentially providing housing, she said. And housing is not cheap.

The senior housing industry also caters to a high-income population, according to Pearson, who is now executive director of the Peterson Center on Healthcare.

“The fit and finish at the buildings … [residents] expect to be really high-end. The amount of amenities and services that are part of that senior housing property … they expect to be high-end,” she said. “The market has seen good returns and then replicated that model.”

And the demand for high-quality, long-term care is only expected to go up as the baby boomer generation continues to age, according to Pearson.

“Most people don’t begin to need long-term care services until between 75 and 85. And so as the baby boomers hit those ages, that is where we’re going to see that demand really explode,” she said.

According to the US Census Bureau, baby boomers – people born from 1946 to 1964 – will all be over the age of 65 by 2030. The oldest members of that generation will be 84 at that point.

In 2019, there were about 8 million middle-income seniors – people 75 and older – living in the United States, Pearson says in her study.

She projects that there will be 14.4 million middle-income seniors in the US by 2029, with 60% expected to have mobility limitations and 20% expected to have “high health care and functional needs.”

“We are going to [have] double the number of middle-income seniors when the baby boomers age,” Pearson said. “Fewer of those baby boomers are going to have spouses or children who live nearby to provide unpaid caregiving support.”

Most family caregivers are spouses or middle-age daughters, the study notes.

At the end of the day, Pearson says, many Americans don’t think about aging until it’s staring them in the face.

“People [think] that they will live healthy and independently until they die, and sadly, that’s just statistically very unlikely for most people,” she said.

Tammy, with her parents and brother, says her family thought they were prepared for the future.

Tammy says her family thought they were prepared for the future.

In 1965, Ada married Tammy’s father, Peter “Jazz” La Barbera, an accountant.

“My dad was a very, very good saver, and he did have a little bit of savings,” Tammy said. “He was set just for the future, not for anything unexpected.”

In 1970, Tammy was born in Queens. She and her older brother, Peter Jr., grew up an hour outside New York City.

“We had a small house, and we lived in that house our whole lives, and … we were the perfect family,” Tammy said.

She eventually moved to California, where she had two kids. Her parents followed, along with her brother and his wife.

Tammy says the physical and mental toll of caring for her husband and son kickstarted Ada's health problems.

But soon after the move, Peter Jr. was diagnosed with cancer, and he died a year later. Two years after that, Tammy’s father received a cancer diagnosis and died within seven weeks.

Tammy believes that the physical and financial toll of taking care of her son and husband kickstarted her mother’s health problems. Shortly after her husband died, Ada had a minor stroke and was diagnosed with dementia.

“It’s almost like her grief was so overwhelming. Especially losing her son. I don’t think her brain had the capacity to deal with anything else anymore,” Tammy said.

The stress associated with taking care of a loved one full-time, or even part-time, can have negative consequences, research has shown.

Some of the physical symptoms associated with taking care of someone with dementia include higher levels of depression and anxiety, worse self-reported physical health, compromised immune function and increased risk of early death, the US Centers for Disease Control and Prevention reports.

Over half (53%) of caregivers indicate that a decline in their health compromises their ability to provide care, according to the CDC.

“I have sacrificed 10 years of my life being a caretaker, and I don’t have a life,” Tammy said. “It’s an honor to take care of my mother. But doing this every single day … it’s a lot.”

Tammy is preparing for her own future by taking part in genetic testing that will tell her whether she is more likely to develop dementia like her mother.

“I would like to prepare as much as I can, whether it’s medication or adjusting my life,” she said. “I just don’t want to put my kids through this.”

She would also like to see changes to the system.

Pearson says the solution to the cost issue is not simple and will probably be resolved only through a combination of incremental Medicaid expansion, changes to the senior housing industry and federal subsidies.

AARP’s Reinhard says tax credits for family caregivers could help people like Tammy get a break. Employers could also help by supporting workers who need to stop working to care for a family member or friend.

In September, the US Department of Health and Human Services, through its Administration for Community Living, announced a national strategy aimed at supporting family caregivers, highlighting nearly 350 actions the federal government will take.

The strategy also includes 150 actions that it says local governments, communities and private businesses can adopt to help build a more supportive system.

“Supporting family caregivers is an urgent public health issue, exacerbated by the long-term effects of the COVID-19 pandemic,” HHS Secretary Xavier Becerra said in a news release. “This national strategy recognizes the critical role family caregivers play in a loved one’s life.”

Gal Wettstein, a senior research economist for the Center for Retirement Research at Boston College, says it would be beneficial for middle-income Americans to speak to a financial adviser as early as possible and transfer assets to a family member if they think they might need to enter a long-term care facility in the near future.

This way, if their only option is to spend down their assets to become eligible for Medicaid, they hit that eligibility sooner.

Long-term care insurance is another option, but experts say it’s rarely sold anymore because it is typically more expensive than other kinds of insurance.

Pearson says Americans can plan ahead by investing in long-term care insurance in their 40s for it to benefit them when they will most likely need it, in their 80s.

Wettstein also recommends long-term care insurance.

“[Long-term care insurance] plans are getting harder and harder to sign, but they do still exist. Some insurers will still sell them,” he said.

Ultimately, covering the cost of senior care comes down to families and how much they save for the future, until changes are made by senior housing providers and policy makers.

“We are so far away from having any sort of swift and universal solution,” Pearson said.

For now, Ada is on a waitlist for a spot at a skilled-nursing home about an hour from where they live. If she moves there, her cost of living might be partially covered through a Medicaid program.

Tammy was told that Ada is one of more than 2,000 people waiting for a spot.

“We’re drowning. We’re care workers, and we’re drowning,” Tammy said. “We don’t have help.”

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Marijuana may make sleep worse, especially for regular users, study finds | CNN

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Editor’s Note: Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.



CNN
 — 

It’s a common assumption among marijuana users: Using weed will help you fall asleep and stay asleep. Scientists, however, aren’t so sure that’s true.

“This is an understudied but important area, as many people are increasingly turning to cannabis products as sleep aids,” said sleep specialist Wendy Troxel, a senior behavioral scientist at Rand Corp., who was not involved in the study.

“But we really lack solid evidence demonstrating whether cannabis helps or hurts sleep,” Troxel added.

Use of weed may actually harm sleep, a December 2021 study has found. The research, published in a BMJ journal, revealed adults who use weed 20 or more days during the last month were 64% more likely to sleep less than six hours a night and 76% more likely to sleep longer than nine hours a night.

Optimal sleep for adults is defined by the US Centers for Disease Control and Prevention as seven to eight hours a night.

Moderate consumption — using weed less than 20 days during the past month — didn’t create short sleep problems, but people were 47% more likely to snooze nine or more hours a night, the study also found.

Why is short and long sleep a problem?

“Large population-based studies show that both short sleep and long sleep are associated with an increased risk of heart attacks and strokes, as well as the long-term progression of things like atherosclerosis, diabetes, coronary artery disease and any of the major cardiovascular diseases,” said lead study author Calvin Diep, who is resident of anesthesiology and pain medicine at the University of Toronto.

“It seems with sleep there’s kind of this ‘Goldilocks phenomenon’ where there’s an amount (that’s) ‘just right,’” Diep said.

One in three Americans don’t get enough sleep, according to the CDC. In addition, 50 million to 70 million Americans struggle with sleep disorders such as sleep apnea, insomnia and restless leg syndrome, which can ruin a good night’s shut-eye.

The CDC calls that a “public health problem,” because disrupted sleep is associated with a higher risk of conditions, including high blood pressure, weakened immune performance, weight gain, a lack of libido, mood swings, paranoia, depression, and a higher risk of diabetes, stroke, cardiovascular disease, dementia and some cancers.

The December 2021 study analyzed use of marijuana for sleep among 21,729 adults between the ages of 20 and 59. The data was gathered by the National Health and Nutrition Examination Survey, and is considered representative of over 146 million Americans.

In addition to issues with short and long sleep, people in the study who used weed within the last 30 days were also more likely to say they have trouble falling asleep or staying asleep, and were more likely to say they have discussed sleep problems with a health care provider, Diep said.

“The problem with our study is that we can’t really say that it’s causal, meaning we can’t know for sure whether this was simply individuals who were having difficulty sleeping, and that’s why they use the cannabis or the cannabis caused it,” he added.

Prior studies have also found a connection between the two components of marijuana, CBD and THC, and poor sleep. CBD, or cannabidiol, is a key component of medical marijuana, while THC, or tetrahydrocannabinol, is the main psychoactive compound in cannabis that produces the high sensation.

A 2018 randomized, double-blind, placebo-controlled study — the gold standard — found no benefit from CBD on sleep in healthy volunteers. Other studies have also found high rates of insomnia when withdrawing from nightly use of marijuana.

“At this time there still isn’t any clear evidence that cannabis is helping sleep,” said Dr. Bhanu Prakash Kolla, a sleep medicine specialist in the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minnesota, who was not involved in any of the studies.

“We know that when people initiate use there is some benefit in the immediate short term, but there is quick tolerance to this effect,” Kolla said. “There currently is no good quality evidence to suggest that cannabis will help improve sleep quality or duration.”

Still, people continue to believe that weed is helping their sleep. Surveys of marijuana users show they do indeed rely on the drug for better sleep.

“The issue is that there’s a disconnect between these anecdotal reports of people reporting therapeutic benefits and the evidence behind it in terms of the data,” Diep said.

One possible reason, Kolla said, is that when people stop using cannabis after a period of regular use, the withdrawal effects from weed can cause sleep disruptions. That leads people to believe “the cannabis was in fact helping (sleep), while what they are actually experiencing are withdrawal symptoms.”

Another factor to consider is the increased potency of weed today as compared with when many of the studies on cannabis and sleep were conducted, said Dr. Karim Ladha, staff anesthesiologist and clinician-scientist of anesthesiology and pain medicine at the University of Toronto.

“A lot of the older data related to cannabis is based on lower doses of THC than what patients are using now, and there’s very little research related to CBD,” Ladha said.

“Studies tell us about what happens at a population level, but on an individual level that discussion is much more personal,” he said. “The studies just give us the possibilities that (marijuana) could hurt your sleep, but it may help and so we just don’t know until you try it.”

That’s why additional studies need to be done, he added.

“Patients are spending money and time and resources to obtain cannabis right now to help with sleep,” Ladha said. “I think as the medical community, we need to do everything we can to make sure that we enable our patients to make the best possible decisions for their health.”

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New study suggests Black women should be screened earlier for breast cancer | CNN

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CNN
 — 

A new study on breast cancer deaths raises questions around whether Black women should screen at earlier ages.

An international team of researchers wrote in the study, published Wednesday in the journal JAMA Network Open, that clinical trials may be warranted to investigate whether screening guidelines should recommend Black women start screening at younger ages, around 42 instead of 50.

The US Preventive Services Task Force – a group of independent medical experts whose recommendations help guide doctors’ decisions – recommends biennial screening for women starting at age 50. The Task Force says that a decision to start screening prior to 50 “should be an individual one.” Many medical groups, including the American Cancer Society and Mayo Clinic, already emphasize that women have the option to start screening with a mammogram every year starting at age 40.

Even though Black women have a 4% lower incidence rate of breast cancer than White women, they have a 40% higher breast cancer death rate.

“The take-home message for US clinicians and health policy makers is simple. Clinicians and radiologists should consider race and ethnicity when determining the age at which breast cancer screening should begin,” Dr. Mahdi Fallah, an author of the new study and leader of Risk Adapted Cancer Prevention Group at the German Cancer Research Center in Heidelberg, Germany, said in an email.

“Also, health policy makers can consider a risk-adapted approach to breast cancer screening to address racial disparities in breast cancer mortality, especially the mortality before the recommended age of population screening,” said Fallah, who is also a visiting professor at Lund University in Sweden and an adjunct professor at the University of Bern in Switzerland.

Breast cancer screenings are typically performed using a mammogram, which is an X-ray picture taken of the breast that doctors examine to look for early signs of breast cancer developing.

“Guidelines for screening actually already do recommend basing a woman’s time to initiate screening on the risk of developing cancer, though race and ethnicity have not been traditional factors that go into these decisions,” Dr. Rachel Freedman, a breast oncologist at Dana-Farber Cancer Institute, who was not involved in the new study, said in an email.

The American Cancer Society currently recommends that all women consider mammogram screenings for breast cancer risk starting at the age of 40 – and for women 45 to 54, it’s recommended to get mammograms every year. Those 55 and older can switch to screening every other year if they choose.

But “we are in the process of updating our breast cancer screening guidelines, and we are examining the scientific literature for how screening guidelines could differ for women in different racial and ethnic groups, and by other risk factors, in a way that would reduce disparities based on risk and disparities in outcome,” Robert Smith, senior vice president for cancer screening at the American Cancer Society, who was not involved in the new study, said in an email. “We are examining these issues closely.”

The American Cancer Society’s recommendations appear to align with the findings in the new study, as the research highlights how screening guidelines should not be a “one-size-fits-all policy,” but rather help guide conversations that patients and their doctors have together.

“We, here at the American Cancer Society, strongly recommend that all women consider a screening mammogram from the age of 40 onwards, and that means having a discussion with their doctor,” said Dr. Arif Kamal, the American Cancer Society’s chief patient officer, who was not involved in the new study.

“The authors highlight that age 50 can be a little late,” Kamal said about the study’s findings on when to begin breast cancer screening. “We are in agreement with that, particularly for women who may be at slightly higher risk.”

The researchers – from China, Germany, Sweden, Switzerland and Norway – analyzed data on 415,277 women in the United States who died of breast cancer in 2011 to 2020. That data on invasive breast cancer mortality rates came from the National Center for Health Statistics and was analyzed with the National Cancer Institute’s SEER statistical software.

When the researchers examined the data by race, ethnicity and age, they found that the rate of breast cancer deaths among women in their 40s was 27 deaths per 100,000 person-years for Black women compared with 15 deaths per 100,000 in White women and 11 deaths per 100,000 in American Indian, Alaska Native, Hispanic and Asian or Pacific Islander women.

“When the breast cancer mortality rate for Black women in their 40s is 27 deaths per 100,000 person-years, this means 27 out of every 100,000 Black women aged 40-49 in the US die of breast cancer during one year of follow-up. In other words, 0.027% of Black women aged 40-49 die of breast cancer each year,” Fallah said in the email.

In general, for women in the United States, their average risk of dying from breast cancer in the decade after they turn 50, from age 50 to 59, is 0.329%, according to the study.

“However, this risk level is reached at different ages for women from different racial/ethnic groups,” Fallah said. “Black women tend to reach this risk level of 0.329% earlier, at age 42. White women tend to reach it at age 51, American Indian or Alaska Native and Hispanic women at age 57 years, and Asian or Pacific Islander women later, at age 61.”

So, the researchers determined that when recommending breast cancer screening at age 50 for women, Black women should start at age 42.

Yet “the authors didn’t have any information on whether the women included in this study actually had mammographic screening and at what age. For example, it is possible that many women in this study actually had screening during ages 40-49,” Freedman, of the Dana-Farber Cancer Institute, said in her email.

“This study confirms that the age of breast cancer-mortality is younger for Black women, but it doesn’t confirm why and if screening is even the main reason. We have no information about the types of cancers women developed and what treatment they had either, both of which impact mortality from breast cancer,” she said.

The harm of starting mammograms at a younger age is that it raises the risk of a false positive screening result – leading to unnecessary subsequent tests and emotional stress.

But the researchers wrote in their study that “the added risk of false positives from earlier screenings may be balanced by the benefits” linked with earlier breast cancer detection.

They also wrote that health policy makers should pursue equity, not just equality, when it comes to breast cancer screening as a tool to help reduce breast cancer death rates.

Equality in the context of breast cancer screening “means that everyone is screened from the same age regardless of risk level. On the other hand, equity or risk-adapted screening means that everyone is provided screening according to their individual risk level,” the researchers wrote. “We believe that a fair and risk-adapted screening program may also be associated with optimized resource allocation.”

The new study is “timely and relevant,” given the overall higher mortality rate for breast cancer in Black women and that Black women are more likely to be diagnosed at a younger age compared with other ethnic groups, Dr. Kathie-Ann Joseph, surgical oncologist at NYU Langone’s Perlmutter Cancer Center and professor of surgery and population health at the NYU Grossman School of Medicine, said in an email.

“While some may argue that earlier screening may lead to increased recalls and unnecessary biopsies, women get recalled for additional imaging about 10% of the time and biopsies are needed in 1-2% of cases, which is quite low,” said Joseph, who was not involved in the new study.

“This has to be compared to the lives saved from earlier screening mammography,” she said. “I would also like to point out that while we certainly want to prevent deaths, earlier screening can have other benefits by allowing women of all racial and ethnic groups to have less extensive surgery and less chemotherapy which impacts quality of life.”

Breast cancer is the most common cancer among women in the United States, except for skin cancers. This year, it is estimated that about 43,700 women will die from the disease, according to the American Cancer Society, and Black women have the highest death rate from breast cancer.

Even though Black women are 40% more likely than White women to die from the disease, Kamal of the American Cancer Society said that the disparity in deaths is not a result of Black women not following the current mammogram guidelines.

Rather, implicit bias in medicine plays a role.

“In the United States, across the country, there are not differences in mammogram screening rates among Black women and White women. In fact, across the entire country, the number is about 75%. We see about 3 in 4 women – Black, White, Hispanic, and Asian – are on time with their mammograms,” Kamal said.

Yet there are multiple timepoints after a patient is diagnosed with breast cancer where they may not receive the same quality of care or access to care as their peers.

“For example, Black women are less likely to be offered enrollment in a clinical trial. That is not because of a stated difference in interest. In fact, the enrollment rate in clinical trials is equal among Black women and White women, if they’re asked,” Kamal said.

“What we have to understand is where the implicit and systemic biases held by patients and their caregivers and their families may exist – those that are held within health systems and even policies and practices that impede everyone having fair and just access to high quality health care,” he said.

Additionally, Black women have nearly a three-fold increased risk of triple-negative breast cancers. Those particular type of cancers tend to be more common in women younger than 40, grow faster than other types of invasive breast cancer and have fewer treatment options.

Black women also tend to have denser breast tissue than White women. Having dense tissue in the breast can make it more difficult for radiologists to identify breast cancer on a mammogram, and women with dense breast tissue have a higher risk of breast cancer.

But such biological differences among women represent just a small part of a much larger discussion around racial disparities in breast cancer, Kamal said.

“There are systemic issues, access to care issues that really go beyond biology,” he said. “The reality is cancer affects everybody and it does not discriminate. Where the discrimination sometimes occurs is after the diagnosis, and that’s really what we need to focus on.”

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On ‘weed day,’ our medical analyst urges caution on recreational marijuana use | CNN

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CNN
 — 

As some people mark 4/20 as “weed day,” a day of celebration of marijuana use, I don’t want to bum you out — but I might.

Over the past decade, there has been a trend toward legalizing marijuana in the United States. Currently, at least 37 states, plus Washington, DC, have a comprehensive medical cannabis program. A growing number of states, currently at 21, have legalized recreational marijuana use.

I wanted to learn about the research around marijuana use, including the effects it has on the user and the medicinal uses for cannabis. I turned to CNN Medical Analyst Dr. Leana Wen, who has many concerns about recreational cannabis use, especially for certain populations such as young people and pregnant people.

Wen, who urged users and would-be users to be cautious, is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner and as chair of Behavioral Health System Baltimore, where she oversaw policy and services around substances that can cause addiction, including marijuana.

CNN: What are the physiological effects of marijuana?

Dr. Leana Wen: Marijuana is a plant that has many active ingredients. One of the principal ones is a psychoactive compound called tetrahydrocannabinol. Often called THC, it’s similar to compounds that are naturally occurring in the body called cannabinoids and can mimic their function by attaching to cannabinoid receptors in the brain. In so doing, THC can disrupt normal mental and physical functions, including memory, concentration, movement and coordination.

Using marijuana can cause impaired thinking and interfere with someone’s ability to learn, according to the National Institute on Drug Abuse. Smoking cannabis can also impair the function of the parts of the brain that regulate balance, posture and reaction time. And THC stimulates the neurons involved in the reward system that release dopamine, or the “feel-good” brain chemical, which contributes to its addictive potential.

CNN: Marijuana is thought to have some positive and medicinal benefits. How can it be used for therapeutic purposes?

Wen: Short-term, many users report pleasant feelings, including happiness and relaxation. As a result, some people use marijuana to self-treat anxiety or depression. This is not a recommended use. What often ends up happening is that the person develops tolerance, requiring more and more of the drug to get the same effect.

There are some approved medicinal uses of marijuana for very specific indications. The US Food and Drug Administration has approved THC-based medications that are prescribed in pill form for treatment of nausea in patients with cancer undergoing chemotherapy and to stimulate appetite in patients with AIDS. There are several marijuana-based medications that are undergoing clinical trials for conditions like neuropathic pain, overactive bladder and muscle stiffness.

I think it’s really important for these and many more studies to continue. Researchers should continue to look not just at marijuana itself but its specific chemical components, since botanicals in their natural form can contain hundreds of active chemicals and obtaining the correct dosages may be challenging. In the meantime, users should use caution in evaluating supposed medicinal claims and clearly understand the risks of cannabis use.

CNN: What are the risks of marijuana use, and who may be particularly vulnerable to them?

Wen: The main concern about marijuana use is its impact on the developing brain. As the US Centers for Disease Control and Prevention states on its website, “Marijuana affects brain development. Developing brains, such as those in babies, children, and teenagers, are particularly susceptible to the harmful effects of marijuana and tetrahydrocannabinol.”

Numerous studies have linked marijuana use in women during pregnancy to a variety of cognitive and behavioral problems in their children. The CDC even warns against secondhand marijuana smoke exposure, and it also encourages breastfeeding individuals to avoid marijuana use.

Marijuana affects young people throughout adolescence and young adulthood. Much research has shown how marijuana use in childhood impacts memory, attention, learning and motivation. Regular cannabis use in adolescence is associated with higher likelihood of not completing high school and even lower IQ later in life. The negative impacts persist beyond the teen years. Some studies of university students have found that the regularity of marijuana use is correlated with lower grade point average in college.

I want to emphasize here that there is still a lot that we don’t know about the effects of marijuana, in particular long-term consequences. A recent study found that in adults, daily use of regular marijuana can increase the risk of coronary artery disease by as much as one-third. That’s the point, though; all the unknowns are exactly why I and many other clinicians and scientists urge caution.

To be clear, there are many reasons to support policy changes of decriminalizing marijuana, including to rectify the decades-long injustices of disproportionately incarcerating minority individuals for marijuana possession. However, supporting decriminalization should not be equated with believing that marijuana is totally safe. It’s not. Marijuana has the potential to cause real and lasting harm, especially to young people.

CNN: Could someone become addicted to marijuana?

Wen: Yes. There is a condition known as marijuana use disorder. Signs of this disorder include trying but failing to quit using marijuana;, continuing to use it even though it is causing problems at home, school or work;, and using marijuana in high-risk situations, including while driving. Some individuals, especially those who use large amounts, experience withdrawal symptoms when they try to stop.

As many as 3 in 10 people who use marijuana have marijuana use disorder, according to the CDC. The risk of developing marijuana use disorder is greater among those who use it more frequently and for those who started earlier in life.

CNN: Some people say that marijuana is no big deal, especially in comparison with other substances like alcohol and opioids. Would you agree that cannabis use is at least better than using those substances?

Wen: I wouldn’t frame it that way. It is true that marijuana doesn’t cause liver damage the way that high amounts of alcohol does, and it doesn’t have the lethality of opioids. If an adult is using marijuana once in a while, and not while driving, it’s probably not going to have lasting consequences.

However, there are harms associated with more frequent use of marijuana and in particular its use in children. In my opinion, the legalization movement has shifted the conversation so much towards acceptance of cannabis that we are neglecting the fact that it is a drug and, I believe, should be regulated just like alcohol, tobacco and opioids.

There should also be much more messaging and education so that people, including young people and their parents or guardians, can be aware of the harms of marijuana — just as they are aware of the harms of other drugs.

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Suicides and suicide attempts by poisoning rose sharply among children and teens during the pandemic | CNN

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CNN
 — 

The rate of suspected suicides and suicide attempts by poisoning among young people rose sharply during the Covid-19 pandemic, a new study says. Among children 10 to 12 years old, the rate increased more than 70% from 2019 to 2021.

The analysis, published Thursday in the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, looked at what the National Poison Data System categorized as “suspected suicides” by self-poisoning for 2021 among people ages 10 to 19; the records included both suicide attempts and deaths by suicide.

The data showed that attempted suicides and suicides by poisoning increased 30% in 2021 compared with 2019, before the pandemic began.

Younger children, ages 10 to 12, had the biggest increase at 73%. For 13- to 15-year-olds, there was a 48.8% increase in suspected suicides and attempts by poisoning from 2019 to 2021. Girls seemed to be the most affected, with a 36.8% increase in suspected suicides and attempts by poisoning.

“I think the group that really surprised us was the 10- to 12-year-old age group, where we saw a 73% increase, and I can tell you that from my clinical practice, this is what we’re seeing also,” said study co-author Dr. Chris Holstege, professor of emergency medicine and pediatrics chief at the University of Virginia School of Medicine. “We’re seeing very young ages ages that I didn’t used to see attempting suicide by poisoning.

“It was pretty stunning from our perspective,” he said.

Twenty or so years ago, when he started working at the University of Virginia, he said, they rarely treated anyone ages 9 to 12 for suicide by poisoning. Now, it’s every week.

“This is an aberration that’s fairly new in our practice,” Holstege said.

The records showed that many of the children used medicines that would be commonly found around the house, including acetaminophen, ibuprofen and diphenhydramine, which is sold under brand names including Benadryl.

There was a 71% jump from 2019 to 2021 in attempts at suicide using acetaminophen alone, Holstege said.

The choice of over-the-counter medications is concerning because children typically have easy access to these products, and they often come in large quantities.

Holstege encourages caregivers to keep all medications in lock boxes, even the seemingly innocuous over-the-counter ones.

If a child overdoses on something like acetaminophen or diphenhydramine, Holstege encourages parents to bring their children into the hospital without delay, because the toxicity of the drug worsens over time. It’s also a good idea to call a poison center, a confidential resource that is available around the clock.

“We want to make sure that the children are taken care of in regards to their mental health but also in regards to the poisoning if there’s suspicion that they took an overdose,” he said.

There were limitations to the data used in the new study. It captured only the number of families or institutions that reached out to the poison control line; it cannot account for those who attempted suicide by means other than poison. It also can’t capture exactly how many children or families sought help from somewhere other than poison control, so the increase in suspected suicides could be higher.

The American Academy of Pediatrics has noted that the Covid-19 pandemic exacerbated existing mental health struggles that existed even. In 2021, the group called child and adolescent mental health a “national emergency.” Emergency room clinicians across the country have also said they’ve seen record numbers of children with mental health crises, including attempts at suicide.

In 2020, suicide was the second leading cause of death among children ages 10 to 14 and the third leading cause among those 15 to 24, according to the CDC.

Although the height of the pandemic is over, kids are still emotionally vulnerable, experts warn. Previous attempts at suicide have been found to be the “strongest predictor of subsequent death by suicide,” the study said.

“An urgent need exists to strengthen programs focused on identifying and supporting persons at risk for suicide, especially young persons,” the study said.

Research has shown that there is a significant shortage of trained professionals and treatment facilities that can address the number of children who need better mental health care. In August, the Biden administration announced a plan to make it easier for millions of kids to get access to mental and physical health services at school.

At home, experts said, families should constantly check in with children to see how they are doing emotionally. Caregivers also need to make sure they restrict access to “lethal means,” like keeping medicines – even over-the-counter items – away from children and keeping guns locked up.

Dr. Aron Janssen, vice chair of clinical affairs at the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children’s in Chicago, said he is not surprised to see the increase in suspected suicides, “but it doesn’t make it any less sad.”

Janssen, who did not work on the new report, called the increase “alarming.”

The rates of suicide attempts among kids had been increasing even prior to the pandemic, he said, “but this shows Covid really supercharged this as a phenomenon.

“We see a lot of kids who lost access to social supports increasingly isolated and really struggling to manage through day to day.”

Janssen said that he and his colleagues believe these suspected suicides coincide with increased rates of depression and anxiety and a sense of real dread about the future.

One of the biggest concerns is that “previous suicide attempts is the biggest predictor of later suicide completion,” he said. “We really want to follow these kids over time to better understand how to support them, to make sure that we’re doing everything within our power to help steer them away from future attempts.”

Janssen said it’s important to keep in mind that the vast majority of children survived even the worst of the pandemic and did quite well. There are treatments that work, and kids who can get connected to the appropriate care – including talk therapy and, in some cases, medication – can and do get better.

“We do see that. We do see improvement. We do see efficacy of our care,” Janssen said. “We just have to figure out how we can connect kids to care.”

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A quarter of Americans live with polluted air, with people of color and those in Western states disproportionately affected, report says | CNN

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CNN
 — 

About 1 in 4 people in the United States – more than 119 million residents – live with air pollution that can hurt their health and shorten their lives, according to a new report from the American Lung Association. People of color are disproportionately affected, as are residents of Western cities.

Since President Richard Nixon signed the Clean Air Act in 1970, emissions of outdoor air pollutants have fallen 78%, according to the US Environmental Protection Agency. But Wednesday’s 2023 State of the Air report, which focuses on ozone and particle pollution, shows that millions put their health on the line every time they step outside.

To capture pollution levels at the county level, researchers analyzed data collected by the EPA’s Air Quality System, a repository of ambient air quality data from more than 10,000 monitors. They characterized the hourly average ozone concentration and the 24-hour average particle pollution concentration for 2019-21 at each monitoring site and factored in year-round pollution information from the EPA.

There were significant improvements in some areas. Generally, 17.6 million fewer people were breathing unhealthy air than in last year’s report, due largely to falling levels of ozone in some regions.

Ozone pollution is the main ingredient in smog. It comes from cars, power plants and refineries. Exposure to ozone can immediately exacerbate asthma symptoms, and people with long-term exposure to higher levels face a significantly higher risk of death from respiratory diseases than those who live with cleaner air.

Around 25% more counties got an A grade in the report for lower levels of ozone pollution. Some of that improvement can be attributed to the Clean Air Act, according to Katherine Pruitt, author of the report and the American Lung Association’s national senior director for policy.

Emission controls have helped, she said, as has the country’s continuing move away from its reliance on coal for its energy needs. Even something simple as the increase in the number of people who work from home has played a role.

“The Biden administration has set themselves a good, strong to do list of things that will help with environmental justice and climate protection,” Pruitt said. “They’re moving kind of slow, though. So we’d like them to pick up the pace.”

Despite the progress, not everyone was lucky enough to live in a county with good ozone levels. More than 100 million people live in counties that get an F for ozone smog, the report says.

Western and Southwestern cities are the most ozone-polluted, with 10 of the 25 most-polluted cities in California. New York, Chicago and Hartford, Connecticut, were the only three on that list east of the Mississippi River.

The five metropolitan areas with the worst ozone pollution are Los Angeles-Long Beach, California; Visalia, California; Bakersfield, California; Fresno-Madera-Hanford, California; and Phoenix-Mesa, Arizona.

Particle pollution, the other form of pollution tracked in the report, still seems to be a significant issue for the US.

Often hard to see, particle pollution is a mix of solid and liquid droplets that may come in the form of dirt, dust, soot or smoke. Coal- and natural gas-fired power plants create it, as do cars, agriculture, unpaved roads, construction sites and wildfires.

Particle pollution is so tiny – 1/20th of a width of a human hair – that it can travel past your body’s usual defenses.

Instead of being carried out when you exhale, it can get stuck in your lungs or go into your bloodstream. The particles cause irritation and inflammation and may lead to respiratory problems. Exposure can cause cancer, stroke or heart attack; it could also aggravate asthma, and it has even been associated with a higher risk of depression and anxiety, studies show.

The new report says the number of people living in counties with failing grades for daily spikes of particle pollution was the highest it has been in a decade. Nearly 64 million live with these kind of unhealthy spikes in counties that get failing grades.

One driver of the high amounts of particle pollution are the wildfires that have consumed hundreds of thousands of acres. In 2021 alone, there were 14,407 fires, many in the West, according to the National Interagency Fire Center. There used to be a wildfire season, experts say, but now they happen year-round.

Those fires are why the regions with the highest concentrations of air pollution are largely in the West.

When the American Lung Association started producing its report in 2004, 106 counties in 30 states got failing grades for daily spikes in particle pollution. Fewer than half were in eight states west of the Rocky Mountains. Today, 111 counties in 19 states got Fs for spikes in particle pollution, and all but eight counties are in the West, the report says.

Urban centers in the Rust Belt and the industrialized East had gotten the most failing grades in the early 2000s, but many have cleaned up and now get passing grades.

Bakersfield, California, displaced Fresno as the metropolitan area with the worst short-term particle pollution, but Fresno did not suddenly develop cleaner air. That city still had the most-polluted label for year-round particle pollution, tied with Visalia, in the agricultural San Joaquin Valley.

Los Angeles is still the city with the worst ozone pollution, according to the report, as it has been for all but one of the years included in the report.

California has some of the more progressive environmental legislation in the country, but the climate crisis has not been kind to the state, said Tarik Benmarhnia, an air pollution and wildfire researcher at the University of California, San Diego, who did not work on the new report.

“All these cities like Bakersfield and Visalia are in a valley near the forests that are seeing big fires. There’s also intense agricultural and industrial work there, so they unfortunately have all the worst conditions for air pollution,” Benmarhnia said.

There are some newcomers to the list of the 25 areas with the most particle pollution, including Denver and Fargo, North Dakota. Reno, Nevada; Yakima and Spokane, Washington; and Boise, Idaho; all made the worst list this year.

San Luis Obispo, California; Portland, Oregon; and Seattle and Bellingham, Washington; all moved off the list of worst 25 cities.

Residents in the cities ranked worst for particle pollution are living with more of it, the report says. In the top 25 cities with the worst air, the average number of days residents were exposed to high levels of fine particle pollution increased to a weighted average of 18.3, up from 16.5 in last year’s report.

East of the Mississippi, Pittsburgh and Lancaster, Pennsylvania, were the two worst metropolitan areas in the country, posting more days high in fine particle pollution in this year’s report.

Not everyone experiences pollution the same way in the US. Regardless of the region, communities of color bear the brunt of the problem.

Specifically, although people of color make up 41% of the overall US population, they are 54% of the nearly 120 million people living in counties with at least one failing grade for unhealthy air. And in the counties with the worst air quality, 72% of the 18 million residents are people of color, the report said.

Other research has also shown this trend. On maps that lay out areas with high levels of air pollution and where communities were redlined – areas where Black people were forced to live – they line up perfectly, Pruitt said.

“Then, the other aspect is, when you have a community of color that is a voluntary community, people aren’t forced to live there, those are communities that tend to have less of a voice, so decision makers place polluting sources in those communities because there’s not as much howling by people with power when they do. So those communities get the highways; they get the landfills; they get the fence lines,” she said.

There’s a myth that only poor communities live with disproportionate pollution levels, says Chris Tessum, a professor in the Civil and Environmental Engineering Department of the University of Illinois. Tessum, who was not involved in the new report, says race really is the determining factor.

“The thinking is that people with more money will buy better property, which has lower air pollution and that’s just the way of the world or whatever, but that’s just kind of emphatically not, not true,” he said.

Communities need to play a key role in making decisions to help clean air, Tessum said.

“People that have the power will use that power to benefit themselves and not the people that have been historically overburdened,” he said.

The new report says government and residents can make a difference. One suggestion is to leverage Inflation Reduction Act funding to help reduce emissions at ports and to invest in zero-emission heavy-duty vehicles and in infrastructure that would improve air quality monitoring.

States can also use the Clean Air Act authority to adopt the California zero-emissions standards for cars and trucks, the report says.

At the federal level, agencies must finalize stronger limits on air pollution to truly protect public health and advance environmental justice, the report says, including standards to move the country toward zero-emissions vehicles. The EPA also has to set stronger national standards for particle pollution and ozone, the researchers say.

Pruitt said she knows firsthand how better policies can work. She said growing up before the Clean Air Act, pollution was so high that she could see it every time she stepped outside. Today, the pollution is not nearly as visible.

“I’m in my mid-60s, and of course, air pollution was very tangible when I was young, but these days, thank goodness it isn’t. Most people don’t see it,” she said. Unless a person has a lung condition, they may not even feel it.

But just because you can’t see it or feel it doesn’t mean it’s not there. Pruitt encourages people to remember that no level of pollution is safe. The World Health Organization estimates that the combined effects of ambient air pollution and household air pollution are associated with 6.7 million premature deaths annually.

“People don’t really recognize that what they’re breathing is impacting their health,” Pruitt said.

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ADHD medication abuse in schools is a ‘wake-up call’ | CNN

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CNN
 — 

At some middle and high schools in the United States, 1 in 4 teens report they’ve abused prescription stimulants for attention deficit hyperactivity disorder during the year prior, a new study found.

“This is the first national study to look at the nonmedical use of prescription stimulants by students in middle and high school, and we found a tremendous, wide range of misuse,” said lead author Sean Esteban McCabe, director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan in Ann Arbor.

“In some schools there was little to no misuse of stimulants, while in other schools more than 25% of students had used stimulants in nonmedical ways,” said McCabe, who is also a professor of nursing at the University of Michigan School of Nursing. “This study is a major wake-up call.”

Nonmedical uses of stimulants can include taking more than a normal dose to get high, or taking the medication with alcohol or other drugs to boost a high, prior studies have found.

Students also overuse medications or “use a pill that someone gave them due to a sense of stress around academics — they are trying to stay up late and study or finish papers,” said pediatrician Dr. Deepa Camenga, associate director of pediatric programs at the Yale Program in Addiction Medicine in New Haven, Connecticut.

“We know this is happening in colleges. A major takeaway of the new study is that misuse and sharing of stimulant prescription medications is happening in middle and high schools, not just college,” said Camenga, who was not involved with the study.

Published Tuesday in the journal JAMA Network Open, the study analyzed data collected between 2005 and 2020 by Monitoring the Future, a federal survey that has measured drug and alcohol use among secondary school students nationwide each year since 1975.

In the data set used for this study, questionnaires were given to more than 230,000 teens in eighth, 10th and 12th grades in a nationally representative sample of 3,284 secondary schools.

Schools with the highest rates of teens using prescribed ADHD medications were about 36% more likely to have students misusing prescription stimulants during the past year, the study found. Schools with few to no students currently using such treatments had much less of an issue, but it didn’t disappear, McCabe said.

“We know that the two biggest sources are leftover medications, perhaps from family members such as siblings, and asking peers, who may attend other schools,” he said.

Schools in the suburbs in all regions of the United States except the Northeast had higher rates of teen misuse of ADHD medications, as did schools where typically one or more parent had a college degree, according to the study.

Schools with more White students and those who had medium levels of student binge drinking were also more likely to see teen abuse of stimulants.

On an individual level, students who said they had used marijuana in the past 30 days were four times as likely to abuse ADHD medications than teens who did not use weed, according to the analysis.

In addition, adolescents who said they used ADHD medications currently or in the past were about 2.5% more likely to have misused the stimulants when compared with peers who had never used stimulants, the study found.

“But these findings were not being driven solely by teens with ADHD misusing their medications,” McCabe said. “We still found a significant association, even when we excluded students who were never prescribed ADHD therapy.”

Data collection for the study was through 2020. Since then, new statistics show prescriptions for stimulants surged 10% during 2021 across most age groups. At the same time, there has been a nationwide shortage of Adderall, one of the most popular ADHD drugs, leaving many patients unable to fill or refill their prescriptions.

The stakes are high: Taking stimulant medications improperly over time can result in stimulant use disorder, which can lead to anxiety, depression, psychosis and seizures, experts say.

If overused or combined with alcohol or other drugs, there can be sudden health consequences. Side effects can include “paranoia, dangerously high body temperatures, and an irregular heartbeat, especially if stimulants are taken in large doses or in ways other than swallowing a pill,” according to the Substance Abuse and Mental Health Services Administration.

Research has also shown people who misuse ADHD medications are highly likely to have multiple substance use disorders.

Abuse of stimulant drugs has grown over the past two decades, experts say, as more adolescents are diagnosed and prescribed those medications — studies have shown 1 in every 9 high school seniors report taking stimulant therapy for ADHD, McCabe said.

For children with ADHD who use their medications appropriately, stimulants can be effective treatment. They are “protective for the health of a child,” Camenga said. “Those adolescents diagnosed and treated correctly and monitored do very well — they have a lower risk of new mental health problems or new substance use disorders.”

The solution to the problem of stimulant misuse among middle and high school teens isn’t to limit use of the medications for the children who really need them, McCabe stressed.

“Instead, we need to look very long and hard at school strategies that are more or less effective in curbing stimulant medication misuse,” he said. “Parents can make sure the schools their kids attend have safe storage for medication and strict dispensing policies. And ask about prevalence of misuse — that data is available for every school.”

Families can also help by talking to their children about how to handle peers who approach them wanting a pill or two to party or pull an all-night study session, he added.

“You’d be surprised how many kids do not know what to say,” McCabe said. “Parents can role-play with their kids to give them options on what to say so they are ready when it happens.”

Parents and guardians should always store controlled medications in a lockbox, and should not be afraid to count pills and stay on top of early refills, he added.

“Finally, if parents suspect any type of misuse, they should contact their child’s prescriber right away,” McCabe said. “That child should be screened and assessed immediately.”

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More people with Down syndrome are living longer, but medical systems aren’t keeping up | CNN

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Montrose, Missouri
KFF
 — 

It took Samantha Lesmeister’s family four months to find a medical professional who could see that she was struggling with something more than her Down syndrome.

The young woman, known as Sammee, had become unusually sad and lethargic after falling in the shower and hitting her head. She lost her limited ability to speak, stopped laughing, and no longer wanted to leave the house.

General-practice doctors and a neurologist said such mental deterioration was typical for a person with Down syndrome entering adulthood, recalled her mother, Marilyn Lesmeister. They said nothing could be done.

The family didn’t buy it.

Marilyn researched online and learned the University of Kansas Health System has a special medical clinic for adults with Down syndrome. Most other Down syndrome programs nationwide focus on children, even though many people with the condition now live into middle age and often develop health problems typically associated with seniors. And most of the clinics that focus on adults are in urban areas, making access difficult for many rural patients.

The clinic Marilyn found is in Kansas City, Kansas, 80 miles northwest of the family’s cattle farm in central Missouri. She made an appointment for her daughter and drove up.

The program’s leader, nurse practitioner Moya Peterson, carefully examined Sammee Lesmeister and ordered more tests.

“She reassured me that, ‘Mom, you’re right. Something’s wrong with your daughter,’” Marilyn Lesmeister said.

With the help of a second neurologist, Peterson determined Sammee Lesmeister had suffered a traumatic brain injury when she hit her head. Since that diagnosis about nine years ago, she has regained much of her strength and spirit with the help of therapy and steady support.

Sammee, now 27, can again speak a few words, including “hi,” “bye,” and “love you.” She smiles and laughs. She likes to go out into her rural community, where she helps choose meals at restaurants, attends horse-riding sessions at a stable, and folds linens at a nursing home.

Without Peterson’s insight and encouragement, the family likely would have given up on Sammee’s recovery. “She probably would have continued to wither within herself,” her mother said. “I think she would have been a stay-at-home person and a recluse.”

The Lesmeisters wish Peterson’s program wasn’t such a rarity. A directory published by the Global Down Syndrome Foundation lists just 15 medical programs nationwide that are housed outside of children’s hospitals and that accept Down syndrome patients who are 30 or older.

The United States had about three times as many adults with the condition by 2016 as it did in 1970. That’s mainly because children born with it are no longer denied lifesaving care, including surgeries to correct birth defects.

Adults with Down syndrome often develop chronic health problems, such as severe sleep apnea, digestive disorders, thyroid conditions, and obesity. Many develop Alzheimer’s disease in middle age. Researchers suspect this is related to extra copies of genes that cause overproduction of proteins, which build up in the brain.

“Taking care of kids is a whole different ballgame from taking care of adults,” said Peterson, the University of Kansas nurse practitioner.

Sammee Lesmeister is an example of the trend toward longer life spans. If she’d been born two generations ago, she probably would have died in childhood.

She had a hole in a wall of her heart, as do about half of babies with Down syndrome. Surgeons can repair those dangerous defects, but in the past, doctors advised most families to forgo the operations, or said the children didn’t qualify. Many people with Down syndrome also were denied care for serious breathing issues, digestive problems, or other chronic conditions. People with disabilities were often institutionalized. Many were sterilized without their consent.

Such mistreatment eased from the 1960s into the 1980s, as people with disabilities stood up for their rights, medical ethics progressed, and courts declared it illegal to withhold care. “Those landmark rulings sealed the deal: Children with Down syndrome have the right to the same lifesaving treatment that any other child would deserve,” said Brian Skotko, a Harvard University medical geneticist who leads Massachusetts General Hospital’s Down Syndrome Program.

The median life expectancy for a baby born in the U.S. with Down syndrome jumped from about four years in 1950 to 58 years in the 2010s, according to a recent report from Skotko and other researchers. In 1950, fewer than 50,000 Americans were living with Down syndrome. By 2017, that number topped 217,000, including tens of thousands of people in middle age or beyond.

The population is expected to continue growing, the report says. A few thousand pregnant women a year now choose abortions after learning they’re carrying fetuses with Down syndrome. But those reductions are offset by the increasing number of women becoming pregnant in their late 30s or 40s, when they are more likely to give birth to a baby with Down syndrome.

Skotko said the medical system has not kept up with the extraordinary increase in the number of adults with Down syndrome. Many medical students learn about the condition only while training to treat pediatric patients, he said.

Few patients can travel to specialized clinics like Skotko’s program in Boston. To help those who can’t, he founded an online service, Down Syndrome Clinic to You, which helps families and medical practitioners understand the complications and possible treatments.

Charlotte Woodward, who has Down syndrome, is a prominent advocate for improved care. She counts herself among the tens of thousands of adults with the condition who likely would have died years ago without proper treatment. Woodward, 33, of Fairfax, Virginia, had four heart surgeries as a child and then a heart transplant in her 20s.

Woodward, who is an education program associate for the National Down Syndrome Society, has campaigned to end discrimination against people with disabilities who need organ transplants.

She said her primary care doctor is excellent. But she has felt treated like a child by other health care providers, who have spoken to her parents instead of to her during appointments.

She said many general-practice doctors seem to have little knowledge about adults with Down syndrome. “That’s something that should change,” she said. “It shouldn’t just be pediatricians that are aware of these things.”

Woodward said adults with the condition should not be expected to seek care at programs housed in children’s hospitals. She said the country should set up more specialized clinics and finance more research into health problems that affect people with disabilities as they age. “This is really an issue of civil rights,” she said.

Advocates and clinicians say it’s crucial for health care providers to communicate as much as possible with patients who have disabilities. That can lead to long appointments, said Brian Chicoine, a family practice physician who leads the Adult Down Syndrome Center of Advocate Aurora Health in Park Ridge, Illinois, near Chicago.

“It’s very important to us that we include the individuals with Down syndrome in their care,” he said. “If you’re doing that, you have to take your time. You have to explain things. You have to let them process. You have to let them answer. All of that takes more time.”

Time costs money, which Peterson believes is why many hospital systems don’t set up specialized clinics like the ones she and Chicoine run.

Peterson’s methodical approach was evident as she saw new patients on a recent afternoon at her Kansas City clinic. She often spends an hour on each initial appointment, speaking directly to patients and giving them a chance to share their thoughts, even if their vocabularies are limited.

Her patients that day included Christopher Yeo, 44, who lives 100 miles away in the small town of Hartford, Kansas. Yeo had become unable to swallow solid food, and he’d lost 45 pounds over about 1½ years. He complained to his mother, Mandi Nance, that something “tickled” in his chest.

During his exam, he lifted his shirt for Peterson, revealing the scar where he’d had heart surgery as a baby. He grimaced, pointed to his chest, and repeatedly said the word “gas.”

Peterson looked Yeo in the eye as she asked him and his mother about his discomfort.

The nurse practitioner takes seriously any such complaints from her patients. “If they say it hurts, I listen,” she said. “They’re not going to tell you about it until it hurts bad.”

Nurse practitioner Moya Peterson speaks to Christopher Yeo of Hartford, Kansas. Peterson leads an rare clinic for adults with Down syndrome.

Yeo’s mother had taken him to a cardiologist and other specialists, but none had determined what was wrong.

Peterson asked numerous questions. When does Yeo’s discomfort seem to crop up? Could it be related to what he eats? How is his sleep? What are his stools like?

After his appointment, Peterson referred Yeo to a cardiologist who specializes in adults with congenital heart problems. She ordered a swallowing test, in which Yeo would drink a special liquid that appears on scans as it goes down. And she recommended a test for Celiac disease, an autoimmune disorder that interferes with digestion and is common in people with Down syndrome. No one had previously told Nance about the risk.

Nance, who is a registered nurse, said afterward that she has no idea what the future holds for their family. But she was struck by the patience and attention Peterson and other clinic staff members gave to her son. Such treatment is rare, she said. “I feel like it’s a godsend. I do,” she said. “I feel like it’s an answered prayer.”

Peterson serves as the primary care provider for some of her patients with Down syndrome. But for many others, especially those who live far away, she is someone to consult when complications arise. That’s how the Lesmeisters use her clinic.

Mom Marilyn is optimistic Sammee can live a fulfilling life in their community for years to come. “Some people have said I need to put her in a home. And I’m like, ‘What do you mean?’ And they say, ‘You know ― a home,’” she said. “I’m like, ‘She’s in a home. Our home.’”

Sammee’s sister, who lives in Texas, has agreed to take her in when their parents become too old to care for her.

Marilyn’s voice cracked with emotion as she expressed her gratitude for the help they have received and her hopes for Sammee’s future.

“I just want her to be taken care of and loved like I love her,” she said. “I want her to be taken care of like a person, and not a condition.”

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To protect kids from tobacco, pediatricians say, focus should be on quitting — or never starting | CNN

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CNN
 — 

Although smoking rates for adults in the US are at their lowest recorded levels, more must be done to stop children from using tobacco, according to a new set of policy statements from the American Academy of Pediatrics.

The statements, published Monday, are the association’s first tobacco policy update since 2015. They’re based on newer science and better reflect how many children now use e-cigarettes as more kid-friendly products have flooded the market.

AAP policy statements are created by expert pediatricians to help leaders craft more effective public health policy and to guide physicians on how to keep kids safe – in this case, from tobacco.

Researchers have been telling Americans for generations that tobacco products are bad for them, yet nearly 200 US children take up smoking every day, according to the US Centers for Disease Control and Prevention.

Tobacco use is the No. 1 cause of preventable death in the United States, the CDC says.

The rates of kids who use e-cigarettes are high, the AAP says, and the use of hookahs and cigars has not declined. However, the pediatricians note, traditional cigarette smoking has declined over the years.

Specifically, in 2022, nearly 5% of middle school and about 17% of high school students reported some form of current tobacco use, according to the CDC. In 2021, about 11% of middle schoolers and 34% of high schoolers said they had ever tried tobacco.

These “try rates” are important because most adult smokers started at young ages, according to the CDC.

And in smoking rates remain disproportionately high in certain communities, including those who are Black, Hispanic, Native American, Alaska Native or LGBTQ+.

In its updated policy statements, the AAP continues to encourage pediatricians to screen for tobacco use as part of a child’s regular checkup. A talk about tobacco should start no later than age 11 or 12, the report says.

For kids who want to quit tobacco, pediatricians should refer them to behavioral interventions like counseling or prescribe nicotine replacement therapy, which has been shown to be effective with children who have moderate or severe tobacco addiction.

That practice has shifted over the years, according to Dr. Susan Walley, co-author of the new policy statements. In medical school, she said, her professors didn’t talk much about smoking except to tell people to quit.

“Now, we know it’s an addiction and a chronic medical disease. Telling someone just to quit would be like telling somebody who’s diabetic, ‘you just need to think about making your blood sugar better.’ We’ve learned so much,” said Walley, a pediatrician at Children’s National in Washington, D.C.

The new report notes that children who smoke cigarettes should not be encouraged to use e-cigarettes as an alternative. Some experts have argued that e-cigarettes are a good smoking cessation tool, but the AAP says evidence is lacking.

At the checkup, pediatricians should also ask caregivers about their tobacco habits and make recommendations. Nearly 40% of kids are regularly exposed to secondhand smoke, the AAP says, and caregiver use is the biggest reason children are exposed to secondhand smoke.

In children, secondhand smoke can lead to respiratory and ear infections and asthma attacks. Since 1964, more than 2.5 million nonsmokers who didn’t smoke have died from health problems caused by exposure to secondhand smoke, according to the CDC.

The AAP is urging the US Food and Drug Administration to better regulate all tobacco and nicotine products and the federal government to fund child-specific tobacco prevention, screening and treatment programs.

Despite getting nearly $27 billion from a tobacco settlement and tobacco taxes this year, states shortchange programs designed to prevent kids from using tobacco products and help people quit, according to the Campaign for Tobacco-Free Kids.

The AAP recommends raising the prices on tobacco products, as higher prices can act as a deterrent for young users.

Taxes are also considered one of the most effective ways to reduce smoking, particularly among children, studies have found. However, Congress hasn’t raised federal tobacco taxes in 14 years. The federal cigarette tax remains $1.01 per pack, and taxes vary for other tobacco products. No state increased its cigarette taxes in 2022, either.

The AAP policy statements on tobacco recommend a total flavor ban, including menthol.

In April, the FDA proposed eliminating two tobacco products popular with children: flavored cigars and menthol cigarettes. But it could be years before that becomes a reality, as even if that rule is finalized this year, manufacturers will probably sue to keep it from going into effect.

Tobacco companies have long used menthol to mask the unpleasant flavors of their products. Studies show that it makes the products more attractive to new users and makes it harder for people to quit.

Tobacco companies are also frequently introducing flavored products in child-friendly disposable vapes in flavors like blue raspberry and sour apple.

“Sadly, they also have very, very high levels of nicotine. Just the tobacco products themselves, they have really exploded. Part of it is the lack of regulation, and then on top of that, there’s these new oral nicotine products that are unfortunately gaining a lot of popularity from our youth,” Walley said.

Walley is optimistic that more children can quit tobacco or not start in the first place, but she knows that pediatricians have their work cut out for them, based on what her sons tell her about school.

“I’m a parent of three boys, and when I hear from my boys [that] they don’t want to go to the bathroom because people will be vaping in there, it just breaks my heart that they’re not having a bathroom break all day because of that,” she said. “That kids are so addicted that they have to sneak away to the bathroom, or they are vaping in class using some covert pieces of clothing, shows this really is a public health crisis.

“We at the AAP want to make sure that people remember, this is one of the most modifiable things in terms of social determinants of health,” Walley said. “A lot of the social determinants of health, we really can’t control, but whether you use tobacco or whether you start using tobacco is something that we can do something about.”

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