It’s a myth that women don’t want sex as they age, study finds | CNN



CNN
 — 

It’s a myth that women lose interest in sex as they enter midlife and beyond, according to research that followed more than 3,200 women for about 15 years.

“About a quarter of women rate sex as very important, regardless of their age,” said Dr. Holly Thomas, lead author of an abstract presented during the September 2020 virtual annual meeting of the North American Menopause Society.

“The study showed substantial numbers of women still highly value sex, even as they get older, and it’s not abnormal,” said Thomas, an assistant professor of medicine at the University of Pittsburgh.

“If women are able to speak up with their partner and make sure that they’re having sex that’s fulfilling and pleasurable to them, then they’re more likely to rate it as highly important as they get older,” she said.

“That’s actually quite refreshing, that there were a quarter of women for whom sex remains not just on the radar but highly important,” said Dr. Stephanie Faubion, medical director for the North American Menopause Society, who was not involved in the study.

“Studies like these provide valuable insights to health care providers who may otherwise dismiss a woman’s waning sexual desire as a natural part of aging.”

It’s true that past studies have found that women tend to lose interest in sex as they age. But women’s health practitioners say that attitude doesn’t jibe with the reality they see.

“Some of the prior studies had suggested that sex goes downhill and all women lose interest in sex as they get older,” Thomas said. “That really isn’t the type of story that I hear from all my patients.”

One issue, she said, is that past studies took a single snapshot of a woman’s desire at one point in her life and compared it with similar snapshots in later decades of life.

“That type of longitudinal study would just show averages over time,” Thomas said. “And if you look at things on average, it may look like everyone follows one path.”

The study presented in 2020 used a different type of analysis that allowed researchers to follow the trajectory of a woman’s desire over time, Thomas said then.

“We wanted to use this different type of technique to see if there really were these different patterns,” she said. “And when you look for these trajectories, you see there are significant groups of women who follow another path.”

The research, which analyzed data from a national multisite study called SWAN, or the Study of Women’s Health Across the Nation, found three distinct pathways in a woman’s feelings about the importance of sex.

About a fourth of the women (28%) followed traditional thinking on the subject: They valued sex less during midlife years.

However, another fourth of the women in the study said the exact opposite. Some 27% of them said sex remains highly important throughout their 40s, 50s and 60s — a surprising contradiction of the belief that all women lose interest in sex as they age.

“Sex is going to look different,” said Faubion, who is director of the Mayo Clinic’s Center for Women’s Health.

“It’s not going to look the same at 40 as it does at 20; it’s not going to look the same at 60 as it does at 40, and it’s not going to look the same at 80 as it did at 60,” she said. “There may be some modifications that we have to do, but people in general who are healthy and in good relationships remain sexual.”

Women in the study who highly valued sex shared the following characteristics: They were more highly educated, they were less depressed, and they had experienced better sexual satisfaction before entering midlife.

“Women who were having more satisfying sex when they were in their 40s were more likely to continue to highly value sex as they got older,” Thomas said.

There could also be socioeconomic factors at play, she added. For example, more highly educated women may have higher incomes and feel more stable in their lives with less stress.

“Therefore they have more headspace to make sex a priority because they’re not worrying about other things,” Thomas said.

The study found another factor important to both lower-interest and high-interest pathways — race and ethnicity.

African American women were more likely to say sex was important to them for the duration of midlife, while Chinese and Japanese women were more likely to rate sex as having low importance throughout their midlife years.

“I do want to emphasize that it’s much more likely to be due to sociocultural factors than any biological factor,” Thomas said. “Women from different cultural groups have different attitudes … different comfort levels about getting older … and whether it’s ‘normal’ for a woman to continue to value sex as she gets older.”

The majority of women (48%) fell into a third pathway: They valued a healthy sex life as they entered the menopausal years but gradually lost interest throughout their 50s or 60s.

There are a number of emotional, physical and psychological factors that might affect how a woman views sex, experts say. Most can be divided into four categories:

Medical conditions: As women enter perimenopause in their 40s and 50s, they begin to experience hormonal changes that can cause sex to become less satisfying or even painful.

The drop in estrogen causes the vulva and vaginal tissues to become thinner, drier and more easily broken, bruised or irritated. Arousal can become more difficult. Hot flashes and other signs of menopause can affect mood and sleep quality, leading to fatigue, anxiety, irritability, brain fog and depression.

Many medical conditions can arise or worsen during midlife that can also affect libido.

“Do they have medical conditions like hip arthritis that cause pain with sex? Or hand arthritis that can make it more difficult? Or things like diabetes where their sensation is not the same, or do they have heart disease?” Faubion asked.

“But there are modifications that we talk about all the time to help people remain sexual, even for quadriplegics,” she said. “There are ways to stay sexual despite disability.”

Mental and emotional considerations: The psychological component of sex can have a huge influence on a woman’s levels of sexual desire. A history of sexual or physical abuse, struggles with substance abuse and depression, anxiety and stress are major players in this category.

“I can’t tell you enough about the impact of anxiety and stress on sex,” Faubion said. “Think of that fight or flight mechanism — your adrenaline’s pumping so you’re back in caveman days and a lion is chasing you.

“Are you going to lie down on the grassy knoll and have sex when the lion is chasing you? The answer is no. And that’s how women with anxiety are all the time, so anxiety is a huge, huge factor for whether women will be sexual.”

While the study did not look specifically at anxiety, results showed women with more symptoms of depression were much less likely to rate sex as a priority in life. In addition to the emotional impact, a reduced libido is a side effect of many antidepressants prescribed to treat depression.

Partner component: Women in midlife can also face dramatic and disturbing changes in their romantic lives that can take a major toll on their interest in sex.

“Are they losing a romantic partner to divorce or to death? Is a romantic partner developing health issues that make sex more difficult or inconvenient? Are they getting busy in other aspects of their life — their career, caring for grandchildren or even grown children who are moving back in? That makes it hard to prioritize sex,” Thomas said.

Even if they have a partner, relationships may have had ups and downs that can affect how a woman feels about intimacy with a significant other.

“Do you like your partner?” Faubion asked. “Is your communication good? Even logistics can get in the way — are you in the same place at the same time?”

Social mores: Society also affects how a woman feels about sex. Religious, cultural and family values about the topic can play a large role in sexual ease and satisfaction.

“Then there’s what society teaches us about aging women,” Faubion said. “And so for some women being sexual is somehow bad. Women aren’t supposed to like sex.”

“I’ve seen plenty of women in my clinic in the 60-to-65 age group who never got any sex education, their partners never got any sex education, and they don’t really want to know about all that stuff.”

Of course, if a woman isn’t bothered by a lack of sex, then there’s no reason to see a doctor, Faubion and Thomas said. But they both said that past studies have shown that about 10% to 15% of women who do have a lower interest in sex are bothered by it and would like to seek a solution.

There are ways in which physicians can help, including medications and therapies, but first a woman must reach out and talk to her doctor.

“Prior research has shown that women often really do hesitate to reach out to their doctors, perhaps because they’re embarrassed or they see it as part of normal aging and and don’t think it’s worth bringing up,” Thomas said.

Faubion added, “Bottom line: Women should talk to their providers if they’re having concerns about their sexual health. It’s an important part of life, and there are solutions for women who are struggling with that.”

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Conjoined Twins Fast Facts | CNN



CNN
 — 

Here’s a look at conjoined twins.

Conjoined twins are physically connected to one another at some point on their bodies.

Conjoined twins occur once every 200,000 live births, according to the University of Minnesota.

About 70% of conjoined twins are female.

Conjoined twins are identical – they are the same sex.

According to the Mayo Clinic, conjoined twins may be joined at any of these areas: chest, abdomen, spine, pelvis, trunk or head.

Scientists believe that conjoined twins develop from a single fertilized egg that fails to separate completely as it divides.

The term “Siamese twins” originated with Eng and Chang Bunker, a set of conjoined twins who were born in Siam (now Thailand) in 1811. They lived to age 63 and appeared in traveling exhibitions. Chang and Eng both married and fathered a total of 21 children between them.

In 1955, neurosurgeon Dr. Harold Voris of Mercy Hospital in Chicago performed the first successful procedure separating conjoined twins.

Lea and Tabea Block
Born August 9, 2003, in Lemgo, Germany, to Peter and Nelly Block. They are joined at the head. On September 16, 2004, the girls are separated. Tabea dies shortly thereafter.

Jade and Erin Buckles
Born February 26, 2004, to Melissa and Kevin Buckles at National Naval Medical Center in Bethesda, Maryland. They share a liver. On June 19, 2004, they are successfully separated.

Tatiana and Anastasia Dogaru
Born January 13, 2004, in Rome to Romanian parents Claudia and Alin Dogaru. They are connected at the head. In August 2007, doctors at University Hospital’s Rainbow Babies & Children’s Hospital in Cleveland announce that they will not perform a separation of the girls because the surgery is too risky.

Abbigail and Isabelle Carlsen
Born November 29, 2005, in Fargo, North Dakota, to Amy and Jesse Carlsen. They are joined at the abdomen and chest. On May 12, 2006, a team of 30 people, including 18 surgeons from various specialties at the Mayo Clinic in Rochester, Minnesota, perform a successful operation to separate the girls.

Regina and Renata Salinas Fierros
Born August 2, 2005, in Los Angeles to Sonia Fierros and Federico Salinas. Born facing each other and joined from the lower chest to the pelvis, they are fused in several places including the liver and genitals, and they share a large intestine. Regina is born with one kidney. On June 14, 2006, the twins are separated during a day-long surgery at Children’s Hospital Los Angeles.

Abygail and Madysen Fitterer
Born August 8, 2006, to Stacy and Suzy Fitterer from Bismarck, North Dakota. They are born joined at the abdomen and share a liver. On January 3, 2007, they are separated in a surgery at the Mayo Clinic.

Preslee Faith and Kylee Hope Wells
Born October 25, 2008, in Oklahoma City to Stevie Stewart and Kylie Wells. They are attached at the chest and are believed to be the first Native American conjoined twins. On January 19, 2009, they are separated at Children’s Hospital at OU Medical Center in Oklahoma City. On February 19, 2011, Preslee Faith dies.

Arthur and Heitor Rocha Brandao
Born April 2009 in Bahia, Brazil, to Eliane and Delson Rocha. They are joined at the hip and share a bladder, intestines, liver and genitals. The twins only have three legs between them. On February 24, 2015, the five-year-old twins undergo a 15-hour separation surgery after months of preparation. Arthur dies three days later after he suffers cardiac arrest.

Angelica and Angelina Sabuco
Born August 2009 in the Philippines to Fidel and Ginady Sabuco. They are joined at the chest and abdomen. On November 1, 2011, they are successfully separated after a 10-hour surgery at Lucile Packard Children’s Hospital in San Jose, California.

Hassan and Hussein Benhaffaf
Born December 2, 2009, in London to Angie and Azzedine Benhaffaf from East Cork, Ireland. They are attached at the chest but share no major organs. On April 8, 2010, they undergo a 14-hour separation surgery at Great Ormond Street Hospital. Both survive.

Maria and Teresa Tapia
Born April 8, 2010, in the Dominican Republic to Lisandra Sanatis and Marino Tapia. They are joined at the lower chest and abdomen and share a liver, pancreatic glands, and part of their small intestine. On November 8, 2011, they are successfully separated following a 20-hour procedure.

Joshua and Jacob Spates
Born January 24, 2011, in Memphis, Tennessee, to Adrienne Spates. They are joined back to back at the pelvis and lower spine, each with separate hearts, heads and limbs. On August 29, 2011, they are successfully separated after a 13-hour surgery. In October 2013, Jacob passes away.

Rital and Ritag Gaboura
Born September 22, 2010, in Khartoum, Sudan, to Abdelmajeed and Enas Gaboura. They are joined at the head. On August 15, 2011, they are successfully separated after a four-stage operation. Two operations took place in May, one in July and the final operation in August.

Allison June and Amelia Lee Tucker
Born March 1, 2012, to Shellie and Greg Tucker. They are attached at the lower chest and abdomen and share their chest wall, diaphragm, pericardium and liver. On November 7, 2012, they are successfully separated after a seven-hour surgery at Children’s Hospital Philadelphia.

A’zhari and A’zhiah Lawrence
Born October 10, 2012, in Virginia to Nachell Jones and Carlos Lawrence. They are joined from the chest to the abdomen and have a conjoined liver. On April 22, 2013, they are successfully separated following 14 hours of surgery. On October 14, 2013, A’zhari passes away.

Emmett and Owen Ezell
Born July 15, 2013, in Dallas to Jenni and Dave Ezell. They are joined at the liver and the intestine. On August 24, 2013, they are successfully separated.

Knatalye Hope and Adeline Faith Mata
Born April 11, 2014, in Houston to Elysse and John Matta. They are joined at the chest, sharing a liver, heart lining, diaphragm, intestines and colon. On February 17, 2015, a team of 12 surgeons separate the twins during a 26-hour procedure.

Erika and Eva Sandoval
Born August 10, 2014, in California to Aida and Arturo Sandoval. They are joined at the lower chest and upper abdomen and share a liver, bladder, two kidneys and three legs. On December 6-7, 2016, they are successfully separated after 17 hours of surgery at Lucile Packard Children’s Hospital Stanford in California.

Acen and Apio Akello
Born September 23, 2014, in Uganda to Ester Akello. They are joined at the hip and pelvis. On September 3, 2015, more than 30 medical specialists help separate the twins’ spinal cord during a 16-hour surgery at Nationwide Children’s Hospital in Ohio. To prepare for the surgery, medical specialists used 3-D printing to create anatomies similar to the girls.

Carter and Conner Mirabal
Born December 12, 2014, in Jacksonville, Florida, to Michelle Brantley and Bryan Mirabal. They are joined at the sternum and abdomen and share a liver and part of their small intestines. On May 7, 2015, the twins are successfully separated after 12 hours of surgery at Wolfson Children’s Hospital in Florida.

Scarlett and Ximena Torres
Born May 16, 2015, in Corpus Christi, Texas, to Silvia Hernandez and Raul Torres. Scarlett and Ximena are connected below the waist, sharing a colon and a bladder. On April 12, 2016, the twins are separated during a 12-hour procedure at the Driscoll Children’s Hospital in Texas.

Anias and Jadon McDonald
Born on September 9, 2015, in Chicago to Nicole and Christian McDonald. They are joined at the head. On October 13-14, 2016, Anias and Jadon are successfully separated after 27 hours of surgery at the Children’s Hospital at Montefiore Medical Center in New York.

Dawa and Nima Pelden
Born on July 13, 2017, in Bhutan to Bhumchu Zangmo. They are joined at the abdomen. On November 9, 2018, Dawa and Nima are successfully separated after a six-hour surgery at Melbourne Royal Children’s Hospital in Australia.

Safa and Marwa Ullah
Born January 7, 2017, in Pakistan to Zainab Bibi. They are joined at the head. On February 11, 2019, Safa and Marwa are successfully separated after 50 hours of surgery, that took place over a four month period, at London’s Great Ormond Street Hospital.

Ervina and Prefina Bangalo
Born June 29, 2018, in the Central African Republic to Ermine Nzutto. They share a skull and a majority of blood vessels. On June 5, 2020, the twins are successfully separated during an operation in Vatican City lasting 18 hours and involving 30 doctors and nurses.

Abigail and Micaela Bachinskiy
Born December 30, 2019, in Sacramento, California. The twins are joined at the head. On October 23-24, 2020, the twins are successfully separated during a 24-hour operation at UC Davis Children’s Hospital in Sacramento, California.

Siphosethu and Amahle Tyhalisi
Born January 30, 2021, in South Africa to Ntombikayise Tyhalisi. They are joined at the head. On February 24, 2021, the twins are successfully separated during an operation at Red Cross War Memorial Children’s Hospital in Cape Town.

Hassana and Hasina
Born in January 12, 2022 in Kaduna, Nigeria to Omar Rayano. They share an abdomen, pelvis, liver, intestines, urinary and reproductive system, and pelvic bones. On May 18, 2023 the twins are successfully separated during an operation at King Abdullah Specialized Children’s Hospital in Riyadh, Saudi Arabia.

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Opioid Crisis Fast Facts | CNN



CNN
 — 

Here’s a look at the opioid crisis.

Experts say the United States is in the throes of an opioid epidemic. An estimated 9.2 million Americans aged 12 and older misused opioids in 2021, including 8.7 million prescription pain reliever abusers and 1.1 million heroin users.

Opioids are drugs formulated to replicate the pain-reducing properties of opium. Prescription painkillers like morphine, oxycodone and hydrocodone are opioids. Illegal drugs like heroin and illicitly made fentanyl are also opioids. The word “opioid” is derived from the word “opium.”

Nearly 110,000 people died of drug overdoses in 2022, and more than two-thirds of those deaths involved a synthetic opioid.

Overdose deaths have been on the rise for years in the United States, but surged amid the Covid-19 pandemic: Annual deaths were nearly 50% higher in 2021 than in 2019, CDC data shows.

Prescription opioid volumes peaked in 2011, with the equivalent of 240 billion milligrams of morphine prescribed, according to the market research firm, IQVIA Institute for Human Data Science.

Alabama, Arkansas, Louisiana and Tennessee had the highest opioid dispensing rates in 2020.

Opioids such as morphine and codeine are naturally derived from opium poppy plants more commonly grown in Asia, Central America and South America. Heroin is an illegal drug synthesized from morphine.

Hydrocodone and oxycodone are semi-synthetic opioids, manufactured in labs with natural and synthetic ingredients.

Fentanyl is a fully synthetic opioid, originally developed as a powerful anesthetic for surgery. It is also administered to alleviate severe pain associated with terminal illnesses like cancer. The drug is up to 100 times more powerful than morphine. Just a small dose can be deadly. Illicitly produced fentanyl has been a driving factor in the number of overdose deaths in recent years.

Methadone is another fully synthetic opioid. It is commonly dispensed to recovering heroin addicts to relieve the symptoms of withdrawal.

Opioids bind to receptors in the brain and spinal cord, disrupting pain signals. They also activate the reward areas of the brain by releasing the hormone dopamine, creating a feeling of euphoria or a “high.”

Opioid use disorder is the clinical term for opioid addiction or abuse.

People who become dependent on opioids may experience withdrawal symptoms when they stop using the medication. Dependence is often coupled with tolerance, meaning that users need to take increasingly larger doses for the same effect.

A drug called naloxone, available as an injection or a nasal spray, is used as a treatment for overdoses. It blocks or reverses the effects of opioids and is often carried by first responders.

More data on overdose deaths

The 21st Century Cures Act, passed in 2016, allocated $1 billion over two years in opioid crisis grants to states, providing funding for expanded treatment and prevention programs. In April 2017, Health and Human Services Secretary Tom Price announced the distribution of the first round of $485 million in grants to all 50 states and US territories.

In August 2017, Attorney General Jeff Sessions announced the launch of an Opioid Fraud and Abuse Detection Unit within the Department of Justice. The unit’s mission is to prosecute individuals who commit opioid-related health care fraud. The DOJ is also appointing US attorneys who will specialize in opioid health care fraud cases as part of a three-year pilot program in 12 jurisdictions nationwide.

On October 24, 2018, President Donald Trump signed opioid legislation into law. The SUPPORT for Patients and Communities Act includes provisions aimed at promoting research to find new drugs for pain management that will not be addictive. It also expands access to treatment for substance use disorders for Medicaid patients.

State legislatures have also introduced measures to regulate pain clinics and limit the quantity of opioids that doctors can dispense.

1861-1865 – During the Civil War, medics use morphine as a battlefield anesthetic. Many soldiers become dependent on the drug.

1898 – Heroin is first produced commercially by the Bayer Company. At the time, heroin is believed to be less habit-forming than morphine, so it is dispensed to individuals who are addicted to morphine.

1914 – Congress passes the Harrison Narcotics Act, which requires that doctors write prescriptions for narcotic drugs like opioids and cocaine. Importers, manufacturers and distributors of narcotics must register with the Treasury Department and pay taxes on products

1924 – The Anti-Heroin Act bans the production and sale of heroin in the United States.

1970 – The Controlled Substances Act becomes law. It creates groupings (or schedules) of drugs based on the potential for abuse. Heroin is a Schedule I drug while morphine, fentanyl, oxycodone (Percocet) and methadone are Schedule II. Hydrocodone (Vicodin) is originally a Schedule III medication. It is later recategorized as a Schedule II drug.

January 10, 1980 – A letter titled “Addiction Rare in Patients Treated with Narcotics” is published in the New England Journal of Medicine. It looks at incidences of painkiller addiction in a very specific population of hospitalized patients who were closely monitored. It becomes widely cited as proof that narcotics are a safe treatment for chronic pain.

1995 – OxyContin, a long-acting version of oxycodone that slowly releases the drug over 12 hours, is introduced and aggressively marketed as a safer pain pill by manufacturer, Purdue Pharma.

May 10, 2007 – Purdue Pharma pleads guilty for misleadingly advertising OxyContin as safer and less addictive than other opioids. The company and three executives are charged with “misleading and defrauding physicians and consumers.” Purdue and the executives agree to pay $634.5 million in criminal and civil fines.

2010 – FDA approves an “abuse-deterrent” formulation of OxyContin, to help curb abuse. However, people still find ways to abuse it.

May 20, 2015 – The DEA announces that it has arrested 280 people, including 22 doctors and pharmacists, after a 15-month sting operation centered on health care providers who dispense large amounts of opioids. The sting, dubbed Operation Pilluted, is the largest prescription drug bust in the history of the DEA.

March 18, 2016 – The CDC publishes guidelines for prescribing opioids for patients with chronic pain. Recommendations include prescribing over-the-counter pain relievers like acetaminophen and ibuprofen in lieu of opioids. Doctors are encouraged to promote exercise and behavioral treatments to help patients cope with pain.

March 29, 2017 – Trump signs an executive order calling for the establishment of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. New Jersey Governor Chris Christie is selected as the chairman of the group, with Trump’s son-in-law, Jared Kushner, as an adviser.

July 31, 2017 – After a delay, the White House panel examining the nation’s opioid epidemic releases its interim report, asking Trump to declare a national public health emergency to combat the ongoing crisis

September 22, 2017 – The pharmacy chain CVS announces that it will implement new restrictions on filling prescriptions for opioids, dispensing a limited seven-day supply to patients who are new to pain therapy.

November 1, 2017 – The opioid commission releases its final report. Its 56 recommendations include a proposal to establish nationwide drug courts that would place opioid addicts in treatment facilities rather than prison.

February 9, 2018 – A budget agreement signed by Trump authorizes $6 billion for opioid programs, with $3 billion allocated for 2018 and $3 billion allocated for 2019.

February 27, 2018 – Sessions announces a new opioid initiative: The Prescription Interdiction & Litigation (PIL) Task Force. The mission of the task force is to support local jurisdictions that have filed lawsuits against prescription drugmakers and distributors.

March 19, 2018 – The Trump administration outlines an initiative to stop opioid abuse. The three areas of concentration are law enforcement and interdiction; prevention and education via an ad campaign; and job-seeking assistance for individuals fighting addiction.

April 9, 2018 – The US surgeon general issues an advisory recommending that Americans carry the opioid overdose-reversing drug, naloxone. A surgeon general advisory is a rarely used tool to convey an urgent message. The last advisory issued by the surgeon general, more than a decade ago, focused on drinking during pregnancy.

May 1, 2018 – The Journal of the American Medical Association publishes a study that finds synthetic opioids like fentanyl caused about 46% of opioid deaths in 2016. That’s a three-fold increase compared with 2010, when synthetic opioids were involved in about 14% of opioid overdose deaths. It’s the first time that synthetic opioids surpassed prescription opioids and heroin as the primary cause of overdose fatalities.

May 30, 2018 – The journal Medical Care publishes a study that estimates the cost of medical care and substance abuse treatment for opioid addiction was $78.5 billion in 2013.

June 7, 2018 – The White House announces a new multimillion dollar public awareness advertising campaign to combat opioid addiction. The first four ads of the campaign are all based on true stories illustrating the extreme lengths young adults have gone to obtain the powerful drugs.

December 12, 2018 – According to the National Center for Health Statistics, fentanyl is now the most commonly used drug involved in drug overdoses. The rate of drug overdoses involving the synthetic opioid skyrocketed by about 113% each year from 2013 through 2016.

January 14, 2019 – The National Safety Council finds that, for the first time on record, the odds of dying from an opioid overdose in the United States are now greater than those of dying in a vehicle crash.

March 26, 2019 – Purdue Pharma agrees to pay a $270 million settlement to settle a historic lawsuit brought by the Oklahoma attorney general. The settlement will be used to fund addiction research and help cities and counties with the opioid crisis.

July 17, 2019 – The CDC releases preliminary data showing a 5.1% decline in drug overdoses during 2018. If the preliminary number is accurate, it would mark the first annual drop in overdose deaths in more than two decades.

August 26, 2019 – Oklahoma wins its case against Johnson & Johnson in the first major opioid lawsuit trial to be held in the United States. Cleveland County District Judge Thad Balkman orders Johnson & Johnson to pay $572 million for its role in the state’s opioid crisis. The penalty is later reduced to $465 million, due to a mathematical error made when calculating the judgment. In November 2021, the Oklahoma Supreme Court reverses the decision.

September 15, 2019 – Purdue files for bankruptcy as part of a $10 billion agreement to settle opioid lawsuits. According to a statement from the chair of Purdue’s board of directors, the money will be allocated to communities nationwide struggling to address the crisis.

September 30, 2019 – The FDA and DEA announce that they sent warnings to four online networks, operating a total of 10 websites, which the agencies said are illegally marketing unapproved and misbranded versions of opioid medicines, including tramadol.

February 25, 2020 – Mallinckrodt, a large opioid manufacturer, reaches a settlement agreement in principle worth $1.6 billion. Mallinckrodt says the proposed deal will resolve all opioid-related claims against the company and its subsidiaries if it moves forward. Plaintiffs would receive payments over an eight-year period to cover the costs of opioid-addition treatments and other needs.

October 21, 2020 – The Justice Department announces that Purdue Pharma, the maker of OxyContin, has agreed to plead guilty to three federal criminal charges for its role in creating the nation’s opioid crisis. They agree to pay more than $8 billion and close down the company. The money will go to opioid treatment and abatement programs. The Justice Department also reached a separate $225 million civil settlement with the former owners of Purdue Pharma, the Sackler family. In November 2020, Purdue Pharma board chairman Steve Miller formally pleads guilty on behalf of the company.

March 15, 2021 – According to court documents, Purdue files a restructuring plan to dissolve itself and establish a new company dedicated to programs designed to combat the opioid crisis. As part of the proposed plan, the Sackler family agrees to pay an additional $4.2 billion over the next nine years to resolve various civil claims.

September 1, 2021 – In federal bankruptcy court, Judge Robert Drain rules that Purdue Pharma will be dissolved. The settlement agreement resolves all civil litigation against the Sackler family members, Purdue Pharma and other related parties and entities, and awards them broad legal protection against future civil litigation. The Sacklers will relinquish control of family foundations with over $175 million in assets to the trustees of a National Opioid Abatement Trust. On December 16, 2021, a federal judge overturns the settlement.

February 25, 2022 – Johnson & Johnson and the three largest US drug distributors – McKesson Corp, Cardinal Health Inc and AmerisourceBergen Corp – finalize a $26 billion nationwide opioid settlement.

March 3, 2022 – The Sackler families reaches a settlement with a group of states the first week of March, according to court filings. The settlement, ordered through court-ordered mediation that began in January, requires the Sacklers to pay out as much as $6 billion to states, individual claimants and opioid crisis abatement, if approved by a federal bankruptcy court judge.

November 2, 2022 – CVS and Walgreens agree to pay a combined $10 billion, over 10 and 15 years, to settle lawsuits brought by states and local governments alleging the retailers mishandled prescriptions of opioid painkillers.

November 15, 2022 – Walmart agrees to the framework of a $3.1 billion settlement, which resolves allegations from multiple states’ attorneys general that the company failed to regulate opioid prescriptions contributing to the nationwide opioid crisis.

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When older parents resist help or advice, use these tips to cope | CNN



KFF Health News
 — 

It was a regrettable mistake. But Kim Sylvester thought she was doing the right thing at the time.

Her 80-year-old mother, Harriet Burkel, had fallen at her home in Raleigh, North Carolina, fractured her pelvis and gone to a rehabilitation center to recover. It was only days after the death of Burkel’s husband, 82, who had moved into a memory care facility three years earlier.

With growing distress, Sylvester had watched her mother, who had emphysema and peripheral artery disease, become increasingly frail and isolated. “I would say, ‘Can I help you?’ And my mother would say, ‘No, I can do this myself. I don’t need anything. I can handle it,’ ” Sylvester told me.

Now, Sylvester had a chance to get some more information. She let herself into her mother’s home and went through all the paperwork she could find. “It was a shambles — completely disorganized, bills everywhere,” she said. “It was clear things were out of control.”

Sylvester sprang into action, terminating her mother’s orders for anti-aging supplements, canceling two car warranty insurance policies (Burkel wasn’t driving at that point), ending a yearlong contract for knee injections with a chiropractor and throwing out donation requests from dozens of organizations. When her mother found out, she was furious.

“I was trying to save my mother, but I became someone she couldn’t trust — the enemy,” Sylvester said. “I really messed up.”

Dealing with an older parent who stubbornly resists offers of help isn’t easy. But the solution isn’t to make an older person feel like you’re steamrolling them and taking over their affairs. What’s needed instead are respect, empathy and appreciation of the older person’s autonomy.

“It’s hard when you see an older person making poor choices and decisions. But if that person is cognitively intact, you can’t force them to do what you think they should do,” said Anne Sansevero, president of the board of directors of the Aging Life Care Association, a national organization of care managers who work with older adults and their families. “They have a right to make choices for themselves.”

That doesn’t mean adult children concerned about an older parent should step aside or agree to everything the parent proposes. Rather, a different set of skills is needed.

Cheryl Woodson, an author and retired physician based in the Chicago area, learned this firsthand when her mother — whom Woodson described as a “very powerful” woman — developed mild cognitive impairment. She started getting lost while driving and would buy things she didn’t need, then give them away.

Chastising her mother wasn’t going to work. “You can’t push people like my mother or try to take control,” Woodson said. “You don’t tell them, ‘No, you’re wrong,’ because they changed your diapers and they’ll always be your mom.”

Instead, Woodson learned to appeal to her mother’s pride in being the family matriarch. “Whenever she got upset, I’d ask her, ‘Mother, what year was it that Aunt Terri got married?’ or ‘Mother, I don’t remember how to make macaroni. How much cheese do you put in?’ And she’d forget what she was worked up about, and we’d just go on from there.”

Woodson, author of “To Survive Caregiving: A Daughter’s Experience, a Doctor’s Advice,” also learned to apply a “does it really matter to safety or health?” standard to her mother’s behavior. It helped Woodson let go of her sometimes unreasonable expectations.

One example she related: “My mother used to shake hot sauce on pancakes. It would drive my brother nuts, but she was eating, and that was good.”

“You don’t want to rub their nose into their incapacity,” said Woodson, whose mother died in 2003.

Barry Jacobs, a clinical psychologist and family therapist, sounded similar themes in describing a psychiatrist in his late 70s who didn’t like to bend to authority. After his wife died, the older man stopped shaving and changing his clothes regularly. Though he had diabetes, he didn’t want to see a physician and instead prescribed medicine for himself. Even after several strokes compromised his vision, he insisted on driving.

An adult child needs to show empathy and respect for the autonomy of an aging parent.

Jacobs’ take: “You don’t want to go toe-to-toe with someone like this, because you will lose. They’re almost daring you to tell them what to do so they can show you they won’t follow your advice.”

What’s the alternative? “I would employ empathy and appeal to this person’s pride as a basis for handling adversity or change,” Jacobs said. “I might say something along the lines of, ‘I know you don’t want to stop driving and that this will be very painful for you. But I know you have faced difficult, painful changes before and you’ll find your way through this.’ “

“You’re appealing to their ideal self rather than treating them as if they don’t have the right to make their own decisions anymore,” he said. In the older psychiatrist’s case, conflict with his four children was constant, but he eventually stopped driving.

Another strategy that can be useful: “Show up, but do it in a way that’s face-saving,” Jacobs said. Instead of asking your father if you can check in on him, “Go to his house and say, ‘The kids really wanted to see you. I hope you don’t mind.’ Or ‘We made too much food. I hope you don’t mind my bringing it over.’ Or ‘I wanted to stop by. I hope you can give me some advice about this issue that’s on my mind.’ “

This psychiatrist didn’t have any cognitive problems, though he wasn’t as sharp as he used to be. But encroaching cognitive impairment often colors difficult family interactions.

If you think this might be a factor with your parents, instead of trying to persuade them to accept more help at home, try to get them medically evaluated, said Leslie Kernisan, author of “When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, and More.”

“Decreased brain function can affect an older adult’s insight and judgment and ability to understand the risks of certain actions or situations while also making people suspicious and defensive,” she noted.

This doesn’t mean you should give up on talking to an older parent with mild cognitive impairment or early-stage dementia, however. “You always want to give the older adult a chance to weigh in and talk about what’s important to them and their feelings and concerns,” Kernisan said.

“If you frame your suggestions as a way of helping your parent achieve a goal they’ve said was important, they tend to be much more receptive to it,” she said.

A turning point for Sylvester and her mother came when the older woman, who developed dementia, went to a nursing home at the end of 2021. Her mother, who at first didn’t realize the move was permanent, was furious, and Sylvester waited two months before visiting. When she finally walked into Burkel’s room, bearing a Valentine’s Day wreath, Burkel hugged her and said, “I’m so glad to see you,” before pulling away. “But I’m so mad at my other daughter.”

Sylvester, who doesn’t have a sister, responded, “I know, Mom. She meant well, but she didn’t handle things properly.” She learned the value of what she calls a “therapeutic fiblet” from Kernisan, who ran a family caregiver group Sylvester attended between 2019 and 2021.

After that visit, Sylvester saw her mother often, and all was well between the two women up until Burkel’s death. “If something was upsetting my mother, I would just go, ‘Interesting,’ or ‘That’s a thought.’ You have to give yourself time to remember this is not the person you used to know and create the person you need to be your parent, who’s changed so much.”

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Concern grows around US health-care workforce shortage: ‘We don’t have enough doctors’ | CNN



CNN
 — 

There is mounting concern among some US lawmakers about the nation’s ongoing shortage of health-care workers, and the leaders of historically Black medical schools are calling for more funding to train a more diverse workforce.

As of Monday, in areas where a health workforce shortage has been identified, the United States needs more than 17,000 additional primary care practitioners, 12,000 dental health practitioners and 8,200 mental health practitioners, according to data from the Health Resources & Services Administration. Those numbers are based on data that HRSA receives from state offices and health departments.

“We have nowhere near the kind of workforce, health-care workforce, that we need,” Vermont Sen. Bernie Sanders told CNN on Friday. “We don’t have enough doctors. We don’t have enough nurses. We don’t have enough psychologists or counselors for addiction. We don’t have enough pharmacists.”

The heads of historically Black medical schools met with Sanders in a roundtable at the Morehouse School of Medicine in Atlanta on Friday to discuss the nation’s health-care workforce shortage.

The health-care workforce shortage is “more acute” in Black and brown communities; the Black community constitutes 13% of the US population, but only 5.7% of US physicians are Black, said Sanders, chairman of the Senate Committee on Health, Education, Labor, and Pensions.

“What we’re trying to do in this committee – in our Health, Education, Labor Committee – is grow the health-care workforce and put a special emphasis on the needs to grow more Black doctors, nurses, psychologists, et cetera,” Sanders said.

At Friday’s roundtable, the leaders of the Morehouse School of Medicine, Meharry Medical College, Howard University and Charles R. Drew University called for more resources and opportunities to be allocated to their institutions to help grow the nation’s incoming health-care workforce.

“Allocating resources and opportunities matter for us to increase capacity and scholarships and programming to help support these students as they matriculate through,” Dr. Valerie Montgomery Rice, president of the Morehouse School of Medicine, told CNN.

“But also, the other 150-plus medical schools, beyond our four historically Black medical schools, owe it to the country to increase the diversity of the students that they train,” Rice said, adding that having a health-care workforce that reflects the communities served helps reduce the health inequities seen in the United States.

Historically Black medical schools are “the backbone for training Black doctors in this country,” Dr. Hugh Mighty, senior vice president for health affairs at Howard University, said at Friday’s event. “As the problem of Black physician shortages rise, within the general context of the physician workforce shortage, many communities of need will continue to be underserved.”

A new study commissioned by the National Institute on Minority Health and Health Disparities estimates that the economic burden of health inequities in the United States has cost the nation billions of dollars. Such inequities are illustrated in how Black and brown communities tend to have higher rates of serious health outcomes such as maternal deaths, certain chronic diseases and infectious diseases.

The researchers, from Johns Hopkins University and other institutions, analyzed excess medical care expenditures, death records and other US data from 2016 through 2019. They took a close look at health inequities in the cost of medical care, differences in premature deaths and the amount of labor market productivity that has been lost due to health reasons.

The researchers found that, in 2018, the economic burden of health inequities for racial and ethnic minority communities in the United States was up to $451 billion, and the economic burden of health inequities for adults without a four-year college degree was up to $978 billion.

“These findings provide a clear and important message to health care leaders, public health officials, and state and federal policy makers – the economic magnitude of health inequities in the US is startlingly high,” Drs. Rishi Wadhera and Issa Dahabreh, both of Harvard University, wrote in an editorial that accompanied the new study in the journal JAMA.

The Covid-19 pandemic “pulled the curtain back” on health inequities, such as premature death and others, Rice said, and “we saw a disproportionate burden” on some communities.

“We saw a higher death rate in Black and brown communities because of access and fear and a whole bunch of other factors, including what we recognize as racism and unconscious bias,” Rice said.

“We needed more physicians, more health-care providers. So, we already know when we project out to 2050, we have a significant physician shortage based on the fact that we cannot educate and train enough health care professionals fast enough,” she said. “We can’t just rely on physicians. We have to rely on a team approach.”

She added that the nation’s shortage of health-care workers leaves the country ill-prepared to respond to future pandemics.

The United States is projected to face a shortage of up to 124,000 physicians by 2034 as the demand outpaces supply, according to the Association of American Medical Colleges.

The workforce shortage means “we’re really not prepared” for another pandemic, Sanders said.

“We don’t have the public health infrastructure that we need state by state. We surely don’t have the doctors and the nurses that we need,” Sanders said. “So what we are trying to do now is to bring forth legislation, which will create more doctors and more nurses, more dentists, because dental care is a major crisis in America.”

In March, Bill McBride, executive director of the National Governors Association, wrote a letter to Sanders and Louisiana Sen. Bill Cassidy detailing the “root causes” of the health-care workforce shortage and potential ways some states are hoping to tackle the crisis.

“Governors have taken innovative steps to address the healthcare workforce shortage facing their states and territories by boosting recruitment efforts, loosening licensing requirements, expanding training programs and raising providers’ pay,” McBride wrote.

“Shortages in healthcare workers is not a new challenge but has only worsened in the past three years due to the COVID-19 pandemic. Burnout and stress have only exacerbated this issue,” he wrote. “The retirement and aging of an entire generation is front and center of the healthcare workforce shortage, particularly impacting rural communities.”

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Older dogs who sleep badly may have dementia, study says | CNN



CNN
 — 

In a veterinary lab in North Carolina, Woofus, a 15-year-old basset hound mix, is allowing researchers to attach an electroencephalogram, or EEG, electrodes to his head before padding off to a dark, cozy room for an afternoon nap.

During his snooze, the study team will analyze Woofus’ brain waves to judge the quality of his sleep. Woofus has canine cognitive dysfunction syndrome, or CCDS, the doggie disorder that’s similar to Alzheimer’s disease in people. The elderly dog’s owners say he is struggling to get enough rest at night.

“Just like humans with Alzheimer’s disease, dogs with CCDS experience sleep disruptions, such as insomnia and sleep fragmentation,” said veterinarian Dr. Natasha Olby, a professor of neurology, neurosurgery and gerontology at North Carolina State College of Veterinary Medicine in Raleigh.

Woofus isn’t the only sleep-deprived dog in this study. On other days in the clinic, Jake, a 13-year-old pointer, and Coco, a 12-year-old dachshund, among others, might be taking a siesta while researchers peer inside their brains.

“Owners of dogs with CCDS report their dogs suffer from difficulty sleeping at night, increased sleeping during the day or both, as well as pacing and vocalizations at night,” Olby said. “This can be very hard on the dog’s owners — not only are they worried for their pet, their sleep is also significantly disrupted.”

To find out whether sleep problems in dogs indicate early signs of dementia as they do in people, Olby and her team turned to a group of senior dogs enrolled in an ongoing study testing antiaging supplements. The dogs visit twice a year “and do all kinds of really fun cognitive testing,” she said. “They really enjoy it and like the handlers they work with.”

To be considered for the antiaging study, the dog must have lived more than 75% of the expected life span for their breed or mix of breeds. A dog also could not be crippled by arthritis or going blind, as the pet needed to be able to perform tasks designed to test their cognitive capabilities.

A dog might be asked, for example, to find a treat hidden under a cup or a snack inside a cylinder in which one end had been closed by a researcher. By repeating the tasks at the clinic every six months, any decline in the dog’s mental agility or performance can be tracked.

Woofus, 15-year-old basset hound mix, plays

For the new study measuring a dog’s brain waves during sleep, researchers used a form of electroencephalogram called polysomnography, used in sleep clinics to diagnose sleep problems in people.

“It’s the gold standard method to look at what the brain is doing during sleep,” Olby said, adding this is the first canine study to apply the same technology used on humans.

“We glue these electrodes on with a really great conductive glue that’s water soluble. Then we just wash it off afterwards,” she said. “We don’t use anywhere near as many electrodes as you see on people in a sleep lab, because dogs have far less cortex and surface area to cover.”

Already at ease with the staff, it wasn’t too difficult to train 28 senior dogs to wear electrodes and walk around with dangling wires without complaint, she said.

Jake, a 13-year-old pointer, was one of 28 dogs trained to sleep with EEG electrodes.

To make the dogs more comfortable during their siestas, owners bring their dogs’ beds from home, which are placed in a protected room with white noise.

“Staff sit with them while they nap to make sure that they’re not trying to pull out or eat the electrodes or do anything that might hurt them,” Olby said.

When sleeping brain waves were compared with a dog’s cognitive testing, researchers found that dogs with greater dementia spent less time in deep and REM sleep, just as people do. The study was recently published in the journal Frontiers in Veterinary Science.

“Dogs that did worse on our memory tests had levels of REM sleep which were not as deep as they should be,” Olby said. “We found the same when it came to deep sleep.”

While no one knows the exact mechanism at work — either in people or in dogs — research like this study may help scientists better understand the process and find ways to treat it, Olby said.

“There’s a possibility we might be able to identify an early signature of change on the EEG that can tell us, ‘Hey, things are starting to slide.’ Because with a chronic neurodegenerative process, of course we’d love to be able to intervene sooner rather than later.”

In the meantime, there are medications for anxiety and melatonin for sleep that veterinarians can prescribe as a dog ages, Olby said. And as with people, diet and exercise appears to be a factor.

“There’s been some very nice studies showing diets that are enriched in flavonoids and antioxidants and medium-chain fatty acids could possibly slow the development of dementia in dogs,” she said. “It’s just like people — if you can eat a Mediterranean diet and do your exercise, you’re going to do better.”

Doggie dementia is a worrisome reality for many senior dogs. Research has found that by 11 or 12 years of age, 28% of dogs had mild and 10% had severe cognitive impairment. By the time the dogs reached age 15, the risk had risen to 68% for mild and 35% for severe cognitive impairment. A 2022 study found the odds of canine cognitive dysfunction increased by 52% with each year of age, Olby said.

Pet owners can look for signs that their dog’s mental functions are declining. According to Olby, vets use an acronym called DISHA-AL, which stands for disorientation, interaction changes, sleep/wake cycle alterations, house soiling; activity changes (increased or decreased); and anxiety and learning & memory.

“One of the earliest signs is you’ll start to see a little confusion just like you do with people, they suddenly start to make some mistakes and things you wouldn’t expect them to do. Very similar to us,” Olby said.

Dogs may also lose learned behaviors, or forget their house training and begin to have unintentional accidents around the house, she added.

“A classic problem is wandering around and getting lost under the table or something — they just can’t process the information and figure out where they are. Changes in sleep cycle, increased anxiety, all of these things are classic signs of dementia,” she said.

Don’t assume that is what is wrong with your dog, however. Just like in people, other health problems such as metabolic disease, urinary tract infections or even brain tumors can mimic classic signs of dementia.

“High blood pressure can make dogs anxious, for example,” Olby said, “so a vet needs to thoroughly check the dog to rule out disease.”

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Don’t use sugar substitutes for weight loss, World Health Organization advises | CNN



CNN
 — 

Don’t use sugar substitutes if you are trying to lose weight, according to new guidance from the World Health Organization.

The global health body said a systematic review of the available evidence suggests the use of non-sugar sweeteners, or NSS, “does not confer any long-term benefit in reducing body fat in adults or children.”

“Replacing free sugars with non-sugar sweeteners does not help people control their weight long-term,” said Francesco Branca, director of WHO’s department of nutrition and food safety. “We did see a mild reduction of body weight in the short term, but it’s not going to be sustained.”

The guidance applies to all people except those with preexisting diabetes, Branca said. Why? Simply because none of the studies in the review included people with diabetes, and an assessment could not be made, he said.

The review also indicated that there might be “potential undesirable effects” from the long-term use of sugar substitutes such as a mildly increased risk of type 2 diabetes and cardiovascular diseases.

However, “this recommendation is not meant to comment on safety of consumption,” Branca said. “What this guideline says is that if we’re looking for reduction of obesity, weight control or risk of noncommunicable diseases, that is unfortunately something science been unable to demonstrate,” he said. “It’s not going to produce the positive health effects that some people might be looking for.”

Non-sugar sweeteners are widely used as an ingredient in prepackaged foods and beverages and are also sometimes added to food and drinks directly by consumers. WHO issued guidelines on sugar intake in 2015, recommending that adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. Following that recommendation, interest in sugar alternatives intensified, the review said.

“This new guideline is based on a thorough assessment of the latest scientific literature, and it emphasises that the use of artificial sweeteners is not a good strategy for achieving weight loss by reducing dietary energy intake,” said nutrition researcher Ian Johnson, emeritus fellow at Quadram Institute Bioscience, formerly the Institute of Food Research, in Norwich, United Kingdom.

“However, this should not be interpreted as an indication that sugar intake has no relevance to weight-control,” Johnson said in a statement.

Instead, one should cut back on using sugar-sweetened drinks, and try to use “raw or lightly processed fruit as a source of sweetness,” Johnson added.

Dr. Keith Ayoob, scientific adviser for the Calorie Control Council, an international association representing the low-calorie food and beverage industry, told CNN via email the WHO’s “insistence on focusing only on prevention of unhealthy ‎weight gain and non-communicable diseases is at the very least, misguided.”

Robert Rankin, president of the Calorie Control Council, said “low- and no-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases.”

The guidance is meant for government health organizations in countries who may wish to use the scientific analysis to implement policy changes for their citizens, Branca said.

“That will likely depend on the way that which sweeteners are consumed in a specific country,” he said. “For example, in a country where consumption patterns are high, those countries might decide to take action in a way or another.”

A total of 283 studies were included in the review. Both randomized controlled trials, considered the gold standard of research, and observational studies were included. Observational studies can only show an association, not direct cause and effect.

Results from randomized trials found the use of non-sugar sweeteners had a “low” impact on reducing body weight and calorie intake when compared with sugar, and no change in Intermediate markers of diabetes such as glucose and insulin, according to the report.

Observational studies also found a low impact on body weight and fat tissue, but no change in calorie intake. However, those studies found a low increase in risk for type 2 diabetes, high blood pressure, stroke, heart disease and death from heart disease, the report noted. A very low risk was also found for bladder cancer and an early death from any cause.

WHO said that the recommendation was “conditional” because the identified link between sweeteners and disease outcomes might be confounded by complicated patterns of sweetener use and the characteristics of the study participants.

In an emailed statement, the International Sweeteners Association, an industry assocation, said “it is a disservice to not recognise the public health benefits of low/no calorie sweeteners and is disappointed that the WHO’s conclusions are largely based on low certainty evidence from observational studies, which are at high risk of reverse causality.”

However, observational studies that follow people over time are important, Branca said. “To show that overweight people can reduce their body weight requires a long-term study. And we’re not seeing that impact from the research we have.”

The recommendation included low or no calorie synthetic sweeteners and natural extracts, which may or may not be chemically modified, such as acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives and monkfruit, the report said.

“Stevia and monkfruit are newer sweeteners so so there’s less published research in the scientific literature,” Branca said. “However they probably work in the body with a similar physiological mechanism as other sweeteners. We cannot say they are different from the others based on the data we have — they play the same role.”

Many people consider stevia products to be more “natural,” since they are derived from the stevia plant. Some natural and artificial sweeteners add bulking sugars to their products to cut their sweetness and add bulk to the product for baking.

A recent study by researchers at the US-based Cleveland Clinic found erythritol — used to add bulk or sweeten stevia, monkfruit and keto reduced-sugar products — was linked to blood clotting, stroke, heart attack and early death.

People with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had the highest levels of erythritol in their blood, the study found.

Just as many people have learned to eat and cook without salt, they can learn to reduce their dependence on free sugars and non-nutritive sweetners, Branca said.

“We need to target children in early life,” he said. “For example, why do parents typically use sweeteners as a reward for children and after almost every meal? We need to recommend to parents to avoid building that sweetness Interest in young children — that’s a very important action to take.”

Even if you are a true sugar “addict,” the good news is that you can tame your sweet tooth, registered dietitian Lisa Drayer said in an article for CNN. She provides the following steps:

Train your taste buds. If you gradually cut back on sugar — including artificial sweeteners — and include more protein and fiber-rich foods in your diet, that can help you crave less sugar, Drayer said.

“When we consume protein and fiber, it slows the rise in blood sugar if we consume it with a sugar-containing food. It can help satisfy us and help us reduce our sugar intake as well,” she said in a previous interview.

Choose no-sugar-added foods and avoid all sugar-sweetened drinks. For example, choose whole-grain cereal or Greek yogurt with no sweeteners. The sugar-sweetened drinks to take off your grocery list should include sodas, energy drinks, sports drinks and fruit punch. Choose water instead.

“If you like sweet carbonated beverages, add a splash of cranberry or orange juice to seltzer or try flavored seltzers. You can also flavor your own waters with fruit slices for natural sweetness or try herbal fruit teas,” Drayer said.

Drink coffee and tea with no or fewer sugars. Be careful at coffee shops, Drayer suggested. All those lattes and flavored coffees can have as much sugar as a can of soda, or more.

Enjoy fruit for dessert. Try cinnamon baked apples, berries or grilled peaches instead of cookies, cake, ice cream, pastries and other sweet treats, Drayer said.

Watch for stealth sugars. Added sugars are often present in foods that you might not think of as “sweet,” like sauces, breads, condiments and salad dressings, Drayer said.

“Pre-packaged sauces — like ketchup, BBQ sauce and tomato sauce — tend to be some of the biggest offenders of hidden added sugars in the diet,” Kristi King, senior pediatric dietitian at Texas Children’s Hospital and a national spokesperson for the Academy of Nutrition and Dietetics, told Drayer in a prior interview.

Check nutrition facts labels. All foods and beverages must list the amount and kind of sugar on the label.

Added sugars can go by other names such as “agave, brown sugar, corn sweetener, corn syrup, dextrose, evaporated cane juice, fructose, fruit juice concentrate, fruit nectar, glucose, high-fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose, molasses, maple syrups, raw sugar, sucrose, trehalose and turbinado sugar,” Drayer said.

The higher up these added sugars are on the ingredients list, the greater the amount of added sugar in the product, she said.

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Covid-19 is no longer a public health emergency, but others remain | CNN



CNN
 — 

The Covid-19 pandemic hit a major milestone this month as public health emergency declarations were ended by both the United States government and the World Health Organization. Emergency declarations for mpox also recently ended.

This doesn’t mean Covid-19 and mpox are no longer of concern, but it does mark the end of the availability of certain logistical capabilities to manage them.

Still, other critical health challenges were identified as health emergencies years before the start of the Covid-19 pandemic and continue to be so: the opioid crisis in the US and the global spread of poliovirus.

Some public health concerns can be serious health threats without a formal emergency declaration, said Dr. Tom Frieden, former director of the US Centers for Disease Control and Prevention.

It largely boils down to the logistics of government operations.

“When there’s an unusual situation that requires multiple parts of an agency or multiple parts of the government or multiple parts of society to come together and coordinate, collaborate and work efficiently, then an emergency declaration can be a useful tool,” said Frieden, president and CEO of Resolve to Save Lives, an organization focused on global epidemic prevention and cardiovascular health.

“Sometimes, an emergency is declared to make the point that it’s a big problem, to get people’s attention. Sometimes, an emergency is declared to get things done because that’s the only way you can bring certain governmental capacities to bear.”

According to WHO, a public health emergency of international concern is “an extraordinary event” that poses public health risk through the international spread of disease.

It creates an agreement between countries to abide by WHO’s recommendations for managing the emergency, often requiring a “coordinated international response.” Each country, in turn, declares its own public health emergency – declarations that carry legal weight. Countries use them to marshal resources and waive rules in order to ease a crisis.

In the US, the secretary of the Department of Health and Human Services can declare a public health emergency for diseases or disorders that pose a threat, including “significant outbreaks” of an infectious disease, bioterrorist attacks or otherwise.

This triggers the availability of a set of resources and actions for the federal government, such as additional funds and data and reporting requirements.

Emergency declarations typically last up to 90 days, with formal renewal required as necessary every three months after that.

The opioid crisis was determined to be a public health emergency in October 2017, during the Trump administration, driven by the rising rates of opioid-related deaths and opioid use disorder.

The declaration has been renewed for more than five years, most recently at the end of March.

According to the CDC, the opioid epidemic started in 1999 with a rise in prescription opioid overdose deaths. Deaths started to increase precipitously as synthetic opioids – particularly fentanyl – started to take over in 2013.

In 2021, overdose deaths reached record levels in the US, and about three-quarters – more than 80,000 deaths – involved opioids.

Within the first year of the opioid emergency declaration, HHS used expanded authorities to field a survey about treatment for opioid use disorder among providers and to expedite research on the topic.

Public health emergencies are also declared to help with recovery after natural disasters, most recently for severe storms that hit Mississippi in March.

However, the Government Accountability Office considers both federal management of the public health emergency system and efforts to combat drug misuse to be “high-risk” areas that are vulnerable or in need of broad reform.

In a recent report, the federal watchdog group said that it has found “persistent deficiencies in HHS’s leadership role preparing for and responding to public health emergencies” and no demonstrated progress in federal agencies’ actions to address drug misuse.

WHO has considered poliovirus a public health emergency of international concern since 2014.

A committee formed to address the emergency reviewed the most recent data on cases and spread this month and voted unanimously that ongoing risks merited an extension of the emergency declaration, which the director-general formalized Friday.

The committee was “encouraged by reported progress” but says that risks remain high for factors including weak vaccination rates that could have been affected by the Covid-19 pandemic.

WHO identified seven counties with potential risk for international spread. And the US is among a group of 37 countries with recently detected cases.

In July, a polio case identified in New York became the first in the US in nearly a decade. The identified case, along with several positive wastewater tests in nearby communities, met WHO criteria to consider the US a country with circulating poliovirus.

Experts warned that it could just be the “tip of the iceberg,” with hundreds of cases spreading silently.

Childhood vaccination rates in the US dropped during the Covid-19 pandemic. A CDC report found that about 93% of kindergarteners enrolled in the 2021-22 school year got the required vaccines, including measles, mumps and rubella (MMR); diphtheria, tetanus and acellular pertussis (DTaP); and polio. Coverage fell for the second year in a row amid the pandemic, from about 94% the previous year and below the federal target of 95%.

While no longer under a formal emergency declaration, Covid-19 continues to be part of the “landscape of health threats,” Frieden said.

But the efficiency and coordination that the formal declaration helps facilitate should always be the goal.

“I think there are really important lessons from Covid, including the need to have a much more resilient public health system so that we can find problems quickly and implement effective solutions quickly,” Frieden said.

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Sleeping will be one of the challenges for astronauts on Mars missions | CNN

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CNN
 — 

Astronauts have been adjusting to the challenges of sleeping in space for years — and the lessons learned from their zero gravity slumbers will ensure that one day the first crewed missions to Mars will have gotten enough rest before exploring the red planet.

Rotating crews have spent an average of six months living and working aboard the International Space Station for nearly 23 years, and they struggle with sleep issues just like people on Earth. Some of the challenges are similar to those of shift workers or people with abnormal schedules, but others are more unique to the space environment.

NASA astronaut Josh Cassada is bundled up in his crew quarters on the International Space Station on March 2.

For example, most people don’t have to worry about floating away from their beds due to zero gravity. Don’t worry — astronauts use special restraints to keep them from floating through the space station while asleep.

Two of the biggest challenges for astronauts include their sleep environment and the establishment of a natural sleep cycle.

Astronauts have dark, quiet and private crew quarters on the space station conducive to good sleep — but that won’t always be the case on other space missions, said Dr. Erin Flynn-Evans, director of the Fatigue Countermeasures Laboratory at NASA’s Ames Research Center in Mountain View, California.

Like their historic Apollo predecessors, the Orion capsules that will be used during future Artemis missions to the moon are small vehicles with limited space for crews and sleeping bags for rest periods.

“I think of it like camping,” Flynn-Evans said. “If it’s for a couple days, probably no big deal. But the longer you’re in close quarters with someone, the more disruptive that can be.”

While the space station affords incredible views of Earth, the 16 sunrises an astronaut witnesses a day can wreak havoc on circadian rhythm, the body’s natural clock for sleeping and waking.

On Earth, disruptions to circadian rhythm occur for people who work overnight shifts or experience jet lag while traveling across time zones.

“Light is what resets our circadian rhythm and keeps us organized to that day-night cycle, but in space we have several challenges,” Flynn-Evans said.

The space station orbits around Earth every 90 minutes, creating alternating cycles of darkness and light. Rather than force the astronauts to adapt to such a strange cycle, experts at NASA have added lighting to the interior of the space station that mimics what people experience during a normal day on Earth.

“We have to try to block out the light from windows during the night,” she said, “and we have to really try to maximize the light either through windows or with internal lighting to make sure the crew are getting that synchronizing stimulus so that they’re able to stay awake and asleep at the right time.”

Jet lag begins before astronauts ever arrive at the space station, and their sleep schedules are shifted for days before liftoff based on the time of day and time zone from which they will launch. Once they reach the space station, each astronaut is shifted to Greenwich Mean Time, “a nice middle ground between all of the countries that participate,” Flynn-Evans said.

At the Fatigue Countermeasures Laboratory, Flynn-Evans and her colleagues develop tools to help astronauts overcome sleep challenges. Some of the strategies involve managing when the astronauts are exposed to blue light, the primary synchronizing wavelength for the circadian system, and when to reduce blue light to help them sleep.

Astronauts have regimented schedules, but the arrival of resupply missions or new crews sometimes interrupt those. Flynn-Evans and other researchers develop approaches to shifting sleep safely for the astronauts, such as determining when to take naps or stay up later to accommodate schedule changes.

The same tips that help astronauts sleep also apply on Earth, including following a regular schedule with waking and falling asleep at the same time as much as possible and limiting exposure to blue light before going to bed, which is emitted by LED TVs, smartphones, computers and tablets.

Although scientists have sleep data from years of spaceflight, conducting simulated missions on Earth allow for more control.

“We do fake space missions all the time,” Flynn-Evans said. “We have what we call an analog space environment at Johnson Space Center called the Human Exploration Research Analog or HERA, and that’s basically a small habitat.”

The CHAPEA crew will live in a habitat with individual quarters at NASA's Johnson Space Center in Houston.

The habitat mimics the size of a lunar base or small spacecraft and can house crews of four people for long periods of time. Flynn-Evans was involved in a study in which crews spent 45 days in the habitat and were restricted to five hours of sleep on weeknights and eight hours on weekends. The participants were tested for alertness and performance.

Findings from the experiment showed that if crew members only got five hours of sleep one night, they needed more opportunities to catch up on sleep on subsequent nights to prevent the ill effects of sleep deprivation. The current requirement is that crew members get 8½ hours of sleep per night on missions to avoid long-term sleep loss, fatigue-induced errors and health complications, according to NASA.

In June, NASA will begin the first experiment in a new 3D-printed Martian habitat at Johnson Space Center called the Crew Health and Performance Exploration Analog, or CHAPEA.

Over the course of one year, a four-person crew will live and work inside a 1,700-square-foot (158-square-meter) space to simulate living on Mars. The focus for the first experiment is nutrition, but Flynn-Evans and her fellow researchers will also monitor how well the crew sleeps.

Habitats such as HERA and CHAPEA allow scientists to simulate surprises that may happen on a real mission to the moon or Mars, such as limited resources, failing equipment, communication issues and other stressors of small habitats.

An unexpectedly rich source of sleep data has proven to be studying the Earth-bound scientists and engineers who work on Mars missions such as the Perseverance rover.

A day on Mars lasts about 39 minutes longer than one on Earth, but it’s just enough that the members of Mars mission control have to adjust their schedules constantly to stay on Perseverance’s timetable.

“If you’re shifting 39 minutes a day, that means that you’re basically going to bed 39 minutes later every day,” Flynn-Evans said. “It doesn’t seem that bad on a single night. But after five days, it’s like you’ve crossed like six time zones. It’s a real stressor on the body.”

Many unknowns still exist about being on “Mars time,” such as how the time shift affects the human body’s metabolism.

Understanding how people on Earth adapt to live on Mars time is one way of preparing for future missions to the red planet. Flynn-Evans and her team are working closely with those planning the Artemis lunar missions to optimize the astronauts’ schedules and ensure that the lighting is sufficient and the noise is dampened inside Orion when they need to sleep.

Researchers also want to study how much caffeine astronauts require for alertness to make sure crews don’t run out of coffee in a spacecraft with limited storage.

“Sleep is intimately tied with performance, alertness, interpersonal communication and relationships,” Flynn-Evans said, “so we want to make sure that the crews are set up for success and getting that sleep they need.”

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How the nursing shortage may lead to gaps in sexual assault care | CNN


Missoula, Montana
KFF Health News
 — 

Jacqueline Towarnicki got a text as she finished her day shift at a local clinic. She had a new case, a patient covered in bruises who couldn’t remember how the injuries got there.

Towarnicki’s breath caught, a familiar feeling after four years of working night shifts as a sexual assault nurse examiner in this northwestern Montana city.

“You almost want to curse,” Towarnicki, 38, said. “You’re like, ‘Oh, no, it’s happening.’”

These nights on duty are Towarnicki’s second job. She’s on call once a week and a weekend a month. A survivor may need protection against sexually transmitted infections, medicine to avoid getting pregnant, or evidence collected to prosecute their attacker. Or all the above.

When her phone rings, it’s typically in the middle of the night. Towarnicki tiptoes down the stairs of her home to avoid waking her young son, as her half-asleep husband whispers encouragement into the dark.

Her breath is steady by the time she changes into the clothes she laid out close to her back door before going to bed. She grabs her nurse’s badge and drives to First Step Resource Center, a clinic that offers round-the-clock care for people who have been assaulted.

She wants her patients to know they’re out of danger.

“You meet people in some of their most horrifying, darkest, terrifying times,” Towarnicki said. “Being with them and then seeing who they are when they leave, you don’t get that doing any other job in health care.”

A former travel nurse who lived out of a van for years, Towarnicki is OK with the uncertainty that comes with being a sexual assault nurse examiner.

Most examiners work on-call shifts in addition to full-time jobs. They often work alone and at odd hours. They can collect evidence that could be used in court, are trained to recognize and respond to trauma, and provide care to protect their patients’ bodies from lasting effects of sexual assault.

But their numbers are few.

As many as 80% of U.S. hospitals don’t have sexual assault nurse examiners, often because they either can’t find them or can’t afford them. Nurses struggle to find time for shifts, especially when staffing shortages mean covering long hours. Sexual assault survivors may have to leave their town or even their state to see an examiner.

Gaps in sexual assault care can span hundreds of miles in rural areas. A program in Glendive, Montana — a town of nearly 5,000 residents 35 miles from the North Dakota border — stopped taking patients for examinations this spring. It didn’t have enough nurses to respond to cases.

“These are the same nurses working in the ER, where a heart attack patient could come in,” said Teresea Olson, 56, who is the town’s part-time mayor and also picked up on-call shifts. “The staff was exhausted.”

The next closest option is 75 miles away in Miles City, adding at least an hour to the travel time for patients, some of whom already had to travel hours to reach Glendive.

Nationwide, policymakers have been slow to offer training, funding, and support for the work. Some states and health facilities are trying to expand access to sexual assault response programs.

Oklahoma lawmakers are considering a bill to hire a statewide sexual assault coordinator tasked with expanding training and recruiting workers. A Montana law that takes effect July 1 will create a sexual assault response network within the Montana Department of Justice. The new program aims to set standards for that care, provide in-state training, and connect examiners statewide. It will also look at telehealth to fill in gaps, following the example of hospitals in South Dakota and Colorado.

There’s no national tally of where nurses have been trained to respond to sexual assaults, meaning a survivor may not know they have to travel for treatment until they’re sitting in an emergency room or police department.

Sarah Wangerin, a nursing instructor with Montana State University and former examiner, said patients reeling from an attack may instead just go home. For some, leaving town isn’t an option.

This spring, Wangerin called county hospitals and sheriff’s offices to map where sexual assault nurse examiners operate in Montana. She found only 55. More than half of the 45 counties that responded didn’t have any examiners. Just seven counties reported they had nurses trained to respond to cases that involve children.

“We’re failing people,” Wangerin said. “We’re re-traumatizing them by not knowing what to do.”

First Step, in Missoula, is one of the few full-time sexual assault response programs in the state. It’s operated by Providence St. Patrick Hospital but is separate from the main building.

The clinic’s walls are adorned with drawings by kids and mountain landscapes. The staff doesn’t turn on the harsh overhead fluorescent lights, choosing instead to light the space with softer lamps. The lobby includes couches and a rocking chair. There are always heated blankets and snacks on hand.

Kate Harrison turns on her pager at the start of her night shift as a sexual assualt nurse examiner.

First Step stands out for having nurses who stay. Kate Harrison waited roughly a year to join the clinic and is still there three years later, in part because of the staff support.

The specially trained team works together so no one carries too heavy a load. While being on night shift means opening the clinic alone, staffers can debrief tough cases together. They attend group therapy for secondhand trauma.

Harrison is a cardiac hospital nurse during the day, a job that sometimes feels a little too stuck to a clock.

At First Step, she can shift into whatever role her patient needs for as long as they need. Once, that meant sitting for hours on a floor in the lobby of the clinic as a patient cried and talked. Another time, Harrison doubled as a DJ for a nervous patient during an exam, picking music off her cellphone.

“It’s in the middle of the night, she just had this sexual assault happen, and we were just laughing and singing to Shaggy,” Harrison said. “You have this freedom and grace to do that.”

When the solo work is overwhelming or she’s had back-to-back cases and needs a break, she knows a co-worker would be willing to help.

“This work can take you to the undercurrents and the underbelly of society sometimes,” Harrison said. “It takes a team.”

That includes co-workers like Towarnicki, who dropped her work hours at her day job after having her son to keep working as a sexual assault nurse examiner. That meant adding three years to her student loan repayment schedule. Now, pregnant with her second child, the work still feels worth it, she said.

On a recent night, Towarnicki was alone in the clinic, clicking through photos she took of her last patient. The patient opted against filing a police report but asked Towarnicki to log all the evidence just in case.

Towarnicki quietly counted out loud the number of bruises, their sizes and locations, as she took notes. She tells patients who have gaps in their memories that she can’t speculate how each mark got there or give them all the answers they deserve.

But as she sat in the blue light of her computer screen long after her patient left, it was hard to keep from ruminating.

“Totally looks like a hand mark,” Towarnicki said, suddenly loud, as she shook her head.

All the evidence and her patient’s story were sealed and locked away, just feet from a wall of thank-you cards from patients and sticky notes of encouragement among nurses.

On the harder evenings, Towarnicki takes a moment to unwind with a pudding cup from the clinic’s snacks. Most often, she can let go of her patient’s story as she closes the clinic. Part of her healing is “seeing the light returned to people’s eyes, seeing them be able to breathe deeper,” which she said happens 19 out of 20 times.

“There is that one out of 20 where I go home and I am spinning,” Towarnicki said. In those cases, it takes hearing her son’s voice, and time to process, to pull her back. “I feel like if it’s not hard sometimes, maybe you shouldn’t be doing this work.”

It was a little after 11 p.m. as Towarnicki headed home, an early night. She knew her phone could go off again.

Eight more hours on call.

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