Don’t serve disordered eating to your teens this holiday season | CNN

Editor’s Note: Katie Hurley, author of “No More Mean Girls: The Secret to Raising Strong, Confident and Compassionate Girls,” is a child and adolescent psychotherapist in Los Angeles. She specializes in work with tweens, teens and young adults.



CNN
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“I have a couple of spots for anyone who wants to lose 20 pounds by the holidays! No diets, exercise, or cravings!”

Ads for dieting and exercise programs like this started appearing in my social media feeds in early October 2022, often accompanied by photos of women pushing shopping carts full of Halloween candy intended to represent the weight they no longer carry with them.

Whether it’s intermittent fasting or “cheat” days, diet culture is spreading wildly, and spiking in particular among young women and girls, a population group who might be at particular risk of social pressures and misinformation.

The fact that diet culture all over social media targets grown women is bad enough, but such messaging also trickles down to tweens and teens. (And let’s be honest, a lot is aimed directly at young people too.) It couldn’t happen at a worse time: There’s been a noticeable spike in eating disorders, particularly among adolescent girls, since the beginning of the pandemic.

“My mom is obsessed with (seeing) her Facebook friends losing tons of weight without dieting. Is this even real?” The question came from a teen girl who later revealed she was considering hiring a health coach to help her eat ‘healthier’ after watching her mom overhaul her diet. Sadly, the coaching she was falling victim to is part of a multilevel marketing brand that promotes quick weight loss through caloric restriction and buying costly meal replacements.

Is it real? Yes. Is it healthy? Not likely, especially for a growing teen.

Later that week, a different teen client asked about a clean eating movement she follows on Pinterest. She had read that a strict clean vegan diet is better for both her and the environment, and assumed this was true because the pinned article took her to a health coaching blog. It seemed legitimate. But a deep dive into the blogger’s credentials, however, showed that the clean eating practices they shared were not actually developed by a nutritionist.

And another teen, fresh off a week of engaging in the “what I eat in a day” challenge — a video trend across TikTok, Instagram and other social media platforms where users document the food they consume in a particular timeframe — told me she decided to temporarily mute her social media accounts. Why? Because the time she’d spent limited her eating while pretending to feel full left her exhausted and unhappy. She had found the trend on TikTok and thought it might help her create healthier eating habits, but ended up becoming fixated on caloric intake instead. Still, she didn’t want her friends to see that the challenge actually made her feel terrible when she had spent a whole week promoting it.

During any given week, I field numerous questions from tweens and teens about the diet culture they encounter online, out in the world, and sometimes even in their own homes. But as we enter the winter holiday season, shame-based diet culture pressure, often wrapped up with toxic positivity to appear encouraging, increases.

“As we approach the holidays, diet culture is in the air as much as lights and music, and it’s certainly on social media,” said Dr. Hina Talib, an adolescent medicine specialist and associate professor of pediatrics at the Albert Einstein College of Medicine in The Bronx, New York. “It’s so pervasive that even if it’s not targeted (at) teens, they are absorbing it by scrolling through it or hearing parents talk about it.”

Social media isn’t the only place young people encounter harmful messaging about body image and weight loss. Teens are inundated with so-called ‘healthy eating’ content on TV and in popular culture, at school and while engaged in extracurricular or social activities, at home and in public spaces like malls or grocery stores — and even in restaurants.

Instead of learning how to eat to fuel their bodies and their brains, today’s teens are getting the message that “clean eating,” to give just one example of a potentially problematic dietary trend, results in a better body — and, by extension, increased happiness. Diets cutting out all carbohydrates, dairy products, gluten, and meat-based proteins are popular among teens. Yet this mindset can trigger food anxiety, obsessive checking of food labels and dangerous calorie restriction.

An obsessive focus on weight loss, toning muscles and improving overall looks actually runs contrary to what teens need to grow at a healthy pace.

“Teens and tweens are growing into their adult bodies, and that growth requires weight gain,” said Oona Hanson, a parent coach based in Los Angeles. “Weight gain is not only normal but essential for health during adolescence.”

The good news in all of this is that parents can take an active role in helping teens craft an emotionally healthier narrative around their eating habits. “Parents are often made to feel helpless in the face of TikTokers, peer pressure or wider diet culture, but it’s important to remember this: parents are influencers, too,” said Hanson. What we say and do matters to our teens.

Parents can take an active role in helping teens craft an emotionally healthier narrative around their eating habits.

Take a few moments to reflect on your own eating patterns. Teens tend to emulate what they see, even if they don’t talk about it.

Parents and caregivers can model a healthy relationship with food by enjoying a wide variety of foods and trying new recipes for family meals. During the holiday season, when many celebrations can involve gathering around the table, take the opportunity to model shared connections. “Holidays are a great time to remember that foods nourish us in ways that could never be captured on a nutrition label,” Hanson said.

Practice confronting unhealthy body talk

The holiday season is full of opportunities to gather with friends and loved ones to celebrate and make memories, but these moments can be anxiety-producing when nutrition shaming occurs.

When extended families gather for holiday celebrations, it’s common for people to comment on how others look or have changed since the last gathering. While this is usually done with good intentions, it can be awkward or upsetting to tweens and teens.

“For young people going through puberty or body changes, it’s normal to be self-conscious or self-critical. To have someone say, ‘you’ve developed’ isn’t a welcome part of conversations,” cautioned Talib.

Talib suggests practicing comebacks and topic changes ahead of time. Role play responses like, “We don’t talk about bodies,” or “We prefer to focus on all the things we’ve accomplished this year.” And be sure to check in and make space for your tween or teen to share and feelings of hurt and resentment over any such comments at an appropriate time.

Open and honest communication is always the gold standard in helping tweens and teens work through the messaging and behaviors they internalize. When families talk about what they see and hear online, on podcasts, on TV, and in print, they normalize the process of engaging in critical thinking — and it can be a really great shared connection between parents and teens.

“Teaching media literacy skills is a helpful way to frame the conversation,” says Talib. “Talk openly about it.”

She suggests asking the following questions when discussing people’s messaging around diet culture:

● Who are they?

● What do you think their angle is?

● What do you think their message is?

● Are they a medical professional or are they trying to sell you something?

● Are they promoting a fitness program or a supplement that they are marketing?

Talking to tweens and teens about this throughout the season — and at any time — brings a taboo topic to the forefront and makes it easier for your kids to share their inner thoughts with you.

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Nearly two years after Texas’ six-week abortion ban, more infants are dying | CNN



CNN
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Texas’ abortion restrictions – some of the strictest in the country – may be fueling a sudden spike in infant mortality as women are forced to carry nonviable pregnancies to term.

Some 2,200 infants died in Texas in 2022 – an increase of 227 deaths, or 11.5%, over the previous year, according to preliminary infant mortality data CNN obtained through a public records request. Infant deaths caused by severe genetic and birth defects rose by 21.6%. That spike reversed a nearly decade-long decline. Between 2014 and 2021, infant deaths had fallen by nearly 15%.

In 2021, Texas banned abortions beyond six weeks of pregnancy. When the Supreme Court overturned federal abortion rights the following summer, a trigger law in the state banned all abortions other than those intended to protect the life of the mother.

The increase in deaths could partly be explained by the fact that more babies are being born in Texas. One recent report found that in the final nine months of 2022, the state saw nearly 10,000 more births than expected prior to its abortion ban – an estimated 3% increase.

But multiple obstetrician-gynecologists who focus on high-risk pregnancies told CNN that Texas’ strict abortion laws likely contributed to the uptick in infant deaths.

“We all knew the infant mortality rate would go up, because many of these terminations were for pregnancies that don’t turn into healthy normal kids,” said Dr. Erika Werner, the chair of obstetrics and gynecology at Tufts Medical Center. “It’s exactly what we all were concerned about.”

The issue of forcing women to carry out terminal and often high-risk pregnancies is at the core of a lawsuit filed by the Center for Reproductive Rights, with several women – who suffered difficult pregnancies or infant deaths shortly after giving birth – testifying in Travis County court this week.

Prior to the recent abortion restrictions, Texas banned the procedure after 20 weeks. This law gave parents more time to learn crucial information about a fetus’s brain formation and organ development, which doctors begin to test for at around 15 weeks.

Samantha Casiano, a plaintiff in the suit filed against Texas, wished she’d had more time to make the decision.

“If I was able to get the abortion with that time, I think it would have meant a lot to me because my daughter wouldn’t have suffered,” Casiano said.

When Casiano was 20 weeks pregnant, a routine scan came back with devastating news: Her baby would be stillborn or die shortly after birth.

The fetus had anencephaly, a rare birth defect that keeps the brain and skull from developing during pregnancy. Babies with this condition are often stillborn, though they sometimes live a few hours or days. Many women around the country who face the prospect choose abortion, two obstetrician-gynecologists told CNN.

But Casiano lived in Texas, where state legislators had recently banned most abortions after six weeks of pregnancy. She couldn’t afford to travel out of the state for the procedure.

“You have no options. You will have to go through with your pregnancy,” Casiano’s doctor told her, she claimed in the lawsuit.

In March, Casiano gave birth to her daughter Halo. After gasping for air for four hours, the baby died, Casiano said during her testimony on Wednesday.

“All she could do was fight to try to get air. I had to watch my daughter go from being pink to red to purple. From being warm to cold,” said Casiano. “I just kept telling myself and my baby that I’m so sorry that this had to happen to you.”

Casiano and 14 others – including two doctors – are plaintiffs in the lawsuit. They allege the abortion ban has denied them or their patients access to necessary obstetrical care. The plaintiffs are asking the courts to clarify when doctors can make medical exceptions to the state’s ban.

Casiano and two other plaintiffs testified Wednesday about hoping to deliver healthy babies but instead learning their lives or pregnancies were in danger.

 Plaintiffs Anna Zargarian, Lauren Miller, Lauren Hall, and Amanda Zurawski at the Texas State Capitol after filing a lawsuit on behalf of Texans harmed by the state's abortion ban on March 7 in Austin, Texas.

“This was just supposed to be a scan day,” Casiano told the court. “It escalated to me finding out my daughter was going to die.”

Lawyers representing the state argued Wednesday that the plaintiffs’ doctors were to blame, saying they misinterpreted the law and failed to provide adequate care for such high-risk pregnancies.

“Plaintiffs will not and cannot provide any evidence of any medical provider in the state of Texas being prosecuted or otherwise penalized for performance of an abortion using the emergency medical exemption,” a lawyer said during the state’s opening statement.

Kylie Beaton, another plaintiff, also had to watch her baby die. Beaton, who didn’t testify this week, learned during a 20-week scan that something was wrong with her baby’s brain, according to the suit.

The doctor diagnosed the fetus with alobar holoprosencephaly, a condition where the two hemispheres of the brain don’t properly divide. Babies with this condition are often stillborn or die soon after birth.

Beaton’s doctor told her he couldn’t provide an abortion unless she was severely ill, or the fetus’s heart stopped. Beaton and her husband sought to obtain an abortion out of state. However, the fetus’s head was enlarged due to its condition, and the only clinic that would perform an abortion charged up to $15,000. Beaton and her husband couldn’t afford it.

Instead, Beaton gave birth to a son she named Grant. The baby cried constantly, wouldn’t eat, and couldn’t be held upright for fear it would put too much pressure on his head, according to the suit. Four days later, Grant died.

Amanda Zurawski of Austin, Texas, center, is the lead plaintiff in the lawsuit.

Experts say that abortion bans in states like Texas lead to increased risk for both babies and mothers.

Maternal mortality has long been a top concern for doctors and health-rights activists. Even before the Supreme Court decision, the United States had the highest maternal mortality rate among wealthy nations, one study found.

Amanda Zurawski, the lawsuit’s lead plaintiff, testified Wednesday that her water broke 18 weeks into her pregnancy, putting her at high risk for a life-threatening infection. Zurawski’s baby likely wouldn’t survive.

But the fetus still had a heartbeat, and so doctors said they were unable to terminate the pregnancy. She received an emergency abortion only after her condition worsened and she went into septic shock.

Zurawski described during Wednesday’s hearing how her family visited the hospital, fearing it would be the last time they would see her. Zurawski has argued that had she been able to obtain an abortion, her life wouldn’t have been in jeopardy in the same way.

“I blame the people who support these bans,” Zurawski said.

Zurawski previously said the language in Texas’ abortion laws is “incredibly vague, and it leaves doctors grappling with what they can and cannot do, what health care they can and cannot provide.”

Pregnancy is dangerous, and forcing a woman to carry a non-viable pregnancy to term is unnecessarily risky when it’s clear the baby will not survive, argued Dr. Mae-Lan Winchester, an Ohio maternal-fetal medicine specialist.

“Pregnancy is one of the most dangerous things a person will ever go through,” Winchester said. “Putting yourself through that risk without any benefit of taking a baby home at the end, it’s … risking maternal morbidity and mortality for nothing.”

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A 45-year-old got pregnant in a state with a ban on abortions. She flew across the country to get one | CNN



CNN
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When 45-year-old Victoria realized she was five weeks late and the lines showed as positive on two pregnancy tests, the New Orleans resident dreamed up a plan to get an abortion.

Traveling out of state was the only abortion option for Victoria, who asked CNN to withhold her last name out of fear of backlash against her and her family. Louisiana is one of several states that have essentially banned all abortions.

“It was probably one of the hardest things I’ve had to go through, from the moment of discovering that I was pregnant at age 45 to actually having to have to take time off work, travel across the country, do a meeting with a doctor, and then take the pills and then skedaddle back home and then go to work like nothing had happened,” Victoria told CNN of her experience earlier this year.

Victoria’s story about the distance she traveled and the hardships she endured to get an abortion reflects a wider American reality, where women seeking the procedure must navigate through a patchwork of states with varying levels of access.

The average travel time to an abortion facility more than tripled, from less than 30 minutes to more than an hour and a half, after the US Supreme Court overturned Roe v. Wade in 2022, according to a November study in the Journal of the American Medical Association. And for women in Texas and Louisiana, average travel times to the nearest abortion facility were seven hours longer – almost a full workday in travel time to get an abortion.

Victoria says she was grateful she could drop everything and afford to spend $1,000 for the procedure, including same-week airfare with connections both ways and appointment and medication fees.

“It was so hard for me wrap my head around the fact that I was able to do this, but I’m one of the lucky ones and that there are so many women who are in much tighter positions,” Victoria said. “And, God, what are they going to do?”

Victoria says plans materialized quickly once she knew which states seemed more accessible.

She researched the parameters for abortion in a state, how long she would have to take off work, travel options and how soon she could get an appointment. She found abortionfinder.org to be a helpful and reliable source, she says.

“Because the situation is so fluid, it changes from day to day, that was really of paramount importance for me to be able to have a reliable source of information,” she said.

Driving to a neighboring state was not an option, as every state adjoining Louisiana has a similarly restrictive law that bans virtually all abortions. Victoria says she considered close states, like Florida, but she ultimately dismissed them because available appointments were farther out.

“Once I saw that Oregon was so, so protective of reproductive rights, I said, ‘Why would I think about going anywhere else?’” she said. “The second I got the definitive pregnancy result, I was like, ‘OK, let’s book a flight to Oregon. When can we do this?’”

She reached out to a friend from college and asked if she could stay with her, detailing the reason for her visit. She then made an appointment and booked a flight for that week, she says.

The provider sent instructions, including that the patient must be in Oregon for the telehealth appointment, according to documents provided to CNN. They contacted her within an hour of making the appointment to make sure she had proof of travel documents because she had made it from Louisiana, where the procedure is illegal.

Victoria planned to take a day off to fly across the country and work remotely for two days, which fits her hybrid work situation. She says she was grateful to have a supportive, female boss who showed understanding for why she had to take the unexpected time off.

“She was the only person I actually kind of broke down and cried for,” Victoria said. “I think it’s because I had been holding it back all week, and telling her was sort of the last thing that I needed to get in place before I could do everything.”

Victoria says the hardest part of her experience was telling her mother because she didn’t know how her mom would feel about it. Victoria and her siblings were raised Catholic. Her father had a strong faith and her mother was a non-practicing Catholic, her mother says. Victoria’s mom asked not to be named for privacy reasons.

Victoria’s mother says she wanted to support her daughter, even if she does not agree with what her daughter did. Victoria coming to her with tickets purchased and a full plan made it easy for her mother to support her, the mother says.

“I agreed to drive her to the airport and that that was the only thing I could do because this would be a real game-changing thing in her life,” her mother said. “I wanted to support what she wanted to do because she has supported me on several family crises. I just wanted to do it because I love her. “

Victoria said she appreciated her mom for being supportive in a way she didn’t expect. They talked about some of her mother’s friends who had abortions throughout the years, both say. Victoria’s mother even told her about when she tried to get her tubes tied, but her husband found out and she did not pursue it.

“I feel like, if anything, it’s made our relationship stronger,” Victoria said. “We already had a fantastically strong relationship, though. So, it’s another rock in the wall.”

After boarding early on a Wednesday in March, Victoria traveled for eight hours on two flights and landed in Portland, Oregon.

Victoria reunited with her friend, and they did the things that old friends do, from staying up late talking about college memories to talking about why Victoria was there. They both described the situation as surreal.

“The vast majority of reproductive conversations I have with friends at this point are people who are trying desperately to get pregnant,” said her friend, Emily, who asked that CNN not use her last name to keep Victoria’s privacy. “The sort of irony is that there could still be an unplanned pregnancy and it would still be just as devastating as it would have been when we were in our teens and twenties was kind of a shock to me.”

Emily, who has been friends with Victoria for about 25 years, says it took so little effort for her to drive to the airport and let her friend stay with her.

“I felt honored that she trusted me,” she said. “I was really proud of Victoria. I was impressed that she had taken this in stride and that she had reached out to someone she knew – I think a lot of people would have been ashamed or hidden it.”

After the telehealth appointment the next day, Victoria received an overnight package.

Victoria took two medications as part of a medication abortion. She took mifepristone at her friend’s home. The next day she took misoprostol before boarding her flight home – she was careful not to take them in her home state, where it’s illegal.

Misoprostol, taken after mifepristone, is a common combination prescribed for a medication abortion.

“It was like a heavy period,” she said. “I took some Aleve, had to get some extra jumbo pads, and I bled a lot on the flights home, but it was fine.”

Physically, she felt fine – it was more of what was happening psychologically that she noticed, she says.

“I had this feeling that I should be having some kind of deep, psychological moment of reckoning or something, but I didn’t really feel that,” Victoria said of the experience. “I’ve never wanted to have a kid. I wasn’t torn about this decision.”

When Victoria learned she was pregnant, a big part of the shock came from not thinking she could get pregnant at age 45, she says.

“You hear so much culturally out there about you’re in your forties, are told you’re too old to get pregnant and carry a child to term,” she said. “I feel like I had sort of a false sense of security.”

Victoria joked that she’s “careening toward menopause,” but she says she has not been diagnosed as perimenopausal.

Her pregnancy news came several months after she was treated for a uterine fibroid, a benign growth, in July 2022, according to medical records. Victoria also tested positive for a PALB2 gene mutation, which can lead to an increased chance of breast cancer, according to a study in the New England Journal of Medicine. She underwent a preventative double mastectomy and reconstruction earlier in 2022, according to medical records provided to CNN.

She says she got an excellent standard of care around her surgeries, but it felt dissonant with her state’s laws around abortion.

“It felt so surreal to get this really high standard of care around my secondary sexual characteristics, but then to have that freeze, slam shut when it comes to reproductive health, it just felt abrupt,” she said.

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Ebola Fast Facts | CNN



CNN
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Here’s a look at Ebola, a virus with a high fatality rate that was first identified in Africa in 1976.

Ebola hemorrhagic fever is a disease caused by one of five different Ebola viruses. Four of the strains can cause severe illness in humans and animals. The fifth, Reston virus, has caused illness in some animals, but not in humans.

The first human outbreaks occurred in 1976, one in northern Zaire (now Democratic Republic of the Congo) in central Africa: and the other, in southern Sudan (now South Sudan). The virus is named after the Ebola River, where the virus was first recognized in 1976, according to the Centers for Disease Control and Prevention (CDC).

Ebola is extremely infectious but not extremely contagious. It is infectious, because an infinitesimally small amount can cause illness. Laboratory experiments on nonhuman primates suggest that even a single virus may be enough to trigger a fatal infection.

Ebola is considered moderately contagious because the virus is not transmitted through the air.

Humans can be infected by other humans if they come in contact with body fluids from an infected person or contaminated objects from infected persons. Humans can also be exposed to the virus, for example, by butchering infected animals.

Symptoms of Ebola typically include: weakness, fever, aches, diarrhea, vomiting and stomach pain. Additional experiences include rash, red eyes, chest pain, throat soreness, difficulty breathing or swallowing and bleeding (including internal).

Typically, symptoms appear eight to 10 days after exposure to the virus, but the incubation period can span two to 21 days.

Ebola is not transmissible if someone is asymptomatic and usually not after someone has recovered from it. However, the virus has been found in the semen of men who have recovered from Ebola and possibly could be transmitted from contact with that semen.

There are five subspecies of the Ebola virus: Zaire ebolavirus (EBOV), Bundibugyo ebolavirus (BDBV), Sudan ebolavirus (SUDV), Taï Forest ebolavirus (TAFV) and Reston ebolavirus (RESTV).

Click here for the CDC’s list of known cases and outbreaks.

(Full historical timeline at bottom)

March 2014 – The CDC issues its initial announcement on an outbreak in Guinea, and reports of cases in Liberia and Sierra Leone.

April 16, 2014 – The New England Journal of Medicine publishes a report, speculating that the current outbreak’s Patient Zero was a 2-year-old from Guinea. The child died on December 6, 2013, followed by his mother, sister and grandmother over the next month.

August 8, 2014 – Experts at the World Health Organization (WHO) declare the Ebola epidemic ravaging West Africa an international health emergency that requires a coordinated global approach, describing it as the worst outbreak in the four-decade history of tracking the disease.

August 19, 2014 – Liberia’s President Ellen Johnson Sirleaf declares a nationwide curfew beginning August 20 and orders two communities to be completely quarantined, with no movement into or out of the areas.

September 16, 2014 – US President Barack Obama calls the efforts to combat the Ebola outbreak centered in West Africa “the largest international response in the history of the CDC.” Speaking from the CDC headquarters in Atlanta, Obama adds that “faced with this outbreak, the world is looking to” the United States to lead international efforts to combat the virus.

October 6, 2014 – A nurse’s assistant in Spain becomes the first person known to have contracted Ebola outside Africa in the current outbreak. The woman helped treat two Spanish missionaries, both of whom had contracted Ebola in West Africa, one in Liberia and the other in Sierra Leone. Both died after returning to Spain. On October 19, Spain’s Special Ebola Committee says that nurse’s aide Teresa Romero Ramos is considered free of the Ebola virus.

October 8, 2014 – Thomas Eric Duncan, a Liberian citizen who was visiting the United States, dies of Ebola in Dallas.

October 11, 2014 – Nina Pham, a Dallas nurse who cared for Duncan, tests positive for Ebola during a preliminary blood test. She is the first person to contract Ebola on American soil.

October 15, 2014 – Amber Vinson, a second Dallas nurse who cared for Duncan, is diagnosed with Ebola. Authorities say Vinson flew on a commercial jet from Cleveland to Dallas days before testing positive for Ebola.

October 20, 2014 – Under fire in the wake of Ebola cases involving two Dallas nurses, the CDC issues updated Ebola guidelines that stress the importance of more training and supervision, and recommend that no skin be exposed when workers are wearing personal protective equipment, or PPE.

October 23, 2014 – Craig Spencer, a 33-year-old doctor who recently returned from Guinea, tests positive for Ebola – the first case of the deadly virus in New York and the fourth diagnosed in the United States.

October 24, 2014 – In response to the New York Ebola case, the governors of New York and New Jersey announce that their states are stepping up airport screening beyond federal requirements for travelers from West Africa. The new protocol mandates a quarantine for any individual, including medical personnel, who has had direct contact with individuals infected with Ebola while in Liberia, Sierra Leone or Guinea. The policy allows the states to determine hospitalization or quarantine for up to 21 days for other travelers from affected countries.

January 18, 2015 – Mali is declared Ebola free after no new cases in 42 days.

February 22, 2015 – Liberia reopens its land border crossings shut down during the Ebola outbreak, and President Sirleaf also lifts a nationwide curfew imposed in August to help combat the virus.

May 9, 2015 – The WHO declares an end to the Ebola outbreak in Liberia. More than 4,000 people died.

November 2015 – Liberia’s health ministry says three new, confirmed cases of Ebola have emerged in the country.

December 29, 2015 – WHO declares Guinea is free of Ebola after 42 days pass since the last person confirmed to have the virus was tested negative for a second time.

January 14, 2016 – A statement is released by the UN stating that “For the first time since this devastating outbreak began, all known chains of transmission of Ebola in West Africa have been stopped and no new cases have been reported since the end of November.”

March 29, 2016 – The WHO director-general lifts the Public Health Emergency of International Concern related to the 2014-2016 Ebola outbreak in West Africa.

*Includes information about Ebola and other outbreaks resulting in more than 100 deaths or special cases.

1976 – First recognition of the EBOV disease is in Zaire (now Democratic Republic of the Congo). The outbreak has 318 reported human cases, leading to 280 deaths. An SUDV outbreak also occurs in Sudan (now South Sudan), which incurs 284 cases and 151 deaths.

1995 – An outbreak in the Democratic Republic of the Congo (DRC) leads to 315 reported cases and at least 250 deaths.

2000-2001 – A Ugandan outbreak (SUDV) results in 425 human cases and 224 deaths.

December 2002-April 2003 – An EBOV outbreak in ROC results in 143 reported cases and 128 deaths.

2007 – An EBOV outbreak occurs in the DRC, 187 of the 264 cases reported result in death. In late 2007, an outbreak in Uganda leads to 37 deaths, with 149 cases reported in total.

September 30, 2014 – Dr. Thomas Frieden, director of the CDC, announces the first diagnosed case of Ebola in the United States. The person has been hospitalized and isolated at Texas Health Presbyterian Hospital in Dallas since September 28.

July 31, 2015 – The CDC announces that a newly developed Ebola vaccine is “highly effective” and could help prevent its spread in the current and future outbreaks.

December 22, 2016 – The British medical journal The Lancet publishes a story about a new Ebola vaccine that tested 100% effective during trials of the drug. The study was conducted in Guinea with more than 11,000 people.

August 1, 2018 – The DRC’s Ministry of Health declares an Ebola virus outbreak in five health zones in North Kivu province and one health zone in Ituri province. On July 17, 2019, the WHO announces that the outbreak constitutes a public health emergency of international concern. On June 25, 2020, the DRC announces that the outbreak is officially over. A total of 3,481 cases were reported, including 2,299 deaths and 1,162 survivors.

August 12, 2019 – Two new Ebola treatments are proving so effective they are being offered to all patients in the DRC. Initial results found that 499 patients who received the two effective drugs had a higher chance of survival – the mortality rate for REGN-EB3 and mAb114 was 29% and 34% respectively. The two drugs worked even better for patients who were treated early – the mortality rate dropped to 6% for REGN-EB3 and 11% for mAb114, according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and one of the researchers leading the trial.

December 19, 2019 – The US Food and Drug administration announces the approval of a vaccine for the prevention of the Ebola virus for the first time in the United States. The vaccine, Ervebo, was developed by Merck and protects against Ebola virus disease caused by Zaire ebolavirus in people 18 and older.

October 14, 2020 – Inmazeb (REGN-EB3), a mixture of three monoclonal antibodies, becomes the first FDA-approved treatment for the Ebola virus. In December, the FDA approves a second treatment, Ebanga (mAb114).

January 14, 2023 – Ugandan authorities officially declare the end of a recent Ebola outbreak after 42 consecutive days with no new cases.

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Autism Fast Facts | CNN



CNN
 — 

Here is a look at autism.

Autism or autism spectrum disorder (ASD) incorporates a group of neurodevelopmental disorders causing impaired communication skills and social skills. ASD generally starts before three years of age and lasts a lifetime, but early intervention plays a role in treatment and progress.

ASD is about four times more common among boys than girls, according to the Centers for Disease Control and Prevention (CDC).

ASD can be found among all races, ethnicities and socioeconomic groups.

The prevalence of ASD in the United States is about one in 36 8-year-olds, according to a 2023 CDC report.

Health care costs for children with autism are four to six times greater than medical costs for children without autism, according to research published in the Journal of Autism and Developmental Disorders.

April 2 is World Autism Day.

There is no definitive medical test to diagnose autism. Instead, the disorder is diagnosed by observing a child’s development.

According to the CDC, signs of autism may include deficits in social communication and interaction in a variety of contexts, difficulty engaging in back-and-forth conversation and an absence of interest in forming friendships with peers.

The debate over whether autism spectrum disorders are caused by vaccines started in 1998 when the medical journal The Lancet published a now-retracted study by researcher Andrew Wakefield linking the MMR vaccine to autism.

Most of Wakefield’s co-authors withdrew their names from the study when they learned he had been compensated by a law firm intending to sue manufacturers of the vaccine in question. In 2010, Wakefield lost his medical license. In 2011, the Lancet retracted the study after an investigation found Wakefield altered or misrepresented information on the 12 children who were the basis for the conclusion of the study.

Other researchers have not been able to replicate Wakefield’s findings. Several subsequent studies trying to reproduce the results have found no link between vaccines and autism, including several reviews by the Institute of Medicine.

Early 1900s – Autistic characteristics are studied as symptoms of schizophrenia.

1938 – Donald Gray Triplett of Mississippi is first examined by child psychiatrist Leo Kanner of Johns Hopkins Hospital and later becomes the first person diagnosed with autism symptoms.

1943 – Triplett is identified as “Donald T.” in the paper “Autistic Disturbances of Affective Contact” by Kanner. The paper elaborates on the idea that autism is related to lack of parental warmth; this is later dubbed the “refrigerator mother” theory.

1944 – Hans Asperger, an Austrian physician, publishes a paper about autistic syndrome. The paper gains wider recognition when it is translated into English in the early 1990s.

1964 – Bernard Rimland, a research psychologist, publishes “Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior,” which contradicts the “refrigerator mother” hypothesis. Kanner is the author of the foreword.

1965 – Rimland founds the National Society for Autistic Children (now the Autism Society). He later establishes the Autism Research Institute.

1980 – Autism is classified separately from schizophrenia in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

December 18, 2007 – The United Nations adopts a resolution declaring April 2 World Autism Awareness Day.

October 29, 2014 – The medical journal Nature reports that scientists have identified 60 genes with a greater than 90% chance of increasing a child’s autism risk.

December 17, 2015 – Scientists at Harvard and MIT announce they have found, for the first time, a link between autistic behavior and reduced activity of a key neurotransmitter, a type of brain chemical that enables the transmission of signals across neurons, allowing the brain to communicate with other organs.

April 21, 2016 – The Simons Foundation announces that it is launching an autism research project called SPARK. The study, which involves scientists at 21 hospitals and university clinics, will focus on the possible connection between genetics and autism. Parents of children with autism are invited to sign up online and participate in the study. The group also works with Autism Speaks and the Autism Science Foundation to run the Autism BrainNet network, which is an autism brain bank that collects postmortem donations.

February 2017 – Researchers find that monitoring MRI brain scans of infants may help predict whether they will develop autism, according to a study published in the journal, Nature. The researchers found a possible link between brain enlargement during the first year of life and an autism diagnosis at age 2. This builds on previous similar research.

March 19, 2017 – CBS News’ “60 Minutes” profiles “Sesame Street’s” newest Muppet character, a girl named Julia who has autism.

April 11, 2017 – A study published in the American Journal of Public Health finds that people with autism are three times more likely than the general population to die because of preventable injuries, and children and young teens with autism are 40 times more likely to die from preventable injury than the general child population. Suffocation, asphyxiation and drowning are the leading causes of fatal injuries among people with autism.

March 26, 2018 – According to a study published in JAMA Pediatrics, children with autism spectrum disorder and their younger siblings are less likely to be fully vaccinated than children unaffected by autism.

March 4, 2019 – A study of over 650,000 children published in the journal Annals of Internal Medicine shows that the measles, mumps, and rubella vaccine does not increase the risk of autism and does not trigger autism in children who are at risk.

April 29, 2019 – A study published in JAMA Pediatrics suggests that children can be screened for autism spectrum disorder at 14 months of age with high accuracy (instead of 18 to 24 months of age, as is currently recommended).

January 23, 2020 – A study in the journal Cell identifies 102 genes that are associated with an autism risk. Previously, researchers were only aware of 65.

May 10, 2020 – In a report published in the Journal of Autism and Developmental Disorders, the CDC estimates that 2.2% of Americans adults have autism spectrum disorder. The report, which is the first US study of autism in adults, indicates that up to 5.4 million people age 18 and older, or about 1 in 45 people, have an autism spectrum condition.

February 14, 2022 – A meta-analysis published in JAMA Pediatrics finds that early mortality, due to natural or unnatural causes, is more than two times more likely for people with autism spectrum disorder than the general population.

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Sleep apnea raises risk of long Covid by up to 75% for some, study says | CNN



CNN
 — 

Adults who have obstructive sleep apnea have up to an 75% increased risk, on average, of developing long Covid after a SARS-CoV-2 infection compared with people without sleep apnea, a new study found.

Women with obstructive sleep apnea had up to an 89% increased risk, while men had a 59% higher risk, according to the analysis of electronic health data on nearly 1.8 million people.

Obstructive sleep apnea is a potentially dangerous disorder in which breathing stops for about 10 seconds multiple times during the night due to a blockage of the airways by heavy or relaxed soft tissues in the mouth and throat.

A second analysis of medical records of a smaller group of 330,000 adults found the risk to be only 12%, according to the study, which is part of RECOVER, or Researching Covid to Enhance Recovery. RECOVER is a National Institutes of Health initiative dedicated to understanding why some people develop long Covid and how best to detect, treat, and prevent the condition.

Why the huge difference in numbers? People in the larger study had additional health concerns, or comorbidities, such as obesity, diabetes, high blood pressure and heart disease, said senior study author Lorna Thorpe, co-lead of the RECOVER Clinical Science Core at NYU Langone Health.

“The range of 12% to 75% is likely due to a combination of different study populations and different levels of comorbidities, but also different definitions of long Covid,” she said. “We didn’t even have a diagnostic code for long Covid until October 2021.

“I believe the risk is likely to be in the middle, but we will need additional studies to tease that out,” added Thorpe, a professor and director of the division of epidemiology at NYU Grossman School of Medicine.

A third analysis of medical records of 102,000 children with sleep apnea found no correlation between sleep apnea and long Covid after the various confounding health conditions were factored out, “which, of course, is great news,” Thorpe said.

“By using three very large networks of electronic health records, we were able to do this study three times, which is one of the strengths of the research,” she added. “This study is the first collaboration of this focus and scale to find that adults with sleep apnea are at greater risk for long Covid.”

This is an “important study” on long Covid, said Dr. Sairam Parthasarathy, a principal investigator of the University of Arizona Health Sciences RECOVER Adult Study and professor of medicine.

“Research needs to be done in a prospective study to verify this association, and if found to be true these findings have implications for treatment of long Covid,” said Parthasarathy, who was not involved in the study.

“It is important to note that some of the symptoms of long Covid such as fatigue may be related to obstructive sleep apnea, and that the treatment of obstructive sleep apnea may improve such long Covid-related symptoms,” he added.

The study, published Thursday in the journal Sleep, is one of a several studies released since Congress allocated $1.15 billion to NIH in January 2021, to study the long-term effects of Covid over a four-year period. To date, the agency says it has used about $811 million to fund research.

Researchers wanted to investigate the role of sleep apnea in long Covid due to the well-known association between the condition and poorer outcomes after a Covid infection.

“People with sleep apnea are at higher risk for a more severe case of Covid-19, admission to intensive care at the hospital and for mortality,” Thorpe said.

“Obstructive sleep apnea can result in increased inflammation, potentially disrupted sleep leading to an increased propensity to develop infections and reduced immunity,” said Dr. Bhanu Prakash Kolla, a sleep medicine specialist in the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minnesota.

“This could potentially explain the pathway by which obstructive sleep apnea leads to an increased risk of having Covid and also … (long Covid),” said Kolla, who was not involved in the study.

Sleep apnea is an underdiagnosed condition regardless of gender, said the University of Arizona’s Parthasarathy.

“It is conservatively estimated that 80% of patients with obstructive sleep apnea (OSA) are not diagnosed,” he said. In addition, “an assumption with these analyses is that patients with OSA are likely to be treated. However, nearly half of them are not using the treatment.”

Why would women have up to an 89% higher risk compared with 59% in men? The study did not address that issue.

However, “one can postulate this difference may be based on what we know about sex differences in sleep and immune responses,” said Dr. Phyllis Zee, director of the Center for Circadian and Sleep Medicine at Northwestern University Feinberg School of Medicine in Chicago.

Zee, who was not involved with the new research, coauthored one of the first published studies on the link between sleep apnea and serious Covid infection.

“Women typically have stronger immune responses to viral infections, and thus also vulnerability for post-infection inflammation,” Zee said. “Women in general have more insomnia and with long Covid tend to present with fatigue and insomnia symptoms, which are also common symptoms of long Covid.”

Another reason could be that sleep apnea has historically been considered a male disease, Thorpe said, which could mean that by the time a woman is diagnosed her apnea is more advanced.

“It could be that the women who are documented in electronic health records have more severe sleep apnea because physicians more often look for sleep apnea among men,” she said.

As scientists continue to learn more about long Covid, further information will become available, Thorpe said. In the meantime, people who have sleep apnea — or who snore, snort and stop breathing at night, which are all signs of the condition — should be exceedingly careful when they contact Covid.

“People with sleep apnea who get infected with Covid should seek early treatment and consider getting Paxlovid, the oral medication prescribed to reduce risk of severe outcomes,” Thorpe said. “They should also keep up with their vaccinations to lower the risk of infection in the first place.”

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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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