Archive for November, 2015

STD cases reaching all-time highs in U.S., California

Repost! Author: Soumya Karlamangla Published: http://www.latimes.com/local/lanow/la-me-ln-2014-std-rates-20151118-story.html

 

Much to the worry of public health officials, new national data show that cases of chlamydia, gonorrhea and syphilis are climbing in the United States and have reached an all-time high.

A report released this week from the U.S. Centers for Disease Control and Prevention shows that though rates of these sexually transmitted diseases fluctuated over the last five years, all three spiked in 2014. The center called the increases “alarming.”

“America’s worsening STD epidemic is a clear call for better diagnosis, treatment and prevention,” said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention.

The volume of chlamydia cases last year was particularly staggering. Nationwide, there were about 1.4 million cases, which is the highest number of annual cases of any condition ever reported to the CDC.

The picture in California is even bleaker. Cases of chlamydia, gonorrhea and syphilis have been steadily increasing here since 2010, while national rates sometimes stagnated or even dipped. In 2014, the rates for all three diseases were higher in the Golden State than in the nation overall.

The new data also show that among the more than 3,000 counties in the nation, Los Angeles County had the most cases of all three diseases in 2014. That’s partly because it’s home to more people than any other county, but also because of high rates of those infections.

Here’s how the prevalence of those diseases in 2014 in L.A. County and California compare with the rest of the country.

  • Chlamydia in the U.S.: 456 cases per 100,000 people
  • Chlamydia in California: 460 cases per 100,000 people
  • Chlamydia in L.A. County: 548 cases per 100,000 people
  • Gonorrhea in the U.S.: 111 cases per 100,000 people
  • Gonorrhea in California: 119 cases per 100,000 people
  • Gonorrhea in L.A. County: 153 cases per 100,000 people
  • Primary and secondary syphilis in the U.S.: 6 cases per 100,000 people
  • Primary and secondary syphilis in California: 10 cases per 100,000 people
  • Primary and secondary syphilis in L.A. County: 12 cases per 100,000 people

Neither California nor L.A. County had the highest rates for any of the diseases.

“STDs are a substantial health challenge facing the United States,” a CDC report summary says. “Each of these infections is a potential threat to an individual’s immediate and long-term health and well-being.”

Chlamydia and gonorrhea are common and curable diseases, but if not treated can cause serious problems such as infertility in women. Officials estimate that undiagnosed STDs cause 20,000 women in the country to become infertile each year.

More than half of chlamydia and gonorrhea cases are among people between the ages of 15 and 24. Officials recommend that sexually active women under 25 be tested annually for these diseases.

Syphilis, which is also curable, can lead to complications such as blindness if allowed to progress.

It has been of particular concern in California, where cases of congenital syphilis — in which a mother infects her child during pregnancy — surged between 2012 and 2014, with cases increasing from 30 to 100. Stillbirths caused by syphilis in California also rose from one case in 2012 to six in 2014.

Health officials recommend using condoms during sex to prevent the spread of these diseases.

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In Fight to Save Young People, Brooklyn Doctor Treats Violence as a Public Health Issue

Author: David Gonzalez Published: http://www.nytimes.com/2015/11/02/nyregion/in-fight-to-save-young-people-brooklyn-doctor-treats-violence-as-a-public-health-issue.html?_r=0

Dr. Robert Gore was stirred awake one morning in July by an urgent phone call from work. That was not unusual, given his job in the emergency department at Kings County Hospital Center in Brooklyn, a level-one trauma center that provides the highest level of care. Still, his years of skillful, coolheaded practice, of stopping bleeding and saving lives, had not prepared him for what he heard.

Young had been stabbed.

Young was Willis Young, 27, one of a small group of people Dr. Gore had enlisted to cool tempers and stop retaliation whenever a young person was brought to the hospital after being shot, stabbed or beaten. An argument with a friend had left Mr. Young critically wounded on a Brooklyn street. Days later, still in the intensive care unit, he died.

Dr. Gore recalled that grim summer day months later, as the leaves turned orange and the air chill. Other young men had died since then, despite his best efforts at the hospital. But that had not dimmed his dedication to what he sees as his duty — not just as a physician, but as an African-American man committed to his community — to find alternatives to violence. For him, that means continuing Mr. Young’s work, as well as redoubling his own efforts in working with almost 100 teenagers in a mentoring program called the Kings Against Violence Initiative.

“When he was stabbed, everything became more real about what we were doing,” Dr. Gore said of Mr. Young. “It personalized what we were doing. All I know is we have somebody doing violence intervention and all of a sudden he is not here. This was avoidable. It’s not a freak car accident. This is somebody who died at the hands of violence.”

Dr. Gore, 39, speaks not just from the perspective of his position at the trauma center. As a native of Brooklyn who has lived in Fort Greene and Bedford-Stuyvesant, he has a personal stake in the issue. And as the son of a schoolteacher and activist, he felt it was in his blood to not just bemoan a community’s misfortunes, but also to do something about them. His epiphany came during his residency at Cook County Hospital in Chicago on a rainy day, when a fellow resident said he hoped that “something exciting” would happen.

“What he meant to say was he hoped we had some penetrating trauma,” Dr. Gore recalled. “When that comes in, there’s always a level of excitement, an opportunity to do something that can be lifesaving. Then I looked around the room and it was me, a nurse and a clerk who were the only people of color. That’s when you start looking at the problem from a different point of view because they look like me or one of my relatives. I started thinking, ‘What can I do to help this?’ ”

The result — put together over years of research and brainstorming — began to take shape in 2011, when Dr. Gore and some like-minded friends and professionals started what became the Kings Against Violence Initiative, which they at first financed on their own. For their mentorship program, they went to the old George W. Wingate High School in Brooklyn, which had been divided into a set of smaller schools, and offered to help students who were considered at risk or otherwise in need of guidance.

 

Today, the initiative and Dr. Gore work with young people whom they are trying to steer clear of trouble and into college. Dr. Gore likes to remind them that while conflict may not be avoidable, violence is. Many have learned to rely on one another, rather than drift to street corners where trouble awaits.

“Before, if I got into problems, I had more of a violent way to handle it,” Jude Bonney, a senior at the High School for Public Service, said. “Here I learned how that can be prevented in the first place, by being aware of my surroundings.”

The approach that Dr. Gore put in place has become part of a larger effort by the city’s Health and Hospitals Corporation, which has similar programs at Harlem Hospital Center in Manhattan and Jacobi Medical Center in the Bronx. The programs share a belief that law enforcement alone cannot eliminate violence among young people. A preventive public health approach is needed.

“If violence is a disease, you need a vaccination,” Erik Cliette, who directs the corporation’s Guns Down, Life Up initiative, said. “If you address violence the way we addressed smoking, the whole concept of how we look at violence will change.”

Dr. Gore had already come to that conclusion by the time he began working at Kings County. Some days he would stitch up someone he had known since childhood. Other days he would return to his Bed-Stuy block to hear that someone he knew from the neighborhood had been hurt.

He met Mr. Young not far from his home a few years ago, and was impressed by his curiosity. When he had the idea to have people intervene at the trauma center to stop the cycle of violence and retaliation, he found Mr. Young to be someone teenagers could relate to: He had dabbled in the street life, lost his father at an early age and had relatives who had had brushes with the law.

“He would know the people who came into the E.R.,” Dr. Gore said. “Brooklyn is big, but it ain’t that big.”

Mr. Young’s death made the borough feel a lot smaller, and emptier.

A grand jury has not handed up an indictment in Mr. Young’s death, although the man with whom he had the fatal confrontation, Chad Hollingsworth, has been charged with second-degree attempted murder, prosecutors said.

According to a complaint, Mr. Hollingsworth told the police he got into an argument over remarks Mr. Young made about a young woman. Mr. Hollingsworth said that Mr. Young had pushed him into a car and that in the ensuing struggle, a knife had fallen from Mr. Young’s belt. Mr. Hollingsworth picked up the knife.

Stephen Drummond, Mr. Hollingsworth’s lawyer, said his client — whom he described as having never had trouble before with the law — was not interested in a plea bargain, but was willing to cooperate with the authorities in the hope that he would be exonerated.

“It’s a very sad case, because these two gentlemen were friends,” Mr. Drummond said. “The evidence will establish that my client had absolutely no choice but to do that which he had to do to save his own life.”

The impact of Mr. Young’s death is still being felt. It has started heartfelt discussions among young people and driven Dr. Gore and his colleagues to consider how they can start addressing the larger social and economic issues facing the community.

“There’s a time to mourn, and we honor that,” Dr. Gore said. “At the same time, we have work to be done. This is still a part of our community’s reality. I can’t point fingers at who is responsible for doing what. This is my neighborhood, my hospital and I can’t expect others to take care of it if I’m not involved.”

Common herbs and their benefits

Black Tea Leaves– help with heart related issues

Mint– helps with an upset stomach

Parsley– helps with halitosis (bad breath)

Ginger– helps with nausea and motion sickness

Eucalyptus– anti-inflammatory, helps with nasal congestion

Licorice– anti-inflammatory, helps with sore throat

Ginseng– energy booster

Chamomile – helps with insomnia or difficulty sleeping

Healthy Foods for the Diabetic

The holidays are approaching and many of us may have family members who are diabetic.  Please check out this article for some food options to incorporate into your family feasts.

Oatmeal

Beans

Apples

Asparagus

Fish

Avocado

Yogurt

Blueberries

Broccoli

Almonds

Carrots

Salmon

Flax Seeds

Egg Whites

Garlic

Kale

Prisons that withhold menstrual pads humiliate women and violate basic rights

Everyone laughed when Piper Chapman emerged from the shower during the first season of Orange Is the New Black with bootleg shoes made of maxi pads – and inmates do sometimes waste precious resources like sanitary products with off-label uses. At York Correctional Institution in Niantic, Connecticut, where I spent more than six years, I used the tampons as scouring pads – certainly not as sponges, because prison tampons are essentially waterproof– when I needed to clean a stubborn mess in my cell.

That should not lead anyone to think that sanitary products are easy to come by in jail. At York, each cell, which houses two female inmates, receives five pads per week to split. I’m not sure what they expect us to do with the fifth but this comes out to 10 total for each woman, allowing for only one change a day in an average five-day monthly cycle. The lack of sanitary supplies is so bad in women’s prisons that I have seen pads fly right out of an inmate’s pants: prison maxi pads don’t have wings and they have only average adhesive so, when a woman wears the same pad for several days because she can’t find a fresh one, that pad often fails to stick to her underwear and the pad falls out. It’s disgusting but it’s true.

The only reason I dodged having a maxi pad slither off my leg is that I layered and quilted together about six at a time so I could wear a homemade diaper that was too big to slide down my pants. I had enough supplies to do so because I bought my pads from the commissary. However, approximately 80% of inmates are indigent and cannot afford to pay the $2.63 the maxi pads cost per package of 24, as most earn 75 cents a day and need to buy other necessities like toothpaste ($1.50, or two days’ pay) and deodorant ($1.93, almost three days’ pay). Sometimes I couldn’t get the pads because the commissary ran out: they kept them in short supply as it appeared I was the only one buying them.

Connecticut is not alone in being cheap with its supplies for women. Inmates in Michigan filed suit last December alleging that pads and tampons are so scarce that their civil rights have been violated. One woman bled through her uniform and was required to dress herself in her soiled jumpsuit after stripping for a search.

The reasons for keeping supplies for women in prison limited are not purely financial. Even though keeping inmates clean would seem to be in the prison’s self-interest, prisons control their wards by keeping sanitation just out of reach. Stains on clothes seep into self-esteem and serve as an indelible reminder of one’s powerlessness in prison. Asking for something you need crystallizes the power differential between inmates and guards; the officer can either meet your need or he can refuse you, and there’s little you can do to influence his choice.

When the York Correctional Institution became coed during my sentence – merging the old Gates Correctional Institution and the women’s prison – a lieutenant who spent his career at York and was unaccustomed to working with male inmates told a group of inmates that the men would rather defecate in their pants than ask him for toilet paper and get jerked around for it.

To ask a macho guard for a tampon is humiliating. But it’s more than that: it’s an acknowledgement of the fact that, ultimately, the prison controls your cleanliness, your health and your feelings of self-esteem. The request is even more difficult to make when a guard complains that his tax dollars shouldn’t have to pay for your supplies. You want to explain to him that he wouldn’t have a paycheck to shed those taxes in the first place if prison staff weren’t needed to do things like feeding inmates and handing out sanitary supplies – but you say nothing because you want that maxi pad.

The guards’ reluctance to hand out the supplies is understandable because of inmates’ off-label uses for the products. Women use the pads and tampons for a number of things besides their monthly needs: to clean their cells, to make earplugs by ripping out the stuffing, to create makeshift gel pads to insert under their blisters in uncomfortable work boots or to muffle the bang that sounds when a shaky double bed hits a cement wall whenever either of its sleepers move. The staff watches us waste a precious commodity. What they fail to acknowledge is that these alternative uses fill other unfulfilled needs for a woman to maintain her physical and mental health. If we had adequate cleaning supplies, proper noise control, band-aids for our blisters or stable beds, we would happily put the pads in our pants.

There are ways to restore dignity to America’s inmates. For example, we could remove the entire sanitary supply problem if American prisons bought the newly-released Thinx for female inmates, which are super absorbent, stain-free underwear designed by a woman’s start-up. Thinx are expensive – $200 for seven pair – but they still might be cost effective when you factor in the cost of buying disposable pads and the time and energy devoted to the pad power struggle in women’s prisons. But I doubt that corrections systems in the United States will give up the forced scarcity of menstrual products in prison.

Though many argue that prisoners cannot be pampered in jail, having access to sanitary pads is not a luxury – it is a basic human right. Just like no-one should have to beg to use the toilet, or be given toilet paper, women too must be able to retain their dignity during their menstrual cycle. Using periods to punish women simply has no place in any American prison.

This article was a MUST share! Originally writen by: Chandra Bozelko and published on: http://www.theguardian.com/commentisfree/2015/jun/12/prisons-menstrual-pads-humiliate-women-violate-rights

How Period Trackers Have Changed Girl Culture

Originally written by: Roni Caryn Rabin and published on: http://well.blogs.nytimes.com/2015/11/12/how-period-trackers-have-changed-girl-culture/?_r=0

My 18-year-old daughter knows exactly when it will be that time of the month. Since June, she’s been plugging the dates of her menstrual cycle into a popular period tracking app called Clue, and has it programmed to send her an alert every month, two days before her next period is due.

“It’s great because I never think about it, and now I never have to think about it,” she said.

Like a lot of young women, my teenager is just too busy. And no, she doesn’t mind being quoted, she said, adding, “Mom: I’m not embarrassed about my period.”

She’s not the only one. Girls and women are openly talking, tweeting and texting about their periods, and not just to Donald Trump. New companies tired of the stigma are selling menstrual products using the “P” word, singers and artists weave menstruation themes into their work, athletes and others have mentioned it on talk shows and at press conferences. Two New York City high school girls developed a video game called “Tampon Run” — the heroine’s mission is “to rid the world of the menstrual taboo.”

Add to this mix period tracker apps, which have helped shift attitudes, demystifying and normalizing menstruation by assigning cute icons to once unmentionables like heavy flow, maxi pads and period pimples. Most important, the apps transform the input into crunchable data that can tell a young woman when her period is due, when it’s late and even why she might be feeling so blue.

There are over 200 different period tracker apps to choose from, and they are immensely popular: consumers have downloadedPeriod Tracker (by GP International) and Period Calendar/Tracker(by ABISHKKING) more than 10 million times from the Android store alone, according to IMS Institute for Healthcare Informatics.

Period tracker apps can track a range of issues related to the menstrual cycle including emotions, cramps, weight, sleep, energy, food cravings and more. They also can record when you had sex (Clue’s icon for protected sex is a man wearing a tie) or remind you to pack tampons, take your birth control pill or do a breast exam, all information women say is both empowering and liberating. Some apps are pink and girlie, all hearts and flowers and butterflies; others take a more subtle approach with lots of graphs in muted shades of purple. Specialized apps have even been developed for niche groups like Orthodox Jewish women who adhere to religious family purity laws. The apps say they are “rabbinically approved.”

“When you see a technology that someone has developed specifically for you as a woman, it really legitimizes talking about your periods and thinking about them,” said Shuangyi “E.E.” Hou, 24, a product designer in San Francisco for apps and websites who has used a period tracker app for over a year. “If we as a society say women should be checking in on their periods, and we give them permission to talk about it, I’m convinced it will be beneficial for women’s health.”

While the apps also can be used to track ovulation, signaling the days the user is more or less likely to become pregnant, most period tracker apps explicitly warn users not to rely on them to prevent pregnancy. The ovulation tracker and fertility prediction can be helpful for a woman trying to conceive, but it can give a false sense of security to a woman who relies on the app as a form of birth control.

That’s because even the most vigilant ovulation tracking methods have shockingly high failure rates, according to the American Academy of Obstetricians and Gynecologists, with up to one in four women becoming pregnant over the course of a year with typical use.

“Apps are a tool; they’re not actually a birth control method,” said Hannah Ransom of San Diego, a certified fertility awareness educator.

But many users of period tracker apps rely on them to help schedule their busy lives or for tracking health conditions that fluctuate with their cycle, rather than contraception. Aliya, a 23-year-old from the Bronx, said she uses Pink Pad Pro to schedule social outings like visits to a Russian bath house and to give her doctor an accurate answer to the inevitable question about the date of her last menstrual period (though she admitted relying on it occasionally for birth control as well).

One college theater student said she always forgets about her period during the week or two before a production, when there are a million other details to think about, so she likes the push notification reminders from Period Tracker Lite.

Ida Tin, who founded Clue, one of the fastest growing period tracker apps with 2 million active users in 180 countries, said her motivation in developing the app was to provide women with more information and greater understanding about a “foundational” part of their lives for 40 years.

“If you just have the data about what is going on in your body,” said Ms. Tin, “It’s a navigating tool for your life.”

Midwives and nurses are as good as docs — and sometimes better, WHO finds

This article was originally written by Maggie Fox and published on: http://www.nbcnews.com/health/health-care/midwives-nurses-are-good-docs-sometimes-better-who-finds-f8C11506820

Midwives, nurse practitioners, physician assistants and other non-doctors do as good a job as MDs in the care they deliver — and patients often like them better, a World Health Organization team reported on Thursday.

These non-physicians are especially effective in delivering babies, taking care of people infected with the AIDS virus, and helping people care for chronic diseases such as diabetes and high blood pressure, the team reported in a WHO bulletin.

The findings extend from the poorest nations to the United States and Europe, they said. While some physician groups have resisted wider use of such professionals, they should embrace them because they are often less expensive to deploy and are far more willing to work in rural areas, the WHO experts said.

“There are some obvious advantages in terms of relying on mid-level health workers,” WHO’s Giorgio Cometto told NBC news in a telephone interview.

“They take less time to be trained. Typically, they cost less to remunerate. In some countries they are more likely to be retained in rural areas.”

David Auerbach, a researcher at the Rand Corp., says other studies have shown the same thing. “There’s really not much difference you can find in the quality,” he said.

Doctors are scarce in the United States. The Association of American Medical Colleges projects a shortfall of 90,000 physicians by 2020. Family practitioners and other generalists are especially scarce, and experts predict it will only get worse as millions of Americans get health insurance under the 2010 Affordable Care Act.

Doctors are also scarce in the developing world, and many countries are looking for ways to fill gaps.

Cometto and colleagues around the world looked at all the studies they could find on the quality of care delivered by non-physicians. They settled on 53 that looked specifically at the quality of care delivered — and at how happy patients were with the care they got.

“The evidence shows there aren’t statistically significant differences,” Cometto said. “The quality of care they provide is comparable to physicians. In some cases, for specific services, they actually outperform physicians.”

For instance, nurse-midwives or midwives who deliver babies end up using fewer drugs and they are less likely than doctors to make a type of cut called an episiotomy. Groups such as the American College of Obstetricians and Gynecologists recommend against episiotomies because they don’t heal as well as the natural tears that occur during childbirth.

Midwives were no more or less likely than doctors to induce labor, perform cesarean sections or use instruments to deliver a baby, Cometto’s team found, and the rates of death of either mother or child were the same among doctors as among midwives.

There were similar findings for treating patients infected with the human immunodeficiency virus (HIV) that causes AIDS. “One study compared the effects of antiretroviral therapy (ART) in patients managed by nurses and those managed by doctors. There was no significant dif­ference in the likelihood of ART failure between groups of patients managed by nurses and those managed by doctors,” the researchers wrote. “Nor was there any difference in mortality, failure of viral suppression or immune recovery between the groups.”

When it came to caring for heart disease and diabetes, patients actually seemed to like nurses and other non-doctors better, the report found. This jibes with what nurse-practitioners and physician assistants working in the United States report. “We look at patients in a more holistic manner,” Judy Honig, associate dean at the Columbia University School of Nursing, said in a recent interview.

The Institute of Medicine, which advises the federal government on health matters, says nurses can do more than they already do and can help meet ballooning demands as the population ages and as more people get health insurance and start seeking care.

The United States has more than three million nurses. They already deliver much of the front line health care that Americans need, from giving vaccinations to delivering babies.

Nurse-practitioners are registered nurses who hold graduate degrees and can perform virtually all of the functions of front-line family doctors — depending on the laws of the state they’re in.

Between 1998 and 2010, the number of Medicare patients treated by NPs increased 15-fold to more than 450,000 people, University of Texas Medical Branch researchers found recently. Groups such as the American Association of Nurse Practitioners are calling for even more to be trained.

Physician assistants are also seen as offering a big plug in the health care hole “Currently, there are more than 93,000 PAs throughout the U.S. whose education in general medicine prepares them to be extremely nimble, positioning them very well to address an influx of 20 million new patients entering the health care system,” says Lawrence Herman, president of the American Academy of Physician Assistants.

Rand’s Auerbach says integrated clinics, using electronic health records and other technology, can really help fill the gaps. But he notes that not all medical groups are on board with the idea.

“It’s getting over a cultural barrier and learning how to work in teams of providers with different expertise,” Auerbach said. “That is not trivial.”

The American Society of Anesthesiologists recently spoke out against what it sees as the overuse of nurse-anesthetists. “Somehow there has become the notion that you can take physician extenders and replace physicians,” said Dr. Jane Fitch, a former nurse anesthetist who is now a physician anesthesiologist. “We are really concerned about patient safety.”