jeudi 30 juin 2016

Art, Stories That Honor Those Who Died By Drug Overdose -- And Help Survivors Too

Art, Stories That Honor Those Who Died By Drug Overdose -- And Help Survivors Too
Sometimes, the very act of creating a symbolic tribute to a deceased relative provides some level of comfort.

mardi 28 juin 2016

Study: 2 Types Of Vaccine Protect Against Zika Virus In Mice

Study: 2 Types Of Vaccine Protect Against Zika Virus In Mice
"We hope that news will galvanize the vaccine effort against Zika virus," says Dr. Dan Barouch of Beth Israel Deaconess Medical Center and Harvard Medical School.

lundi 27 juin 2016

Opinion: Supreme Court Ruling Suggests Public Health Data Matters In Abortion Cases

Opinion: Supreme Court Ruling Suggests Public Health Data Matters In Abortion Cases
Today, the Supreme Court set a new standard for the role that evidence should play in judicial analyses.

dimanche 26 juin 2016

Possible Nurses Strike At Brigham And Women's Hospital Averted

Possible Nurses Strike At Brigham And Women's Hospital Averted
The tentative agreement still needs to be ratified by the full Brigham and Women's nurse membership.

vendredi 24 juin 2016

Brigham And Women's Hospital Outlines Contingency Plan For Possible Nurses Strike

Brigham And Women's Hospital Outlines Contingency Plan For Possible Nurses Strike
The hospital says it has 700 temporary nurses ready to care for patients if its union nurses walk out on Monday.

More Golden Years: Older Americans Living Not Just Longer But Healthier Lives

More Golden Years: Older Americans Living Not Just Longer But Healthier Lives
Heartening new data finds that older Americans are not just living longer but spending less time disabled.

jeudi 23 juin 2016

Narrating Medicine: When Doctors Forget To Feel

Narrating Medicine: When Doctors Forget To Feel
Unfortunately, under a culture of medical stoicism, we subdue or ignore our emotions, writes Dr. Isaac Chan.

mercredi 22 juin 2016

Expert Says Hospital Leaders, Staff Face 'Challenging Times' As Technology Upgrades Boost Costs

Expert Says Hospital Leaders, Staff Face 'Challenging Times' As Technology Upgrades Boost Costs
We hear from Maureen Bisognano about the challenges facing hospitals and their staffs as a strike looms for Brigham and Women's Hospital nurses.

Thanks To Efforts Of 4 Moms, Broad Institute Launches Initiative To Better Understand Food Allergies

Thanks To Efforts Of 4 Moms, Broad Institute Launches Initiative To Better Understand Food Allergies
Four mothers were fed up with all the unknowns surrounding their children's food allergies. So they raised close to $10 million to launch the Food Allergy Science Initiative at the Broad.

lundi 20 juin 2016

Soon To Be Talk Of The Islands: Do We Modify Mouse Genes To Fight Lyme Disease?

Soon To Be Talk Of The Islands: Do We Modify Mouse Genes To Fight Lyme Disease?
An MIT evolutionary biologist lays out his proposal for Nantucket and Martha's Vineyard to consider genetically modifying mice to fight Lyme disease.

NYT On Exercise As Miracle Cure, Best Public Health Buy, No-Brainer

NYT On Exercise As Miracle Cure, Best Public Health Buy, No-Brainer
A column in The New York Times offers a sweeping -- and overwhelming -- roundup of the health benefits of exercise.

vendredi 17 juin 2016

Wired To Be A Dad: Recent Science Fuels A New View Of Fatherhood

Wired To Be A Dad: Recent Science Fuels A New View Of Fatherhood
Researchers say men are biologically wired to be fathers -- and children are innately and uniquely responsive to their fathers.

jeudi 16 juin 2016

Why To Exercise Today: A Better Memory (But Timing Is Key)

Why To Exercise Today: A Better Memory (But Timing Is Key)
The reason for this likely hinges on the importance of naturally occurring chemical compounds and hormones in the “encoding of memory,” researchers report.

mercredi 15 juin 2016

Podcast Pilot: The Magic Pill, Your Daily Dose Of Get-Up-And-Go

Podcast Pilot: The Magic Pill, Your Daily Dose Of Get-Up-And-Go
Check out the pilot episode of The Magic Pill, a new exercise podcast in development at WBUR that aims to give you a daily dose of get-up-and-go. (Why The Magic Pill? Because exercise is the closest thing we have to one -- but every day, there are forces working against you...)

In A Safe Space, Medical Professionals Monitor What's Really Happening During A Drug High

In A Safe Space, Medical Professionals Monitor What's Really Happening During A Drug High
At the Supportive Place for Observation and Treatment (SPOT), drug users could ride out their high under medical supervision.

vendredi 10 juin 2016

‘Adult Onset ADHD’: Is It A Real Thing, Or Must It Have Started In Childhood?

‘Adult Onset ADHD’: Is It A Real Thing, Or Must It Have Started In Childhood?
New research is fueling questions about the origins and trajectory of the brain disorder.

jeudi 9 juin 2016

Judy Collins On Suicide, Mental Illness And The Story Her Voice Is Telling

Judy Collins On Suicide, Mental Illness And The Story Her Voice Is Telling

Singer and songwriter Judy Collins at WBUR. (Robin Lubbock/WBUR)

Singer and songwriter Judy Collins at WBUR. (Robin Lubbock/WBUR)

I thought I loved Judy Collins because her voice was ineffably crystalline, because her songs were the soundtrack of my youth, because her “Who Knows Where The Time Goes?” becomes ever more relevant as I get older.

But now that I’ve heard her converse with Here & Now host Robin Young, I understand something more: that infusing her inimitable voice were the pain and the power that come from a life that has included glory but also rock-bottom despair: alcoholism, depression and the 1992 suicide of her son, Clark.

Not that she has kept any of her travails secret. Now 77, she has written and spoken about them so publicly that this week she received the McLean Award from McLean Hospital for “her work to increase awareness about mental health through her many interviews, compelling memoirs and advocacy efforts.”

“She has courageously and very publicly shared her experience with depression, alcoholism and the struggles she faced following her son’s suicide, thus helping dispel the stigma of psychiatric disorders,” says the award’s text. “She has reached countless people with her message and is a true champion of mental wellness for all.”

Here’s some of her conversation on Here & Now, lightly edited:

RY: What was it like? You became sober, I’m sure still, in some part of your heart, mourning your father, the alcoholic, and then having to watch your son…

JC: The worst, the worst. He committed suicide in relapse. I don’t know how I got over it, really. You don’t get over it. I shouldn’t put it that way. You get through it, however. And people reached out to me — people were so kind. There was a kind of cluster of women — Mariette Hartley and Iris Bolton, Joan Rivers.

Joan called me one night from Las Vegas, while she was in the dressing room, getting dressed, and she said, “I know” — it was about four days after his death — she said, “I know you want to stop working.” I said, “You bet, I’ve already canceled everything for the next year.” I said, “Bury it. I don’t even want to look at it.” She said, “You can’t do that because you won’t recover unless you keep working.” And she knew that because she’d lost her husband to suicide.

You said at the time, “His suicide has both ruined my life and probably saved my life, because I have to live through it, I have to get through it.”

You have to. I was determined. Then I had to learn, how do I not kill myself today? And it happens for a lot of issues in terms of our lives. “I just won’t do that for today.” And I think that’s part of our search for mental health, the ability to stabilize your own, sometimes-erratic emotions. If you know where you can finally wind up — I’m in AA, I’ve been in AA for 38 years. I will never not be there, because that’s where the recovery is. And we have had, over the past 10 or 15 years, a kind of revolution in our attitude about this. This is not a secret. This is not a big, terrible, dark secret.

There is a change now, viewing it as a disease.

We now have a man who’s the head of the drug and alcohol commission — Botticelli is his name. I saw him on television the other day when he said that the moment he walked into a meeting and he got it — his eyes teared up. I said, “That’s right.” Mine did too, when I heard him say that because when you understand that there is a solution — you said it was like wrestling with a jellyfish.

We were talking earlier, and I said mental illness is like wrestling with a jellyfish.

I will quote you from now on, because it is. However, there are many solutions. And frankly, human contact with other people who are awake is a big start. I’m very happy that my life is one of sobriety and of living a day at a time, and of working — and I’m so grateful that I’ve been able to work. I have this brand new album, which is to me like a lifeline, and a new world. It’s about the continuity of creativity, and you know you cannot do that when your head is buried in a bottle. I do not believe that what happens when we’re completely out of it doesn’t kill the things in us that are alive and happy and joyful and able to spread the word.

Does it help at all, or maybe even propel you, that while you couldn’t do it for yourself for a long time, you were doing so much for everybody else [with your music]?

Well, I was also keeping myself alive and thriving, because the music, and the artistic aspects of everything in my life, were there. I’m the first person that gets the benefit of all that, so I was staying on the planet and there was a lot of beauty and wonder and extraordinary experience in those years. And until I really went down at the end of ’77 — and I really thought it was all over, because I couldn’t sing, either — in many ways I was thrilled, of course, with the life I had and I was ecstatic much of the time — when I wasn’t passed out. But you cannot keep that up. You cannot.

I’m wondering if we hear any of those early struggles — your son, when he was taken in the custody agreement — do we hear any of that in the music you wrote?

I don’t think that there’s so much a biography, but I think art takes over and makes out of what you are living something that is of you, but it doesn’t have to be autobiographical. It tells the story. I think the voice may tell it. I think you may hear it in the quality of the voice, more than anyplace else. I believe that.

Yuck! The Weird Things Kids Swallow Or Stuff Go On Display At Boston Children’s

Yuck! The Weird Things Kids Swallow Or Stuff Go On Display At Boston Children’s

A variety of items ingested by children, from a sardine can key to a crucifix, are on display at Boston Children's Hospital. (Charles Krupa/AP)

A variety of items ingested by children, from a sardine can key to a crucifix, are on display at Boston Children’s Hospital. (Charles Krupa/AP)

A chicken claw. An FDR pin. A crucifix. A toy sheriff’s star.

Those are some of the weird items that have been removed from kids’ throats, nostrils and ears by doctors at Boston Children’s Hospital and are included in a macabre, yet important, display.

A visitor’s first reaction might be to laugh at the framed collection of dozens of items that dates to 1918 and hangs at the entrance to the hospital’s ear, nose and throat department, but it’s also a reminder to the parents who walk past it every day to remain vigilant.

A doll's eye and a Scottie dog trinket will be part of the collect that serves as a gruesome reminder to parents who walk past them what children have mistakenly ingested or stuffed in their bodies. (Charles Krupa/AP)

A doll’s eye and a Scottie dog trinket are also part of the collection, which serves as a gruesome reminder to parents. (Charles Krupa/AP)

“It is definitely something that catches the eyes of parents and makes them think twice about what their kids are exposed to,” said Dr. Anne Hseu, a head and neck surgeon at Children’s who has removed Christmas ornaments, toys, carpet tacks and other items from young patients.

One of Hseu’s colleagues removed a rosary bead that had blocked a boy’s breathing passage. The boy might have died, but the bead lodged vertically, so he was able to get air through the bead’s threading hole.

Disc-like button batteries are among the more commonly swallowed items these days, and particularly dangerous because the chemicals in them can burn esophageal tissue in a couple of hours, Hseu said.

Latex balloons, magnets and colorful laundry detergent pods are also frequently swallowed, said Dr. Sarah Denny, an emergency department pediatrician at Nationwide Children’s Hospital in Columbus, Ohio, who has extracted a cellphone button from a teenager’s ear and a gum wrapper that was stuck in a child’s nostril for a couple of weeks.

The Boston collection, which also includes a screw hook, a tiny doll hand and a sardine tin key, is a tribute to late Children’s Hospital physician Charles Ferguson, who worked there for 35 years and removed most of the items himself.

A tea cup hook, star pin and coconut shard are part of the collection on display. (Charles Krupa/AP)

A tea cup hook, star pin and coconut shard are part of the collection. (Charles Krupa/AP)

Thousands of children a year are treated for sticking stuff they’re not supposed to in their mouths, noses and ears, Denny said. Parents need to keep small objects out of the reach of toddlers and make sure toys are age appropriate.

Besides the obvious hazards of choking — brain damage or death — ingesting a foreign object can lead to infection.

Pain, a chronic cough or even recurring pneumonia could indicate a child has swallowed something they shouldn’t have and needs a doctor’s attention. A foreign object can often be removed without surgery using an instrument that doctors call a “peanut grasper,” Hseu said.

A Roosevelt campaign pin is one of the more unusual items included in the collection. (Charles Krupa/AP)

A Roosevelt campaign pin is one of the more unusual items included in the collection. (Charles Krupa/AP)

mercredi 8 juin 2016

Narrating Medicine: What I Learned About Cancer Survivorship Clinics

Narrating Medicine: What I Learned About Cancer Survivorship Clinics

In this 2015 file photo, a nurse places a patient's chemotherapy medication on an intravenous stand at a hospital in Philadelphia. (Matt Rourke/AP)

In this 2015 file photo, a nurse places a patient’s chemotherapy medication on an intravenous stand at a hospital in Philadelphia. (Matt Rourke/AP)

When a friend recently finished her grueling year of breast cancer chemotherapy, she received warm congratulations from her health care team and was invited to ring a special bell set up in her doctor’s office. Another friend, cancer-free for a year, is rewarding herself by taking part in a bike ride fundraising for cancer research. Me? Now that I have been on maintenance chemo for two years, I am celebrating by getting a mammogram.

Let me explain. Cancer survivors need continued specialized health care to assess for late side effects from the treatment and the cancer, and specialized preventative care. For example, girls who have received radiation therapy need mammograms at a far younger ages than their peers, and children who have received brain radiation need a yearly hearing assessment.

One way to assess and treat cancer survivors is through Survivorship Clinics. These are places where patients get multidisciplinary appointments and where survivors meet with, for example, specialized health care providers, mental health care providers, nutritionists and physical therapists.

Research presented this week at the American Society of Clinical Oncology describes the value of such clinics. Care of survivors is especially important in children: Over 80 percent of children with cancer survive and need a care plan to guide surveillance for late effects of cancer therapy.

Yet while almost three-quarters of children have a late side effect from their cancer treatment fewer than 20 percent get surveillance for late effects.

In the study presented this week, the authors randomized patients to either attending a Survivorship Clinic or receiving a customized survivorship care plan to use with their primary care provider. The authors found that the participants in the Survivorship Clinic were much more likely to receive recommended testing and more likely to have late effects of treatment identified. In fact, out of about 50 patients in each group, the authors found previously unidentified late effects of cancer — including obesity, high lipids, hypothyroidism, neuropathy, osteopenia, restrictive lung disease, substance abuse and anxiety — 21 times in the Survivorship Clinic group, but only once in the group that that received a written care plan.

The study didn’t explore why the Survivorship Clinics were better. My guess is that it was, in part, because most primary care doctors don’t get trained in long-term care of cancer patients. But I think the bigger benefit of these clinics — as with multidisciplinary clinics for diabetes and cystic fibrosis and other chronic diseases — is that having a number of people with varied expertise working together, focusing on one person in one place, is an ideal way to think about a patient. These clinics focus on the whole person, not just on a patient’s disease.

To be sure, Survivorship Clinics can be expensive and are usually located only at big hospitals in big cities. And only one-third of cancer survivors go to Survivorship Clinics. Many people don’t want to go to a Survivorship Clinic because it reminds them of their cancer — of what they’ve survived, and what they might not have survived.

When I was first diagnosed with metastatic colon cancer 2013, the care plan involved intense chemotherapy —  oxaliplatin, bevacizumab, irinotecan and capecitabine — every other week. I was taking prednisone and aprepitant for the nausea, lidocaine cream for the injection site pain and pegfilgrastim for the decreasing white blood cell count. My other regular intake included scrambled eggs, Ensure, meat and white bread. Preventive care — like mammograms, pap smears and regular exercise — was not part of the care plan.

Last week, two and a half years after my cancer diagnosis and two years after I started maintenance chemotherapy and went back to work, I went to Survivorship Clinic. My doctors didn’t recommend it — a friend did. My primary care doc and my gynecologist are both great doctors, but when I have asked questions about preventive care related to my cancer (like, “Should I get re-vaccinated?”) they both acknowledge their ignorance and emit a bit of fear of making a mistake. My oncologist’s job is to worry about wandering cancer cells. All three of them do an outstanding job — I am still here, after all — but they are not experts in the long-term care of the cancer patient.

At first I didn’t want to go to Survivorship Clinic. I feel a little like a faker being called a cancer survivor. Both because I still have plenty of cancer in my abdomen (it just hasn’t gone anywhere for two years) and because I am doing really well.

It turns out that people with cancer are considered survivors the day after we get our diagnosis. Whether we have survived one day, one year or 10 years, people use the word survivor to describe our status. I am not sure I agree with the use of the word this way and to be honest, I probably went to Survivorship Clinic to please my friend and because I thought the physical therapist might give me stretching exercises to do after I jog. Not because I identify as a survivor.

Over two hours, I met with a nutritionist, a physical therapist, a social worker and a nurse practitioner. The nurse practitioner had meticulously reviewed my chart, checked into all my prevention needs, and made recommendations with full knowledge of my cancer status.

“You need to get a mammogram,” she told me.

What woman hears this and thinks to herself, “Great news”?

A survivor.

Preventative health measures — including mammograms, pap smears, good nutrition and regular exercise — are important for people who are going to live for 10 years or more. For the same reason that women in their 80s don’t need these things — something else is likely to kill them before a small breast or cervical lesion — people with metastatic colon cancer don’t need them either.

Until they do.

Apparently I am doing well enough that I need to get back on that bandwagon of preventive care. So long, as-much-chocolate-cake-as-I-want-because-I-have-cancer. Hello, mammogram.

And having heard the rest of the recommendations for me from Survivorship Clinic — balance exercises, hearing test, eating well and exercising — I am a believer in the specialized clinic and maybe even calling myself a survivor.

A pediatric oncologist friend of mine, knowing she won’t get everyone to Survivorship Clinic, throws a survivorship picnic for her pediatric patients and their families every summer. Near the bouncy house, there are tables of information on eating well for cancer survivors. Next to the balloon stand there are places to sign up for hearing tests. There are trivia games and cooking lessons. And 400 people come every year. It’s not quite personalized follow up for a cancer survivor but it’s a start.

As more and more of us survive, primary care docs will become better versed in our care. Until that point, we need specialized follow up care that reminds us to exercise, eat our vegetables and yes, get mammograms.

Marjorie S. Rosenthal is a pediatrician at Yale and a 2015-’16 Public Voices Op-Ed fellow. 

mardi 7 juin 2016

New England Governors Converge To Address Opioid Epidemic

New England Governors Converge To Address Opioid Epidemic

Seated from left are Vermont Gov. Peter Shumlin, Rhode Island Gov. Gina Raimondo, Connecticut Gov. Dannel P. Malloy, Maine Gov. Paul LePage, Hassan, and Massachusetts Gov. Charlie Baker. The governors met Tuesday in Boston to discuss strategies to deal with the opioid addiction problem in all their states. (Michael Dwyer/AP)

Seated from left are Vermont Gov. Peter Shumlin, Rhode Island Gov. Gina Raimondo, Connecticut Gov. Dannel P. Malloy, Maine Gov. Paul LePage, Hassan, and Massachusetts Gov. Charlie Baker. The governors met Tuesday in Boston to discuss strategies to deal with the opioid addiction problem in all their states. (Michael Dwyer/AP)

Pressing for the same or nearly the same limits on opioid prescriptions is one of the ways New England’s Republican and Democratic governors are working together to address the drug epidemic.

The six regional governors gathered in Boston Tuesday for an opioid panel.

There are some signs that efforts to slow the surge of opioid overdoses are working, but the death toll is grim. Narcan or Naloxone, the drug that reverses the effects of many overdoses, is becoming more widely available — and that’s a good thing, says Gov. Charlie Baker.

“We lost 1,500 people in Massachusetts in 2015, but my own speculation, based on the data I’ve seen, makes me think the number without Narcan would have been north of 5,000,” he said. “And it has a ton of, still, negative momentum.”

Baker and his five New England colleagues agree on a few ways to try and stop that momentum.

One is requiring that doctors limit their use of opioids (such as Oxycontin or Vicodin) to treat acute pain. But just how low should they go? Massachusetts and Maine recently imposed seven-day caps on first-time opioid prescriptions. A new law in Vermont sets a lower limit, in the range of just 10 pills.

Rhode Island Gov. Gina Raimondo says the governors are trying to coordinate these regulations.

“So, for instance in Rhode Island, we’re making a sure [of] a five-day limit for an initial prescription and you heard from other governors they’re going in the same direction, since a lot of people cross borders and we want to be as coordinated as possible,” she said.

The governors spoke to an international conference of physicians who prescribe or study opioids and urged them to reduce opioid prescribing on their own.

Dr. Paul Sloan, a conference co-chair is professor of anesthesiology and pain medicine at the University of Kentucky. He says doctors are thinking about the minimum amount needed to cope with acute pain.

“We as physicians have to work with that, that’s the environment which we’re in when we’re trying to deal with a public health issues, there’s just no way around that,” he said.

The Massachusetts Medical Society says just under 5,000 physicians (4,872) have taken new online courses on responsible opioid pain management since the beginning of the year. But there are lots of stories about doctors or dentists who are still sending patients home with a 30-day or greater supply of opioid pain killers.

New Hampshire Gov. Maggie Hassan says patients need more non-medical options, like acupuncture or physical therapy, for treating pain

“We need to find a way to make sure that people can get the right kind of pain treatment,” Hassan said. “This is a real challenge: Find that right kind of pain care that isn’t the delivery of an opioid.”

The New England governors are also pledging to increase efforts to stop the street supply of heroin, fentanyl and other addictive drugs. But for Vermont’s Peter Shumlin that’s a more difficult problem.

“We should keep doing all the things we can to slow down illicit drugs into this country, but no one’s figured out the silver bullet for how to get that done,” he said. “I do believe I have the answer for reducing this crisis. It is to stop passing out opiates like candy.”

Shumlin blames pharmaceutical firms and the FDA for making opioids widely available. He says the next president should fire everyone at the FDA who has signed off on increasingly powerful pain drugs.

In response to Shumlin’s critique, an FDA spokesperson sent a speech in which the agency commissioner talks about the difficulty of balancing a drug’s pain benefit against its potential for misuse, and about the FDA’s legal obligation to approve most generic versions of a drug.

Related:

vendredi 3 juin 2016

Birth Control’s Next Frontier? Clinic Aims For Quick And Easy IUDs And Implants

Birth Control’s Next Frontier? Clinic Aims For Quick And Easy IUDs And Implants

Family Health Center of Worcester. (Jesse Costa/WBUR)

Family Health Center of Worcester. (Jesse Costa/WBUR)

Come in to the Family Health Center of Worcester for just about any reason and, if you’re a woman of child-bearing age, you’re all but certain to be asked “the one key question.” In Portuguese, if that’s what you speak, or Albanian or Vietnamese — or English:

“Are you planning to become pregnant in the next year?”

If you’re not, that’s an opening for a conversation about birth control options. Vietnamese medical interpreter Annie Huynh says that after just a few months of those conversations, she’s already seeing a dramatic shift away from the many accidental pregnancies she was seeing a couple of years ago.

“Now, I hardly ever hear [it’s] an accident anymore,” she says. “It’s something either they plan for, or they don’t get pregnant anymore because of the education I got that I’m able to pass on to them.”

That education includes training on how to talk about birth control, says Jennifer Averill Moffitt, the clinic’s prenatal services manager.

“Whereas before, perhaps the counseling was, ‘Here are these 12 methods, choose which one is best for you,’ ” she says. “Now, we’re saying, ‘Here’s the most effective method, and here are some other choices. Choose what’s best for you.’ ”

The most effective method is long-acting birth control. That includes intrauterine devices, or IUDs, and the Nexplanon hormonal implant — a matchstick-sized rod that’s implanted in a woman’s arm and prevents pregnancy for three years. They’re not for everyone, but for typical users, both have failure rates of well under 1 percent, compared to an annual pregnancy rate of 9 percent for women who take the pill. (That’s due mainly to user error: Pills are easy to miss, while the long-acting methods are “set and forget.”)

The long-acting methods are on the rise nationwide — about 12 percent of women on birth control now use them — and they’re getting a lot of the credit for the recent drop in unintended pregnancies to a 30-year low. But the rate is still strikingly high: Forty-five percent of all American pregnancies are unplanned.

So why aren’t even more women using IUDs and implants, especially now that Obamacare makes them much more likely to be covered?

For one thing, they’re not always easy and quick to get — particularly for low-income women, whose unplanned pregnancy rate can be five times the rate of high-income women.

Enter Upstream USA. It’s a nonprofit that aims to remove the health care system’s remaining barriers to long-acting birth control.

“There are many health centers we work with that are literally not offering IUDs and implants at all. Period. So literally zero percent of women are getting access to these methods,” says Mark Edwards, the Boston-based co-founder of Upstream USA.

“From our point of view, that’s unconscionable,” he adds. “This is a method of contraception which research studies have shown is actually 20 times more effective than the pill in terms of real-world use, and yet health centers are not making these methods available. In any other form of medicine it would just be an outrage. If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”

Upstream goes into health clinics like the Family Health Center of Worcester and helps them up their birth-control game. That means training just about the entire staff on birth control counseling, from the medical assistants and interpreters to the schedulers.

“Having a culture shift — that says, ‘This is important enough that everyone who works in a health center should have this education’ — is huge,” Moffitt says.

It also means back-end work on medical paperwork and billing so the center doesn’t lose money on long-acting birth control. And training more medical staff to be able to insert the devices.

Plus, there’s workflow: A woman who wants an IUD or an implant often has to come back for at least one additional appointment — and that can take weeks. She may not come back, or by the time the appointment rolls around, it may be too late.

“That’s what happened with me, actually,” says Angelica Rodriguez, who books appointments at the clinic and is also a patient there, with a wry laugh. After she went through the Upstream training last year, she decided she wanted a Nexplanon implant. She booked an appointment to get one.

“But the appointment was one month after, and then, when the appointment came, it was June something, I was already pregnant,” she says. “When I found out I was pregnant I was like, ‘This is not what I wanted!’ But still I had the baby.”

Rodriguez was in shock at first, she says, because her other son was only just over a year old, But she loves her four-month-old son, planned or not. And, she notes, it’s faster now to book appointments for long-acting birth control.

These days, she’d only have to wait a week or so — and Moffitt says the Family Health Center of Worcester will soon have same-day IUD and implant appointments.

A Nexplanon birth control hormonal implant. (Merck/AP)

A Nexplanon birth control hormonal implant. (Merck/AP)

The clinic doesn’t have data yet on whether its Upstream training has cut the unintended pregnancy rate, she says. But she expects the rate to drop, as it has repeatedly in demonstration projects that gave teens and low-income women better access to long-term birth control.

“When we give women the choice, hopefully our number of unplanned pregnancies can plummet,” Moffitt says.

How far they can drop remains to be seen. Experts point out that unintended pregnancy is complicated. Unplanned doesn’t necessarily mean unwanted, says Megan Kavanaugh, a senior researcher at the Guttmacher Institute, a leading think tank on pregnancy and birth control.

And, she says, many factors go into a woman’s choice of birth control: Not all women will or even should use an IUD or implant.

But, she says, there have long been barriers to long-acting birth control, and “for women who really want to use these methods, and who now have access to these methods, that’s a huge accomplishment. That’s a great coup, I’d say, for the family planning field.”

Upstream USA is working at a half dozen sites around the country these days — including a statewide project in Delaware — and its budget, funded by donations, has gone from $1.7 million last year to over $10 million this year.

Edwards, the company’s co-founder, says he hopes Upstream will become obsolete someday.

“As a nonprofit, our goal is really to be out of business in about 12 years,” he says. “We see no reason we can’t be — that we can really change the face of unplanned pregnancy in this country in that period of time.”

He doesn’t expect an end to all unintended pregnancy in a dozen years, of course. But, Edwards says, if any American woman can get an IUD or implant whenever she wants one, that would be a major step forward.

Readers, have you encountered barriers to getting an IUD or an implant? Sarah Kliff of Vox wrote about some here.

jeudi 2 juin 2016

Minimum Age For Buying Tobacco In Worcester Raised To 21

Minimum Age For Buying Tobacco In Worcester Raised To 21

The new regulation would go into effect on Sept. 1. (Charles Rex Arbogast/AP)

The new regulation would go into effect on Sept. 1. (Charles Rex Arbogast/AP)

The Worcester Board of Health has unanimously voted to increase the minimum age for purchasing tobacco products in the city from 18 to 21.

The Telegram & Gazette reports that the new regulation, which goes into effect Sept. 1, was among several tobacco proposals the board had been discussing internally.

Local retailers opposing the measure say the new minimum likely won’t have much of a difference on teens who seek out tobacco products.

Chairwoman Abigail Averbach says it has long been a mission of the board to limit Worcester residents’ exposure to nicotine.

Dr. Lester Hartman, co-founder of the Tobacco 21 movement, says the new age restriction creates an important “social distancing” effect where young teens can no longer count on fellow students to buy them tobacco.

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mercredi 1 juin 2016

Bad Allergies, Yes. Worst Boston Year Ever? Experts Say No, But Perfect Storm Of Trees, Grass, Mold

Bad Allergies, Yes. Worst Boston Year Ever? Experts Say No, But Perfect Storm Of Trees, Grass, Mold

"At this moment there's a lot of tree pollen in the air and a lot of grass pollen in the air," says Dr. Mariana Castells, an allergist at Brigham and Women's Hospital. (Courtesy Lukasz Szmigiel/Unsplash)

“At this moment there’s a lot of tree pollen in the air and a lot of grass pollen in the air,” says Dr. Mariana Castells, an allergist at Brigham and Women’s Hospital. (Courtesy Lukasz Szmigiel/Unsplash)

I got a call from the school nurse this week: my daughter had an itchy rash on her arms and neck and red blotchy patches around her mouth.

“My best guess is it’s allergies,” the nurse said, suggesting Benadryl and hydrocortisone cream. “This is a particularly bad season. Kids who never had allergies are coming in. Kids who take Zyrtec or Claritin in the morning are still coming in — their eyes so inflamed and irritated.”

Mention allergies these days and you’re sure to get a story: a colleague left Cape Cod early this weekend, because her allergies got so bad. “The pollen was everywhere,” she said. “It was even on my dishes.”

Micheline Maynard, a senior producer at Here & Now, sent me an email detailing her own allergy hell:

Last week, I had a bout of allergies that had me weeping in the newsroom, and sneezing and coughing. (I was apologizing to my colleagues and saying, “I’m not crying!”) Claritin did nothing, and I took half a Sudafed 12-hour, which helped a little.

I went to Michigan over the weekend, which is basically the same latitude as Boston, and enjoyed a problem-free weekend. I slept with my windows open, I did things out in the garden, and felt completely recovered. No coughing, sneezing, no headache.

Within an hour of getting back to Boston on Monday, my head was completely stuffed up. I was sneezing and coughing, and feeling generally blah… I actually Googled “severe allergies” because I’d never experienced anything like it.

Dr. Elisabeth Poorman, a CommonHealth contributor and third-year medical resident at Cambridge Health Alliance, said she’s experiencing bad allergies this year, “and [I] never have since moving from Atlanta, where pollen is a way of life.”

So is this season truly the most awful for allergy sufferers — the worst one ever — or, as one doctor suggests, do a high percentage of reporters and their friends just happen to have allergies, hence the outcry?

Dr. Anna Kovalszki, M.D., clinical director in the Allergy & Inflammation division at Beth Israel Deaconess Medical Center, offers a reality check:  “I think this year is not as bad as last,” she said. “This year is definitely causing symptoms — like other years in the past. But every year I have patients who say, ‘this is the worst year ever.’ ”

Last year, when the thaw finally came following that freezing, snowy winter, “everything started to bloom,” Kovalszki said, and that led to extreme allergy symptoms that felt like they’d come on overnight.

She said patients were arriving last year with their eyes swollen shut, for instance, and due to such intense symptoms, she prescribed strong medications that she normally doesn’t, like oral prednisone — a steroid typically reserved for asthma sufferers.

This year, she says, due to the mild winter, the allergy season seemed to start earlier. And right now “tree pollen is the worst, but the grasses are starting to come up too so there’s a double whammy: if you’re allergic to both, you would have some cumulative symptoms.”

Dr. Mariana Castells, M.D., an allergist at Brigham and Women’s Hospital, agreed that last year allergy sufferers exhibited more severe symptoms that came on abruptly.

But this year, she said, there’s a “prolonged” allergy season that started earlier, with patients having “progressive” symptoms since March. Extreme temperature shifts didn’t help, she said, noting that the season could drag on: “There will be pollen very, very late in the season.”

“At this moment there’s a lot of tree pollen in the air and a lot of grass pollen in the air. Also, with the rain, there’s a lot of mold, so mold spores are something people can be allergic to,” Castells said, noting that the most common symptoms include itchy eyes and nose, nasal congestion and sneezing, post nasal drip, sinus pressure, and coughing.

If you suffer from allergies, though, it doesn’t much matter which season is the worst. Right now, it seems, there’s no escape, with pollen visible everywhere: in the yard, on the car and, at least for my colleague, on the dishes.

And in general, seasonal allergies may be getting worse, doctors suggest. It could be due to overall warming temperatures, or other factors. Kovalszki said that epidemiologic studies looking at food and peanut allergies suggest that incidences are rising.

“I suspect the environmental allergies are as well, there are certainly studies suggesting this with pet dander and also pollens,” she said.

Why? “The most discussed theory is called ‘hygiene hypothesis‘ as to why it is happening: we aren’t exposed to enough microbes, dirt, etc. and hence our bodies are finding something else to attack,” Kovalszki explained.

It’s tough to get a full and accurate picture of allergy sufferers around the region. The state Department of Public Health doesn’t track seasonal allergies, for instance.

The illness trackers at HealthMap, a group based at Boston Children’s Hospital that posts reports on disease outbreaks, says there’s nothing in the data worth noting this year about seasonal allergies.

“Maybe it’s not worse, but just longer given our mild winter?” suggests HealthMap’s Colleen M. Nguyen. “Actually [I] went to the allergist last week, and it was quite busy in the office.”

Readers, tell us your allergy story. Are things worse this year? Better? And how are you coping?

Diagnosing CTE In The Living: Massive Degenerative Brain Disease Study To Begin

Diagnosing CTE In The Living: Massive Degenerative Brain Disease Study To Begin

Robert Stern, director of Clinical Research at BU's Chronic Traumatic Encephalopathy Center, and former New England Patriot safety Tim Fox. (Jesse Costa/WBUR)

Robert Stern, director of Clinical Research at BU’s Chronic Traumatic Encephalopathy Center, and former New England Patriot safety Tim Fox. (Jesse Costa/WBUR)

About 50 medical researchers from around the country converged on Boston Wednesday, as they prepare to launch a massive seven-year study into the brain disease known as chronic traumatic encephalopathy, or CTE, in July.

CTE is a degenerative disease similar to Alzheimer’s. It’s only found in people who’ve played football, boxed or taken part in other contact sports.

The researchers are recruiting 180 former NFL and college football players to study their brains. The goal is to develop ways to diagnose CTE in people when they’re alive. The only way to diagnose it right now is by studying the brain after death.

One of the lead researchers is Robert Stern, Ph.D. He’s a Boston University School of Medicine professor of neurology and neurosurgery and director of clinical research at BU’s Chronic Traumatic Encephalopathy Center.

Helping Stern champion the research is Tim Fox, a 62-year-old former NFL safety who played for the Patriots, Chargers and Rams. He thinks he has CTE.

Fox and Stern spoke with WBUR’s All Things Considered host Lisa Mullins about the disease. Stern says while much of the focus has been on concussions, CTE is caused by something that can seem more benign.

Audio from the interview will be added to this post after it airs on All Things Considered.

Interview Highlights

On diagnosing chronic traumatic encephalopathy:

Stern: “The only people who have ever been diagnosed with it after life, which is the only way to diagnose it, have had a history of repetitive hits to the head. It’s never been seen in someone without that kind of history… It’s a disease that gets set in motion from having repetitive hits … regardless of whether they are symptomatic concussions.”

Fox: “For me, the symptoms are difficulty recalling names, events, issues — even in common speech. I have trouble sometimes grasping what I want to say. It affects your personality. It’s a very frustrating situation when you can’t recall things that you’d like to recall. And I don’t know whether that leads to a much shorter fuse. You know, I don’t have the patience that I once had … and from my perspective it’s looking down the barrel, to me, of a ticking time bomb, because I see all these things in players that have been diagnosed after death, and I look at those symptoms and it’s eerily similar. I would very much like to see them succeed in being able to diagnose this while you are living. I don’t want to have to die to be confirmed that I’ve had issues for the last 10, 20 years of my life. And once they can definitively diagnose it, then we can more accurately, I would assume, definitively treat it.”

Stern: “We have to figure out what the risk factors are for CTE. We know that there’s a necessary risk factor, and that’s getting your head hit over and over again. But obviously not everyone who hits their head a bunch gets this brain disease. So we need to figure out why one person gets it, and another person doesn’t. Is it something about the number of hits, the age of hits, the type of hits? We’re trying to figure that out. But is it also something about genetics? And so we’ve got these incredible geneticists involved with this project to be able to start answering questions about who might be at increased risk based on their genetic kind of make-up. But one of the things we know about these types of brain diseases is that if we can detect it early on and implement some kind of intervention that modifies the disease course, then in a way, that’s prevention. By changing the course of the disease, slowing it down enough, at a time before there’s too much brain destruction, that’s the ultimate goal.”

On a congressional report that found the NFL improperly tried to influence the research and withdrew funding for the study because it felt Stern is biased:

Stern: “I don’t talk about funding issues. It’s just not the thing to do in science. I’m absolutely thrilled that the NIH decided to fund this project. And I’m just really focused on moving the science forward.”

Fox: “The NFL is scared to death of CTE because it can affect their bottom line. And the reality is the NFL is all about making money. They’ve got 32 owners that want to protect their income source. And this is a dramatic threat to the game itself. It’s a dramatic threat to Pop Warner. It’s a threat to high school football. It’s a threat to college football. And as people stop playing at those levels, they will not have the same level of interest in the NFL. So the NFL has consistently dragged their feet in terms of trying to recognize that they have a problem, and they will only admit they have a problem when they’re backed into a corner or they say something by mistake. And so the example of taking the funding away from a project that they had pledged — where they said there would be no strings attached — and then backtracked and took the money back, is just another example of that.”

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