Tagged Children’s Health

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Yours truly is back from beautiful Vietnam and it seems I missed one or two … ahem … minor news events while traipsing around.

I come bearing no souvenirs but rather two health reminders (one via Sen. Bernie Sanders). Firstly, don’t forget your flu shot — Australia has had an unusually early and severe season, which rarely bodes well for our own. The second comes in the form of a hard-earned lesson from a 2020 candidate: Don’t ignore those heart attack warning signs! (This is especially directed at women, who are dying unnecessarily from cardiac events.)

Now enough mother-henning. (You missed me, didn’t you?) On to the news of the week!

The Supremes are back in action, and a look at the high court’s docket reveals a potentially doozy of a politically charged term (with rulings expected to land as the general election heats up in 2020).

In the health care sphere, a big case to watch is the Louisiana abortion suit. An essentially identical Texas law — which requires doctors performing abortions to have admitting privileges at nearby hospitals — was ruled unconstitutional by the court in 2016, but that means little with two new justices appointed by President Donald Trump weighing in.

The New York Times: As the Supreme Court Gets Back to Work, Five Big Cases to Watch

Oral arguments in two other health-related cases were held this week. The justices grappled with the moral and legal complexities of the insanity defense. The case prompted questions such as this one from Justice Stephen Breyer: One defendant kills a victim he thinks is a dog. “The second defendant knows it’s a person but thinks the dog told him to do it,” Breyer said. “They are both crazy. And why does Kansas say one is guilty, the other is not guilty?”

The New York Times: Supreme Court Opens New Term With Argument on Insanity Defense

Tuesday was all about LGBTQ rights. Although most of the justices were divided along ideological lines on whether federal civil rights legislation applies to sexual orientation and gender identification, Justice Neil Gorsuch hinted his vote might be in play. As an avowed believer in textualism, he suggested that the words of Title VII are “really close, really close” to barring employment discrimination for those workers. But don’t go placing bets on the outcome yet. He also noted that he was worried about “the massive social upheaval” that would follow such a Supreme Court ruling.

The New York Times: Supreme Court Considers Whether Civil Rights Act Protects L.G.B.T. Workers

On that note, the 2020 Democratic candidates participated in an LGBTQ forum on the eve of National Coming Out Day. There were a handful of notable moments through the night (including a zinger from Sen. Elizabeth Warren that was met with loud applause), but much of the spotlight was on protesters who demanded the candidates pay attention to violence against black transgender women. “We are hunted,” said one member of the audience.

CNN: Protesters Interrupt CNN LGBTQ Town Hall to Highlight Plight of Black Transgender Women

Elsewhere on the campaign trail this week, controversy over a pregnancy discrimination talking point from Warren’s stump speech prompted women — including Warren rival Sen. Amy Klobuchar — to speak out on social media about their own and their mothers’ experiences.

NBC News: Women Rally in Support of Elizabeth Warren by Sharing Their Own Pregnancy Discrimination Stories

Sanders’ campaign confirmed that the health scare from last week was indeed a heart attack. The 2020 candidate — who promised to return “full blast” to the race — said he hopes people learn from his “dumb” mistake of ignoring the warning signs. In true politician-running-for-office style, he also was able to use the scare as a way to emphasize the importance of his signature policy proposal, “Medicare for All.”

Reuters: Democratic Presidential Hopeful Sanders Says He Was ‘Dumb’ to Ignore Health Warnings

In a sign of what’s to come for Big Pharma, South Bend Mayor Pete Buttigieg, one of the field’s more moderate candidates, released a drug pricing plan that is decidedly not moderate. The move falls in line with a broader sense that there’s an ever-growing appetite among even middle-ground Dems for action to rein in drugmakers.

Stat: Buttigieg Unveils an Aggressive Plan for Lowering Drug Prices

And for you political wonks out there, this was an interesting read on the shifting political dynamics of doctors, who once used to be a sure thing for the GOP.

The Wall Street Journal: Doctors, Once GOP Stalwarts, Now More Likely to Be Democrats

A key ruling on the health law is expected in the next few weeks, but officials (on condition of anonymity,  mind you) said that if the ruling is against the ACA, the Trump administration will ask the court to put any changes on hold — possibly until after the election. The reports further support the idea that the law, which has been, uh, politically fraught (to say the very least) over its entire life span, is at the moment viewed as an Achilles’ heel for Republicans.

The Washington Post: Trump Administration Plans to Delay Any Changes If the ACA Loses in Court

Two other major news items out of the administration this week to pay attention to:

The Associated Press: Trump Signs Proclamation Restricting Visas for Uninsured

The Associated Press: Overhaul Is Proposed for Decades-Old Medicare Fraud Rules

The first teenager’s death in the outbreak of vaping-related lung illnesses drove home this week public health officials’ message that young people are “playing with their lives” when they partake. The number of cases jumped to 1,299 as of Oct. 8, with the number of deaths rising to 26.

The Wall Street Journal: New York City’s First Vaping-Related Death Is a Bronx Teen

Reuters: U.S. Vaping-Related Deaths Rise to 26, Illnesses to 1,299

Although Juul is facing a barrage of lawsuits, one filed this week was notable. It was believed to be the first from school districts, which claim that fighting the vaping epidemic has been a drag on their resources. While some legal experts are dubious about whether the school districts can establish their standing, others aren’t ruling it out.

The New York Times: Juul Is Sued by School Districts That Say Vaping Is a Dangerous Drain on Their Resources

And the ripple effect of the crisis is spreading to life insurance prices.

Bloomberg: Prudential Plans to Boost Life Insurance Prices for Vapers

Time for you to flex your ethical muscles for the week: Should there be boundaries to highly personalized medicine? A pricey drug designed — and named for! — just one patient sparked questions this week about how far researchers should go in the name of curing a single person. Especially when there are thousands of patients out there with rare diseases. Would only the wealthiest subset be given cures? Who would decide which patients deserve limited research hours over others?

The New York Times: Scientists Designed a Drug for Just One Patient. Her Name Is Mila.

And ProPublica shines a light on the practice of drug companies using flashy Facebook ads, cash incentives and other marketing techniques to woo Mexican residents over the border to donate plasma. It’s not as innocuous as it might seem — donating too much plasma can compromise the immune system. (Selling plasma has been banned in Mexico since 1987.)

ProPublica: Pharmaceutical Companies Are Luring Mexicans Across the U.S. Border to Donate Blood Plasma

In the miscellaneous file for the week:

  • An Ohio doctor is being charged in 25 fentanyl-related deaths. How on earth was such a lapse allowed to occur? The New York Times peels back the curtain on years of lapses and missed warnings in one Columbus intensive care unit.

The New York Times: One Doctor. 25 Deaths. How Could It Have Happened?

  • During the week of World Mental Health Day, research finds that Americans are starting to internalize all the political rhetoric (and myths) about the connection between mental health and violence. “People want simple solutions: They want to be able to neatly explain things,” said one expert.

Los Angeles Times: Americans Increasingly Fear Violence From People Who Are Mentally Ill

  • There’s more than one way to keep a community healthy, and that goes beyond doctor’s offices, clinics and hospitals. A growing number of medical professionals are embracing the notion that steady paychecks, stable housing and good food are crucial to supporting their patients before they get sick.

The New York Times: When a Steady Paycheck Is Good Medicine for Communities

  • In a sad sign of the times, a muppet on “Sesame Street” is going to have a mother struggling with addiction. The storyline is meant to help an ever-increasing number of children affected by the opioid crisis.

Stat: ‘Sesame Street’ Launches Initiative to Help Explain Parental Addiction to Kids

  • High levels of uranium were found in the blood of Navajo women and babies in a study that underscored the real costs of America’s atomic development. Lawmakers are pushing for legislation that would compensate those who have been exposed.

The Associated Press: US Official: Research Finds Uranium in Navajo Women, Babies

  • And the Nobel Prizes are given out this week: In medicine, scientists who worked with oxygen and cells were honored. Their work has the potential to be the building blocks for things like cancer treatments.

The Washington Post: Nobel Prize in Medicine Awarded for Discovery of How Cells Sense Oxygen

That’s it from me! It’s good to be back with you guys, and I hope you have a great weekend!

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As Vaping Illnesses Rise, So Do Pleas To Quit-Smoking Help Lines

“I stopped for a few days and then I ended up buying new pods. The withdrawals got to me.”

“My friends are the ones who got me into vaping. And they think I shouldn’t stop, but I want to because I don’t want to hurt my family if I get sick.”

“I feel like I get winded easily and I just know it’s not good for me. I want to quit so bad but it’s really hard when all your friends are vaping around you.”

These are just a few of the messages that teen vapers texted in September to the new “My Life, My Quit” program, which offers phone, text and chat lines to young people trying to quit smoking in 13 states.

Even though “quitlines” were designed to help people kick cigarette habits, calls and texts from people who use e-cigarettes are climbing as more people fall ill with a mysterious and devastating respiratory illness linked to vaping.

Health officials are investigating 1,299 cases in 49 states and the District of Columbia, including at least 26 deaths. In California, more than 120 residents have fallen ill, at least three of whom died, according to the California Department of Public Health.

The department in September called on everyone to refrain from vaping, “no matter the substance or source,” while the investigations continue. The Centers for Disease Control and Prevention also advised people to “consider refraining” from using e-cigarette products, especially those that contain THC, the main psychoactive ingredient in marijuana, which has been linked to most of the illnesses.

The rise in calls to help lines means the message is penetrating, said Stanton Glantz, director of the University of California-San Francisco Center for Tobacco Control Research and Education.

“The more we learn about e-cigarettes, the more dangerous they look,” Glantz said. “Callers are right to be worried, frankly.”

Optum, which operates tobacco quitlines for 23 states and the District of Columbia and for more than 1,000 employers, logged a 50% increase in callers asking for help to quit vaping since the CDC released its first report on the illnesses in early September, said Seth Serxner, the company’s chief health officer.

The majority of state quitlines are run by Optum or National Jewish Health, a respiratory research hospital in Denver, whose My Life, My Quit program is aimed at youths. National Jewish Health runs help lines for 16 states — not all of which offer My Life, My Quit — enrolling about 100,000 people each year into tobacco cessation programs.

The quitlines are publicly funded, and the counseling is free.

Almost 20% of callers to Optum’s help lines said they used vapes, up from 3% during the same period in 2015, Serxner said.

“People are going, ‘Whoa, I didn’t know this was that bad for me,’” he said.

In July, National Jewish Health enrolled 88 people into its cessation program who said they vaped exclusively. In August and September combined, the organization enrolled 457 people who vaped exclusively, more than five times the July figure, said Thomas Ylioja, clinical director for health initiatives at the organization.

Calling 1-800-QUIT-NOW routes callers to counselors in their state, where they can get counseling to help them set quit dates and identify triggers that could lead to a relapse. If clients give permission, counselors follow up with them in the days and weeks after their initial call, when quitting can be most difficult.

Depending on where callers live and what kind of insurance they have, they may qualify for free nicotine replacement therapy, like patches, gum, lozenges or prescription medication. Vapes and e-cigarettes are not a federally approved treatment for smoking cessation, so help lines have not recommended them to clients to help them quit.

Not all state quitlines are seeing an uptick in calls. Calls from vapers were flat for West Virginia’s help line from July through September compared with the same period in 2018, said Lindsy Hatfield, program director for First Choice Services, which operates the state’s quitline.

But starting in August, Hatfield noticed that some callers didn’t realize that their Juul e-cigarettes, the nation’s most popular brand, could addict them to nicotine, even though it is listed as an ingredient on the package.

“Some people we found did not know that Juul was an e-cigarette, vape or nicotine device,” Hatfield said. “They felt that Juul did not have nicotine in it, and so it couldn’t be the same thing” as an e-cigarette.

The University of California-San Diego runs California’s tobacco quitline (which offers help in English and Spanish) and serves about 30,000 callers a year. It also runs a national help line for people who speak Mandarin, Cantonese, Vietnamese and Korean.

Since 2017, the quitline has received a steady increase in calls from people who vape. Most said they were using e-cigarettes to quit or cut down on cigarettes because they thought of vapes as a “better alternative,” said Niki Hoang, a San Diego-based counselor and former smoker who has been with the help line for seven years.

Hoang and her colleagues noticed a change this summer: Callers who used vapes to quit cigarettes are now trying to quit vaping, she said.

And smokers who have never tried vaping are vowing to stay away, saying they don’t want to “be the guinea pig,” according to Hoang.

The summer’s influx of calls prompted the help line to train the California staff — about 60 counselors — on the history of the devices and how to counsel people who want to quit.

The calls for help are a far cry from 2007, about the time vapes hit the U.S. market and were described as safer than cigarettes.

Millions have started using them since then, including teens and young adults. Recent federal data funded by the National Institute on Drug Abuse shows that 25% of this year’s high school seniors and 20% of 10th graders reported vaping nicotine in the past month. That’s more than double the use reported in 2017.

Little research exists on the best strategies to stop vaping, so quitline counselors generally employ techniques they’d use for cigarette addiction.

But there is at least one key difference between smoking and vaping that might make the latter more difficult to quit, said Ylioja of National Jewish Health. Vapers have an easier time evading restrictions on smoking in indoor spaces or public places because the smell dissipates faster, he said.

That makes it difficult for vapers to make a plan to avoid situations or people sparking future cravings.

“They have a harder time identifying what triggers might be,” Ylioja said. “They were using these products in so many different social situations.”

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California Public Health

Congenital Syphilis Continues To Rise At An Alarming Rate

One of the nation’s most preventable diseases is killing newborns in ever-increasing numbers.

Nationwide, 1,306 infants acquired syphilis from their mother in 2018, a 40% rise over 2017, according to federal data released Tuesday. Seventy-eight of those babies were stillborn, and 16 died after birth.

In California, cases of congenital syphilis — the term used when a mother passes the infection to her baby during pregnancy — continued a stark seven-year climb, to 332 cases, an 18.1% increase from 2017. Only Texas, Nevada, Louisiana and Arizona had congenital syphilis rates higher than California’s. Those five states combined made up nearly two-thirds of total cases, although all but 17 states saw increases in their congenital syphilis rates.

The state-by-state numbers were released as part of a broader report from the Centers for Disease Control and Prevention tracking trends in sexually transmitted diseases. Cases of syphilis, gonorrhea and chlamydia combined reached an all-time high in 2018. Cases of the most infectious stage of syphilis rose 14% to more than 35,000 cases; gonorrhea increased 5% to more than 580,000 cases; and chlamydia increased 3% to more than 1.7 million cases.

For veteran public health workers, the upward trend in congenital syphilis numbers is particularly disturbing because the condition is so easy to prevent. Blood tests can identify infection in pregnant women. The treatment is relatively simple and effective. When caught during pregnancy, transmission from mother to baby generally can be stopped.

“When we see a case of congenital syphilis, it is a hallmark of a health system and a health care failure,” said Virginia Bowen, an epidemiologist with the CDC and an author of the report.

It takes just a few shots of antibiotics to prevent a baby from getting syphilis from its mother. Left untreated, Treponema pallidum, the corkscrew-shaped organism that causes syphilis, can wiggle its way through a mother’s placenta and into a fetus. Once there, it can multiply furiously, invading every part of the body.

The effects on a newborn can be devastating. Dr. Philip Cheng is a neonatologist at St. Joseph’s Medical Center in Stockton, a city in San Joaquin County in California’s Central Valley. Thirty-one babies were infected last year in San Joaquin County, according to preliminary data provided by the county.

The brain of one of Cheng’s patients didn’t develop properly and the baby died shortly after birth. Other young patients survive but battle blood abnormalities, bone deformities and organ damage. Congenital syphilis can cause blindness and excruciating pain.

Public health departments across the Central Valley, a largely rural expanse, report similar experiences. California has yet to release its county-by-county numbers for 2018, but multiple county health workers throughout the valley said their congenital syphilis cases rose. In 2017, 30 stillbirths statewide were attributed to syphilis.

For the past several years, Fresno County, which had 60 cases of congenital syphilis in 2017, had the highest rate in California (though that may change for 2018). The epidemic is far from under control. “I couldn’t even tell you how soon I think we’re going to see a decrease,” said Jena Adams, who oversees HIV and STD programs for Fresno County.

Syphilis was once a prolific and widely feared STD. But by the 1940s, penicillin was found to have a near-perfect cure rate for the disease. By 2000, syphilis rates were so low in the U.S. that the federal government launched a plan to eliminate the disease. Today, that goal is a distant memory.

Health departments once tracked down every person who tested positive for chlamydia, gonorrhea or syphilis, to make sure they and their partners got treatment. With limited funds and climbing caseloads, many states now devote resources only to tracking syphilis. The caseloads are so high in some California counties that they track only women of childbearing age or just pregnant women.

“A lot of the funding for day-to-day public health work isn’t there,” said Dr. Jeffrey Klausner, a professor at the University of California-Los Angeles who ran San Francisco’s STD program for more than a decade.

The bulk of STD prevention funding is appropriated by Congress to the CDC, which passes it on to states. That funding has been largely flat since 2003, according to data from the National Coalition of STD Directors, which represents health departments across the country. Take into account inflation and the growing caseloads, and the money is spread thinner. “It takes money, it takes training, it takes resources,” Klausner said, “and policymakers have just not prioritized that.”

A report this year by Trust for America’s Health, a public health policy research and advocacy group, estimated that 55,000 jobs were cut from local public health departments from 2008 to 2017. “We have our hands tied as much as [states] do,” said Bowen of the CDC. “We take what we’re given and try to distribute it as fairly as we can.”

San Joaquin County health officials have reorganized the department and applied for grants to increase the number of investigators available as congenital syphilis has spiked, said Hemal Parikh, county coordinator for STD control. But even with new hires and cutting back to tracking only women of childbearing age with syphilis, an investigator can have anywhere from 20 to 30 open cases at a time. In other counties, the caseload can be double that.

In 2018, Jennifer Wagman, a UCLA professor who studies infectious diseases and gender inequality, was part of a group that received CDC funding to look into what is causing the spike in congenital syphilis in California’s Central Valley.

Wagman said that, after years of studying health systems in other countries, she was shocked to see how much basic public health infrastructure has crumbled in California. In many parts of the Central Valley, county walk-in clinics that tested for and treated STDs were shuttered in the wake of the recession. That left few places for drop-in care, and investigators with no place to take someone for immediate treatment. Investigators or their patients must make appointments at one of the few providers who carry the right kind of treatment, and hope the patients can keep the appointment when the time comes.

In focus groups, women told Wagman that working hourly jobs, or dealing with chaotic lives involving homelessness, abusive partners and drug use, can make it all but impossible to stick to the appointments required at private clinics.

Wagman found that women in these high-risk groups were seeking care, though sometimes late in their pregnancy. They were just more likely to visit an emergency room, urgent care or even a methadone clinic — places that take drop-ins but don’t necessarily routinely test for or treat syphilis.

“These people already have a million barriers,” said Jenny Malone, the public health nurse for San Joaquin County. “Now there are more.”

The most challenging cases in California are wrapped up with the state’s growing housing crisis and a methamphetamine epidemic with few treatment options. Women who are homeless often have unreliable contact information and are unlikely to have a primary care doctor. That makes them tough to track down to give a positive diagnosis, or to follow up on a treatment plan.

Louisiana had the highest rate of congenital syphilis in the country for several years — until 2018. After a 22% drop in its rate, combined with increases in other states, Louisiana now ranks behind Texas and Nevada. That drop is the direct result of $550 million in temporary supplemental funding that the CDC gave the state to combat the epidemic, said Chaquetta Johnson, deputy director of operations for the state’s STD/HIV/hepatitis program. The money helped bolster the state’s lagging public health infrastructure. It was used to host two conferences for providers in the hardest-hit areas, hire two case managers and a nurse educator, create a program for in-home treatment and improve data systems to track cases, among other things.

In California, more than 40% of pregnant women with syphilis passed it on to their baby in 2016, the most recent year for which data is available. Gov. Gavin Newsom made additional funding available this year, but it’s a “drop in the bucket,” said Sergio Morales of Essential Access Health, a nonprofit that focuses on sexual and reproductive health and is working with Kern County on congenital syphilis. “We are seeing the results of years of inaction and a lack of prioritization of STD prevention, and we’re now paying the price.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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