NPR Health Blog

Syndicate content Shots - Health News
NPR's online health program
Updated: 23 min 10 sec ago

One More Reason To Reach For A Paper Book Before Bed

Fri, 12/26/2014 - 4:26pm
One More Reason To Reach For A Paper Book Before Bed December 26, 2014 4:26 PM ET Listen to the Story 2 min 15 sec  

Sleepy in the day and wide awake at night? Give the screen a rest.

Guido Mieth/Getty Images/Flickr RM

E-readers may make it particularly hard to get a good night's sleep, according to research out this week.

A study that followed every nightly twitch, turn and snore of 12 volunteers for a couple weeks found that those who read from an iPad before hitting the sack had a harder time falling asleep, spent less time in a crucial phase of sleep, and were less alert the next day.

Shots - Health News Skimping On Sleep Can Stress Body And Brain NPR Ed Kids And Screen Time: What Does The Research Say?

This is cause for concern because sleep disruptions may be associated with a variety of health problems, according to the study's leader, Anne-Marie Chang, who studies sleep and circadian rhythms at the Brigham & Women's Hospital in Boston. "Sleep deficiency is associated with negative consequences for health," including obesity, diabetes, cardiovascular disease, Chang says.

Previous research has indicated that exposure to certain types of light seems to disrupt sleep more than others, Chang says. Devices that emit shorter-wavelength, blue light might be especially problematic, she and her team suspected, because it has the greatest effect on the hormone melatonin, which regulates sleep.

"We knew that light in the evening affects circadian rhythms and affects sleep and alertness," Chang says. "But we wanted to test if light from light-emitting devices, such as e-readers, which were gaining in popularity, would have the same effect if people were using them to read before bedtime."

Books Put Down Your E-Reader: This Book Is Better In Print

So the researchers asked 12 healthy young people to spend a couple of weeks in a sleep lab. For five nights, they read what they considered to be relaxing material on an iPad for four hours before going to sleep. For another five nights, they read the same kind of material from books made of paper.

In the study published in this week's issue of the Proceedings of the National Academy of Sciences, the researchers found that on the nights participants read from iPads, it took longer for them to fall asleep and they spent less time in an important phase of slumber known as rapid eye movement (REM) sleep.

"They also reported feeling less sleepy in the evening but more sleepy the following morning," Chang says.

The team also discovered that the light from the iPad was suppressing and delaying the production of melatonin.

Based on the findings and others, Chang recommends that if people want to read before bed, they should consider devices that don't emit light — or just pull out an old-fashioned paper book.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

A Split View On Obamacare's Past And Future

Fri, 12/26/2014 - 3:33am
A Split View On Obamacare's Past And Future December 26, 2014 3:33 AM ET

fromWNPR

Jeff Cohen Listen to the Story 4 min 14 sec  

Kevin Counihan (left) runs HealthCare.gov, and Michael Cannon, of the Cato Institute, is a prominent critic of Obamacare.

Courtesy of Chion Wolf/WNPR; Courtesy of the Cato Institute

Kevin Counihan and Michael Cannon look at the Affordable Care Act and see very different things.

Cannon is part of the brain trust behind a Supreme Court case that could result in the repeal of a part of the exchanges he says is illegal.

Counihan's job is to make the exchanges work.

Shots - Health News Obamacare Sign-Ups Show Wide Variation By State, Ethnicity

Millions of people got insurance through the exchanges since they went into operation in October of 2013 (millions also got coverage through Medicaid). But the year ended with doubt. Republicans, largely opposed to the Affordable Care Act, won both houses of Congress, and the U.S. Supreme Court said it will hear a case that could derail the exchanges altogether.

Counihan

Kevin Counihan began 2014 running Connecticut's health exchange, one of the most successful state. He was tapped in August to leave Connecticut and run the federal insurance marketplace, HealthCare.gov. He says that serving consumers is a top priority. The good news for him is that bar is pretty low. At its launch in 2013, HealthCare.gov began by failing. Now, things are looking up.

Shots - Health News HealthCare.gov Recruits Leader Of Successful Connecticut Effort

"A year ago, when somebody would come on HealthCare.gov they would have to walk through 76 screens in order to complete their application. That's been reduced now to 16," says Counihan.

He points to other successes, too. There are more insurers in the marketplace. People renewing could have a fairly easy time of it, since their applications have 90 percent of their information already entered. And millions of people got in touch before Dec. 15, which was the deadline for those who wanted coverage beginning Jan. 1, 2015.

"We had an extraordinary weekend," says Counihan, referring to Dec. 13 and 14. Call centers fielded 1.6 million calls, he said with over 1 million calls on Dec. 15. "And the next day, that Tuesday, the 16th, at our morning stand-up meeting, the first thing we asked was, 'What are the service issues?' No consumers had called in with service issues," he says.

Counihan says he hasn't had time to worry about the broader existential threats to the Affordable Care Act. He's just focused on making it run.

"The basic premise is that having more people insured than fewer is better for both the people and the country because it provides the best way to improve people's lives and also to better control health care costs," he says. "I think it could be described really as probably the most significant social program in 50 years — since the creation of Medicare and Medicaid."

Cannon

That's one way of looking at it. Here's another, from Cannon: "It's amazing what you can accomplish when you're willing to break the law."

Shots - Health News If Supreme Court Strikes Federal Exchange Subsidies, Health Law Could Unravel

Cannon is the director of health policy studies at the libertarian Cato Institute and has long opposed the Affordable Care Act.

As he sees it, the Obamacare train may be running on time, but it never should have left the station to begin with. He says the subsidies are only meant for state-based exchanges. Meaning, the subsidies the government is paying to consumers who buy their insurance through HealthCare.gov are not in the law. By paying those subsidies, he says, Obama is breaking that law.

Cannon concedes that millions of people have gotten subsidies. And there's no avoiding the fact that the exchanges are up and running, and there are more insurers in the market creating competition. But he says it's all flawed.

"None of this would have happened if not for those illegal subsidies the president is offering in the 36 states with federal exchanges. There would be no exchanges, there would be no competition, there would be no insurers participating. None of this would have happened if the president were following the law. There would be no successes if the president had followed the law."

Cannon has spent the last few years arguing that the subsidies are a problem. Soon the Supreme Court will hear the case.

"By mid 2015, the Supreme Court could rule that the administration has been breaking the law and, at that point, some five million people who the administration has enrolled in health insurance through HealthCare.gov will see their premiums quadruple, see their tax liabilities increase by thousands, they could see their plans disappear," he says.

While that may be disruptive, Cannon says it wouldn't be nearly as bad as letting the subsidies continue. That, he says, would give Obama and all future presidents permission to govern beyond the limits of the law.

But Cannon cautions against getting too caught up in how the justices will rule. Even if Obama wins the legal argument, with Republicans in charge of Congress, the political fights will continue.

This story is part of a reporting partnership with NPR, WNPR and Kaiser Health News.

Copyright 2014 Connecticut Public Radio. To see more, visit http://www.wnpr.org.
Categories: NPR Blogs

When Home And Health Are Just Out Of Reach

Wed, 12/24/2014 - 4:25pm
When Home And Health Are Just Out Of Reach December 24, 2014 4:25 PM ET

fromWCPN

Sarah Jane Tribble Listen to the Story 3 min 52 sec  

Donna Giron wheels through the halls of the nursing home she's lived in since May. Finding an affordable home of her own has been difficult.

Sarah Jane Tribble/WCPN

Donna Giron is frail. She has Crohn's disease and uses a wheelchair to get around because walking exhausts her.

But she doesn't want to be in the nursing home where she has lived since May.

Shots - Health News This Nursing Home Calms Troubling Behavior Without Risky Drugs

Giron, 65, is looking to rent a small house in the industrial town in the Cleveland suburbs where she grew up. Using federal funds from a special project, thousands of elderly and disabled nursing home residents have been able to move into their own homes in recent years. The experimental project has reached people in 44 states, including more than 5,400 in Ohio. It connects people to the medical and living support they need to move into private homes, so that they can live independently.

But often the housing is the sticking point. Giron doesn't have family members who could take her in, so she's house-hunting. As she tours one likely prospect, she manages to get out of her wheelchair to maneuver down some stairs; at the bottom, Giron looks out a window at the front porch and says she can picture herself sitting outside watching the neighborhood.

Then, she sees the kitchen.

"Oh, we even got a dishwasher! Oh, my goodness gracious. Yeah, I want this one. I want this one," she says, laughing.

Despite her health problems, Giron feels out of place in the nursing home, where many residents are older and sicker than she is.

"I'm a very independent woman," she says. "I have been for most of my life. I mean, I've had to be."

Shots - Health News Getting People Out Of Nursing Homes Turns Out To Be Complicated Shots - Health News Connecticut Considers Letting Health Aides Give Medicines To Homebound

But independence is difficult to achieve. And until recently her health insurance – Medicaid — has been the roadblock. Ohio Medicaid director John McCarthy explains that the federal program that offers health coverage for the poor and disabled is primarily set up to help people live in nursing homes.

"It's the housing that's the hard part, because Medicaid will not pay for housing costs, meaning room and board," McCarthy says. "It will only pay for room and board in institutions."

If Giron finds a home, she will have to pay rent out of her small pension. But as part of this experimental program, Medicaid will pay for the costs of setting up house: house-hunting, deposits for rent, and the purchasing of household items like furniture. Perhaps most importantly, it provides a transition coordinator to help find the home and connect Giron to services she'll need, such as home health workers.

"It is a lot of work," McCarthy says. "These are not easy cases to deal with. It's not like you just find somebody and move them. It takes a lot of time and effort to make this happen."

Many in the program are older and disabled like Giron. But most in Ohio are actually younger than 65, often with physical or mental challenges that make finding the right housing particularly difficult.

In every category, though, making it possible for these Medicaid recipients to live on their own saves the state and federal government money. McCarthy and his team estimate that the average costs for an individual in the experimental program (which is called Money Follows the Person) is $49,000. Under traditional Medicaid it costs about $64,000 annually for nursing home care in Ohio.

The state's Republican administration believes so strongly in this project that it stepped up efforts to transition people into it three years ago, right after the project was funded again, under the Affordable Care Act.

Ohio, Texas and Washington account for 40 percent of the nation's home placements since the federal project began.

The program is very popular with beneficiaries, policy makers and even some nursing homes, but there are still two big challenges. For one, funding for the program was extended under the Affordable Care Act in 2010 but is set to expire in September 2016.

And, secondly, people like Giron who are waiting to get a home are finding it very difficult to find one that's affordable.

"I just want my own place," Giron says. "I don't want anything fancy. I just want something to call my own. I just want to be in my own home. I just want to live my life normally like most people do. I want to be on my own. I want to be happy." She starts to cry.

Giron did not end up getting the little, two-story house with the dishwasher. But she did get some good news for the holidays: A few days ago she signed a lease for a different place and is slated to move into the home in January.

This story is part of an NPR reporting partnership with WCPN and Kaiser Health News.

Copyright 2014 Cleveland Public Radio. To see more, visit http://www.wcpn.org.
Categories: NPR Blogs

Would You Like Health Insurance With Those Stocking Stuffers?

Wed, 12/24/2014 - 1:35pm
Would You Like Health Insurance With Those Stocking Stuffers? December 24, 2014 1:35 PM ET

fromKQED

April Dembosky

Need a gift for a 20-something kid about to age out of the family's health plan? Juana Rivera (left) discusses insurance options with Fabrizzio Russi, an agent from Sunshine Life and Health Advisors, at the Mall of the Americas in Miami.

Joe Raedle/Getty Images

California's health insurance marketplace, Covered California, has supported the development of more than 200 new storefronts at or near shopping centers across the state this year, each tasked with explaining the ins and outs of different health plans to holiday (and everyday) shoppers.

Storefronts like this one in Pleasant Hill, Calif., capture a lot of walk-in traffic for health insurance.

Marc Protenic/HealthMarkets

"Especially during this time of year, malls have incredible foot traffic," says James Scullary, a Covered California spokesperson. "You may have someone who is running an errand or picking someone up who passes one of these facilities, and it passes in their mind: This is something they need to take care of."

Connecticut opened up storefronts in 2013 to great success, and the idea is being echoed across the country. The federal government has forged a partnership with Westfield Shopping Centers to set up kiosks in malls where people can talk to an enrollment counselor, in between visits to Macy's and Toys R Us. Officials have even suggested that health insurance could make a nice gift, especially for young adults who will soon age out of their parents' plan.

It's a new concept for many holiday shoppers.

"Health insurance? That's weird," says Irvin Barboza, who recently took his three kids to get their picture taken with Santa Claus at the Sunvalley Shopping Center in Concord, 30 miles east of San Francisco. "But I mean, I guess it's a good pitch. While everyone's shopping, might as well shop for health insurance, right?"

Agents with HealthMarkets, a national independent insurance agency, opened a storefront just down the block from the mall a couple of months ago, in time for the holiday shopping season. They planted several Covered California signs on the lawn to catch people driving by. About half their customers are walk-ins.

"A lot of them are going to the mall to buy Christmas presents and they see the sign and go, 'Oh my God, I have to do that,' " says Marc Protenic, head of sales.

He says this is a lesson learned from last year. Covered California pushed people to sign up online or over the phone. But it turned out many people preferred to get in-person help.

Shots - Health News Customers Rush To Retail Store In Connecticut To Buy Obamacare Shots - Health News For Some Uninsured, Simply Signing Up Is A Challenge

"What we discovered was that a storefront was better," Protenic says.

Covered California also realized that people often had several interactions with an agent, or visited the website several times, before they finally signed up, says Scullary.

Shots - Health News State Health Insurance Exchanges Hope To Woo Urban Minorities

"People wanted and needed several touch points before they would make a decision and pick a plan," he says, adding that establishing more storefronts was one way of creating more opportunities for this. "Being in the community, where people work or where they shop. It's just being where people are."

Many of the storefronts will close when the open enrollment period ends Feb. 15, Scullary says. But some, like the HealthMarkets shop near the Concord mall, plan to stay open year-round to help people with other insurance questions that arise in the off season.

This story was produced by State of Health, KQED's health blog.

Copyright 2014 KQED Public Media. To see more, visit http://www.kqed.org/news.
Categories: NPR Blogs

Obama Administration Downplays Court Challenge To Health Law

Wed, 12/24/2014 - 3:25am
Obama Administration Downplays Court Challenge To Health Law December 24, 2014 3:25 AM ET

Partner content from

Julie Rovner Listen to the Story 1 min 58 sec  

Elisa Carrero assists Julian Gauiria, of Paterson, N.J., with enrollment in the health insurance exchange in November. Signups continue to be brisk, health officials say.

Tyson Trish/North Jersey/Landov

This time last year, federal officials were scrambling to get as many people enrolled in health insurance through HealthCare.gov as they could before the start of the program on Jan. 1.

Now, with the technical problems mostly fixed, they're facing a different problem: the possibility that the Supreme Court might rule that the subsidies that help people afford coverage are illegal in the 37 states where the federal government is running the program.

Shots - Health News In Surprise Move, Supreme Court Takes On Fate Of Obamacare Again

At a news conference Tuesday, Health and Human Services Secretary Sylvia Burwell mostly focused on the good news, and tried to brush off the potential problem.

“ "The law of the land is that ... those subsidies are available and people are shopping. They are coming in; they are getting affordable care. ... We believe we have a position that will prevail."

"Through Friday, Dec. 19, nearly 6.4 million consumers selected a plan or were automatically re-enrolled into their current plan or one with similar benefits," she told reporters. "More than 1.9 million signed up for the first time."

The deadline for this year's open enrollment is mid-February, Burwell noted, adding, "We still have a ways to go and a lot of work before Feb. 15. But we do have an encouraging start."

Of the people nationwide who enrolled in Obamacare for 2014 and are now re-enrolled, the percentage that registered with the website to either renew their old plans for the next year or change to a different one is "somewhere in the mid- to high-30s" Burwell said.

Most of the rest were automatically re-upped for the same plan, though about 2 percent of policyholders, she said, could not be auto-renewed because their plan had been discontinued and there was no similar one. Those people, as well as anyone who was auto-renewed, can still change plans until Feb. 15.

Many people will find it financially advantageous to switch plans for a variety of reasons. In some places there are now more plans to choose from than last year. Premiums may have changed in other cases, or a change in the enrollee's financial circumstances may change the amount of subsidy for which he or she is eligible.

Those who remain uninsured in 2015 will have to pay increased penalties — the greater of $325 or 2 percent of their taxable income. That's up from $95 or 1 percent of income for 2014.

Shots - Health News If Supreme Court Strikes Federal Exchange Subsidies, Health Law Could Unravel

But Burwell steadfastly refused to answer questions about whether her department is making contingency plans in the event that the Supreme Court rules that subsidies are not available in the 37 states where HealthCare.gov is operating the insurance exchange. The court announced earlier this week that it would hear oral arguments in the case, King v. Burwell, on March 4.

"The law of the land is that where we are right now is, those subsidies are available and people are shopping. They are coming in, they are getting affordable care," Burwell said. "We are focused on open enrollment, and we are focused on a position where we believe we have a position that will prevail."

The plaintiffs in the case argue that Congress intended to make subsidies to purchase insurance available only in exchanges that were "established by a state." That does not include the federally run exchange, the plaintiffs say.

In contrast, backers of the law (including most of the Democrats who wrote it) say the wording was awkward, but the law always intended to make the subsidies available to all, regardless of whether an exchange was run by a state or federally run.

If the Supreme Court rules that subsidies are not available in the federal exchange, it could prompt millions to drop coverage because their insurance would become immediately unaffordable. That, in turn, could leave in the insurance pool only those who need insurance most — eventually raising rates prohibitively.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

Costly Hepatitis C Drugs Threaten To Bust Prison Budgets

Wed, 12/24/2014 - 3:18am
Costly Hepatitis C Drugs Threaten To Bust Prison Budgets December 24, 2014 3:18 AM ET

fromRIPR

Listen to the Story 5 min 6 sec  

Dr. Michael Poshkus treats inmates with hepatitis C at the John J. Moran Medium Security facility in Cranston, R.I. Some 12 to 35 percent of inmates nationwide are afflicted with the chronic liver disease.

Kristin Gourlay /RIPR

Every week, Dr. Michael Poshkus visits the John J. Moran Medium Security prison in Cranston, R.I., to see patients infected with hepatitis C.

Until recently, their only treatment option was a weekly injection in the stomach for at least a year. It worked less than half the time and caused debilitating side effects. But everything has changed.

“ "The advent of these new treatments for hepatitis C came like a monsoon on a calm summer day. We didn't see it coming."

Drug maker AbbVie won FDA approval Monday for a new hepatitis C treatment that combines several drugs and can cure the disease in a matter of weeks or a few months. The news caps a year of medical milestones for the estimated 3.2 million Americans (including 12 to 35 percent of prisoners) who are chronically infected with this viral liver disease. Yet most of the hepatitis C drugs to hit the market this year cost tens of thousands of dollars. That puts them out of reach for many inmates and threatens to break prison health care budgets.

On a recent day, a Moran inmate named Louis shows up for his appointment with Poshkus and settles onto the exam table. NPR agreed to not use his last name in this story; Louis is worried that after he's released in 2017, he might not be able to get a job if people know his history.

Poshkus tells Louis his liver shows signs of damage from hepatitis C, but treating it now will prevent further damage. If a medical review committee from the prison approves his case, Louis will take a drug called Sovaldi. One pill a day for 12 weeks.

But each pill costs $1,000, and patients have to take it in combination with another expensive drug. The prison simply can't afford to treat everyone who is sick right now, so the review committee — made up of prison health officials and local doctors who specialize in treating hepatitis C — decides who will get the drug, prioritizing the sickest patients.

Louis figures that now that he's a candidate for the treatment, he'll be high on the list.

"It kind of brings tears to your eye, you know?" he says, "because, finally it's going to be over with."

Louis is 52, and he's served a lot of time for crimes he committed while dealing or doing drugs. He's had hepatitis C nearly half his life. He knows the treatment is expensive and that some taxpayers might not like the idea of footing a prisoner's bill.

"We are still somebody's father, daughter, mother," Louis says. "And time to time you will hear people say, 'Well, they're bad people,' this and that. But until it happens to somebody in their family, it's a different ballgame."

Besides, Louis asks, isn't it better to treat inmates while they're a captive audience? So many inmates already struggle with addiction, and if they end up shooting drugs and sharing needles when they get out, they could spread the disease to others.

Shots - Health News Insurers May Cover Costly Hepatitis C Drugs Only For The Very Ill

But beyond the public health argument, there's a legal one. The Constitution guarantees prisoners the same medical care that's standard in the community. The trouble is, that standard of care changed practically overnight. A.T. Wall, director of the Rhode Island Department of Corrections, says he still hasn't figured out how to pay for it.

Shots - Health News Costly Hepatitis C Pill Shreds Drug Industry Sales Record Shots - Health News Maker Of $1,000 Hepatitis C Pill Looks To Cut Its Cost Overseas

"The advent of these new treatments for hepatitis C came like a monsoon on a calm summer day," Wall says. "We didn't see it coming."

When Wall submitted this year's prison budget to Rhode Island's General Assembly, he didn't know the new hepatitis treatment would cost nearly $150,000 per inmate. Now he faces some impossible math: Hundreds of inmates under his care have hepatitis C, many with advanced liver disease. But his entire health care budget barely tops $19 million.

Prisons across the country are facing the same dilemma, according to Rich Feffer of the National Hepatitis Corrections Network, a group that advocates better hepatitis prevention, testing and treatment in prisons and jails. Most facilities, Feffer says, are simply waiting for something to give.

"Even in systems where those drugs are being used, there are still tight controls on access," he says, "and they're not being used in a wide variety of people or universally, by any means."

Treating these inmates could make a big dent in the epidemic, Feffer says. Finding the money to do it is another story.

This story by Kristin Gourlay was produced as part of her National Health Journalism Fellowship, a program of the University of Southern California's Annenberg School of Communication and Journalism.

Copyright 2014 Rhode Island Public Radio. To see more, visit http://www.ripr.org/.
Categories: NPR Blogs

Being Thin Doesn't Spare Asian-Americans From Diabetes Risk

Tue, 12/23/2014 - 11:07am
Being Thin Doesn't Spare Asian-Americans From Diabetes Risk December 23, 201411:07 AM ET Alison Bruzek iStockphoto

We know that you can be fat while still fit, but how about skinny and unhealthy? This may be the case for many Asian-Americans who look slim, but actually face a higher risk of diabetes than people belonging to other ethnic groups.

As a result, Asian-Americans should consider getting tested for diabetes at a lower body mass index than previously recommended, according to new guidelines published Tuesday by the American Diabetes Association.

The old guidelines didn't take race and ethnicity into account, suggesting all adults with a body mass index, or BMI, of 25 (considered overweight) be tested for diabetes. The new guidelines lower the bar for Asian-Americans, saying testing should begin at 23.

Shots - Health News When It Comes To A1C Blood Test For Diabetics, One Level No Longer Fits All

"We've never differentiated based on ethnicity because frankly, in the past, we haven't done a good job evaluating different ethnicities," says Dr. Jane Chiang, senior vice president of medical and community affairs at the ADA and one of the authors of the statement. "We used to think that one size fits all, but now we know that that's not true."

Asian-Americans, the fastest-growing racial or ethnic group in the U.S., are 18 percent more likely to have Type 2 diabetes than their non-Hispanic white counterparts. Even Asian-Americans who aren't considered overweight by standard measures (a BMI of 25 to 30) are still at risk for diabetes.

"Asian-Americans with a BMI of 23 ... might have a similar risk as someone who is not Asian-American with a BMI around 27," says Dr. George King, chief scientific officer at the Joslin Diabetes Center, who was not a part of the study.

This is partially because BMI isn't a perfect predictor of diabetes risk. The index compares height and weight, but distribution of body fat can be more relevant. Asian-Americans typically gain their fat around the waist, rather than the thighs or other parts of the body. And abdominal fat is a known risk factor for diabetes.

Shots - Health News What Diabetes Costs You, Even If You Don't Have The Disease

The ADA's recommendations come from a review of five meta-analyses that looked at 156 studies. The studies looked at Asian-American populations to consider the effects of an American lifestyle and environment.

The ADA's Chiang says the new guidelines will help increase early detection of diabetes in Asian-Americans and enable more preventive measures. But doctors must beware the trap of treating all Asian-Americans, or people of any race or ethnicity the same. "Asian-Americans are still a very heterogeneous population, so each individual needs to be evaluated separately," she says.

A BMI calculator (like this one from the National Institutes of Health) is a good place to start figuring diabetes risk. Chiang recommends all Asian-Americans calculate their BMI. Chiang says Asian-Americans with a BMI around 23 or 24, particularly those with a family history of diabetes, should ask their doctor about getting tested.

And don't expect this race/ethnic-specific recommendation to be the ADA's last. Says Chiang, "I think this is just the beginning of what we need to do making recommendations for people of different ethnicities."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Can I Keep My Marketplace Insurance If I Enroll In Medicare?

Tue, 12/23/2014 - 10:29am
Can I Keep My Marketplace Insurance If I Enroll In Medicare? December 23, 201410:29 AM ET

Partner content from

Michelle Andrews Sally Elford/Getty Images/Ikon Images

We have received a bunch of questions about enrolling in Medicare lately. Here are answers to two that came up recently.

My wife has been automatically re-enrolled in a silver policy on the Oklahoma health insurance marketplace. She will turn 65 and be enrolled in Medicare on May 1, 2015. Can she keep her silver policy when she is enrolled in Medicare? And, if she does, will she automatically lose her premium subsidy? Do we have to cancel the policy or will the insurer do it automatically?

Your wife doesn't have to give up her marketplace policy when she turns 65, but financially it probably doesn't make sense to keep it, says Tricia Neuman, director of the program on Medicare policy at the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.)

Once she's eligible for Medicare, your wife will no longer qualify for premium tax credits on the marketplace, making that coverage more expensive.

In addition, she may face higher Medicare premiums if she doesn't enroll in that coverage once she becomes eligible. "Those who delay could face a lifetime premium penalty for late enrollment," Neuman says.

The penalty could be 10 percent for every year she delays enrolling in Medicare Part B, which covers outpatient services, and 1 percent for every month she delays enrolling in Part D, which covers prescription drugs.

Recently, my mother changed her primary residence from Illinois to Florida. She didn't realize that her Medicare prescription drug plan insurer would disenroll her as a result. Though I was able to find a new plan for her that will take effect Jan. 1, we have had to pay full fare for the prescription drugs for the final months leading up to the new plan year. Many people initiate Part D drug plans when they first turn 65. In their late 80s, how many will remember the rules?

It's certainly possible that your mother's drug plan doesn't provide coverage in both states. Although some Medicare prescription drug plans are available in all 50 states, others cover a more limited geographic area.

But your mother shouldn't have to wait until January to enroll in a new plan. Moving out of a drug plan's service area creates a three-month special enrollment period when she can sign up for a new plan near her new home.

"Try contacting the local [state health insurance assistance program] for one-on-one counseling," says Jack Hoadley, a research professor at Georgetown University's Health Policy Institute. You can locate your local program by searching this website.

Yes, it seems plausible that many people are unlikely to remember plan rules 15 years after they sign up. But that's all the more reason for people to review their plan options during open enrollment rather than simply renewing their existing plan.

"Plans change from one year to the next, and so do the needs of consumers," Neuman says.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

Baby Thrives Once 3-D-Printed Windpipe Helps Him Breathe

Tue, 12/23/2014 - 3:29am
Baby Thrives Once 3-D-Printed Windpipe Helps Him Breathe December 23, 2014 3:29 AM ET Listen to the Story 4 min 0 sec  

Jake and Natalie Peterson and their son Garrett in October 2014.

Courtesy of Brittany Jacox

Garrett Peterson was born in 2012 with a defective windpipe. It would periodically just collapse, because the cartilage was so soft, and he'd stop breathing. This would happen every day — sometimes multiple times a day.

"It was really awful to have to watch him go through his episodes," says his father, Jake Peterson of Layton, Utah. "He'd be fine and then all of a sudden start turning blue. It was just like watching your child suffocate over and over again."

Shots - Health News Doctors Use 3-D Printing To Help A Baby Breathe

It was so bad that Garrett couldn't leave the hospital; he spent more than a year in intensive care. This time last year, doctors weren't sure how much longer they could keep him alive.

"Garrett was so sick in the hospital and we — we really, really thought we were going to lose him," remembers his mother, Natalie Peterson. "The doctors were telling us, you know, that there really wasn't anything more they could do."

Then the Petersons heard about some doctors at the University of Michigan who were using 3-D printers to custom-make tiny devices they call "splints" to prop open defective windpipes for babies like Garrett. The Petersons rushed their son to Ann Arbor.

When Shots first reported this story back in March, Garrett had just gotten his splint, and it seemed to be working really well. But at that point, he was still in the hospital.

“ "We never knew if we would be able to get Garrett home. To be able to see him just napping — breathing comfortably on the floor in our family room — it was just overwhelming."

Two weeks later, he was finally able to leave the hospital for the first time in his life.

Since getting home, Garrett has still needed some help, especially at night, his parents say. But he's getting better every day.

"He can breathe — like, on his own completely," says Natalie Peterson. "It's so nice just to hear him breathe ... to be able to hear him take big deep breaths and things that we never knew he'd be able to do."

Other physical problems Garrett was having have also improved, such as complications with his heart and digestive system.

"It's just been amazing to see how much it's helped him," Jake says. "It's just been completely night and day."

The Petersons have started living a normal life with their son — they can now do things like roll around with him on the floor, read him books on their laps and laugh together at his favorite Mickey Mouse videos.

Natalie remembers a moment recently when Garrett fell asleep on the floor of their family room, which was dark except for the lights on the Christmas tree.

"I was sitting there thinking, 'Wow,' " she says. "We never knew if we would be able to get Garrett home. To be able to see him just napping — breathing comfortably on the floor in our family room — it was just overwhelming."

Dr. Glenn Green, a pediatric head and neck specialist who treated Garrett, says he expects that the boy will continue to improve.

Garrett Peterson in October 2014.

Courtesy of Brittany Jacox

"We know the splint has been opening up the way that we wanted," Green says. "And so the airway is able to grow. So, at this point, we're just waiting for further growth to happen and for the splint to eventually dissolve."

Another boy Green had treated earlier, on an experimental basis, and a third baby who got a splint a few months after Garrett are also doing well, Green says. So he's now working to get his 3-D-printed windpipe splints officially approved by the Food and Drug Administration, which he hopes will make it easier to help even more babies.

"I'm just extremely pleased to see the children doing well," Green says. "It just is the most rewarding thing for a physician — to see somebody that had never been home from the hospital now able to enjoy the holidays. I couldn't ask for a better present."

The Petersons are looking forward to Christmas, too.

"We're just so, so excited to have him home and to able to, you know, spend Christmas morning in our pajamas — just hanging out in our family room," Natalie says. "It's going to be great."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Is Your Heart Doctor In? If Not, You Might Not Be Any Worse Off

Mon, 12/22/2014 - 4:31pm
Is Your Heart Doctor In? If Not, You Might Not Be Any Worse Off December 22, 2014 4:31 PM ET

Partner content from

Jordan Rau Gary Waters/Getty Images/Ikon Images

If your cardiologist is away at a conference when you're having a stabbing feeling in your chest, don't fret. You may be more likely to live.

A study published Monday in the journal JAMA Internal Medicine found frail patients admitted to teaching hospitals with two common types of heart problems were more likely to survive on days when national cardiology conferences were going on.

The researchers also discovered that heart attack patients who were at higher risk of dying were less likely to undergo angioplasties when conferences were occurring, yet their mortality rates were the same as similar patients admitted at other times. An angioplasty, in which a doctor unblocks an artery with an inflatable balloon inserted by a small tube, is one of the most common medical procedures for cardiac patients.

The conclusions about teaching hospitals surprised even the authors, who had begun their inquiry anticipating that death would be more common during cardiology meetings because hospital staffs were more short-handed than usual. Finding the opposite, the researchers speculated that for very weak patients, aggressive treatments may exceed the benefits.

Shots - Health News More Squash, Less Bacon: Calculating Your Real-Life Heart Risk

"There's something very specific about cardiology meetings and cardiology outcomes," said Dr. Anupam Jena, a professor at Harvard Medical School and the lead researcher of the study. "I can tell you with almost certainty that something different is happening in the hospital, but I can't tell you why this is happening."

The study looked at Medicare patients admitted to 263 major teaching hospitals between 2002 and 2011, during days that the American Heart Association or the American College of Cardiology held their annual meetings.

These conferences draw thousands of doctors, nurses, pharmacists and other medical professionals who come to hear of the latest research, therapies, drugs and technologies, as well as to network and socialize with colleagues.

Dr. Patrick O'Gara, president of the American College of Cardiology, said he was reassured by the finding that patient mortality didn't increase when those doctors were away. "People should take away from this particular paper that they should be confident of going to a teaching hospital at any time of the year," he said. He cautioned against drawing any conclusions from the paper's finding that mortality rates dropped for some people, noting that the data are "not granular enough to provide information about what types of patient therapies the patients received."

Shots - Health News I Thought It Was Just Stress, Until It Broke My Heart

For patients with heart failure, heart attacks or cardiac arrest, the researchers examined death rates — either in the hospital or within 30 days of leaving —and compared them with the rates for patients hospitalized on the same days of the week during the three weeks before the conferences started and the three weeks after.

The lower death rates during conferences were limited to high-risk patients in teaching hospitals. Researchers didn't see a change in mortality for high-risk patients in other hospitals. The study also found that the majority of patients with more robust health had no greater chance of expiring if their hospitalization overlapped with a conference.

The researchers found that 18 percent of high-risk patients with heart failure —where the heart muscle doesn't pump blood as well as it should — died on conference days, while 25 percent died on the non-meeting days. The difference was even greater for patients with cardiac arrest, when the heart isn't pumping blood. The study found 59 percent of cardiac arrest patients died when conferences were underway, while 69 percent died on other days.

The researchers suggested several possibilities, but also found reasons to doubt those explanations. It could be that cardiologists who attend conferences are more likely to do aggressive medical treatments such as complex angioplasties than are those doctors who skip conferences. While invasive treatments often save lives, they can also result in infections and other complications, some of which can be deadly.

The researchers also postulated that when a patient's primary cardiologist is out of town, a substituting doctor may be less likely to perform an aggressive intervention. However, the researchers were unable to find evidence of any procedures that were being performed less frequently for heart failure or cardiac arrest patients during conference dates. Jena said aggressive procedures, such as placing catheters into neck veins to measure the heart, can cause complications but aren't always easy to identify in the Medicare billing data used in the study.

The researchers hypothesized that during conferences, there might be fewer patients undergoing elective procedures, therefore giving the remaining doctors more time to focus on the urgent cases. However, they didn't find any decrease in the number of heart patient admissions during conference days. They also found no difference in the general health of patients hospitalized on meetings days and those admitted at other times.

One more possibility, Jena said, "is that the doctors who leave are primarily researchers and they don't take care of as many patients as other doctors, so they are worse doctors."

Heart attack patients were just as likely to die on conference dates as other dates. But 21 percent received angioplasties or stents when conferences were going on, less than the 28 percent who received these interventions other times. "Patients at the very least are no worst off and in fact they may be better off by having less stenting," Jena said.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

When Humans Quit Hunting And Gathering, Their Bones Got Wimpy

Mon, 12/22/2014 - 3:03pm
When Humans Quit Hunting And Gathering, Their Bones Got Wimpy December 22, 2014 3:03 PM ET Listen to the Story 2 min 7 sec  

Farming helped fuel the rise of civilizations, but it may also have given us less robust bones.

Leemage/UIG via Getty Images

Compared with other primates and our early human ancestors, we modern humans have skeletons that are relatively lightweight — and scientists say that basically may be because we got lazy.

Biological anthropologist Habiba Chirchir and her colleagues at the Smithsonian's National Museum of Natural History were studying the bones of different primates including humans. When they looked at the ends of bones near the joints, where the inside of the bone looks almost like a sponge, they were struck by how much less dense this spongy bone was in humans compared with chimpanzees or orangutans.

"So the next step was, what about the fossil record? When did this feature evolve?" Chirchir wondered.

Humans Our Skulls Might Have Evolved To Withstand Blows To The Face

Their guess was that the less dense bones showed up a couple of million years ago, about when Homo erectus, a kind of proto-human, left Africa. Having lighter bones would have made it a lot easier to travel long distances, Chirchir speculated.

But after examining a bunch of early human fossils, she realized their guess was wrong. "This was absolutely surprising to us," she says. "The change is occurring much later in our history."

The lightweight bones don't appear until about 12,000 years ago. That's right when humans were becoming less physically active because they were leaving their nomadic hunter-gatherer life behind and settling down to pursue agriculture.

A report on the work appeared Monday in the Proceedings of the National Academy of Sciences, along with a study from a different research group that came to much the same conclusion.

Shots - Health News Golden Arches: Human Feet More Flexible Than We Thought

Those researchers looked at the bones of people in more recent history who lived in farming villages nearly 1,000 years ago and compared them with the bones of people who had lived nearby, earlier, as foragers.

The bones of people from the farming communities were less strong and less dense than those of the foragers, whose measured bone strength was comparable to similar-size nonhuman primates.

"We see a similar shift, and we attribute it to lack of mobility and more sedentary populations," says Timothy Ryan, an associate professor of anthropology at Penn State University. "Definitely physical activity and mobility is a critical component in building strong bones."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

A Family's Long Search For Fragile X Drug Finds Frustration, Hope

Mon, 12/22/2014 - 3:42am
A Family's Long Search For Fragile X Drug Finds Frustration, Hope December 22, 2014 3:42 AM ET Listen to the Story 6 min 51 sec  

Katie Clapp shares a laugh with her son Andy Tranfaglia, 25, at their home in West Newbury, Mass. Andy has a rare genetic condition called fragile X syndrome.

Ellen Webber for NPR

For a few weeks last year, Michael Tranfaglia and Katie Clapp saw a remarkable change in their son, Andy, who'd been left autistic and intellectually disabled by fragile X syndrome. Andy, who is 25, became more social, more talkative and happier. "He was just doing incredibly well," his father says.

The improvements came while Andy was taking an experimental drug — a drug made possible by the efforts of his parents. And at the time, it appeared this drug might become the first effective treatment for fragile X, a rare genetic syndrome that affects brain development and can lead to intellectual and social disabilities. The reality would turn out to be more complicated.

The story of this drug begins in 1994, when Clapp, a computer scientist, and Tranfaglia, a psychiatrist, helped launch the FRAXA Research Foundation. Their goal was simple: find a way to help Andy and other people with fragile X.

Andy in September 2010, before he began the new medication. He used to spend hours packing and unpacking videotapes and DVDs, especially when he was upset. His mother says he does that much less now.

Courtesy of Katie Clapp

The couple didn't know much about running a foundation. But they made some smart decisions. One of these was that FRAXA should support a researcher at MIT named Mark Bear, who made a big discovery. He found evidence that fragile X disrupts an important pathway in the brain called mGluR5.

Bear also realized that two big drug companies, Novartis and Roche, were already working on drugs for depression and addiction that might help repair this pathway. So Tranfaglia and Clapp began lobbying those companies to try the experimental drugs on people with fragile X.

Part of the sales pitch was that any drug that could reduce autism symptoms in people with fragile X might help millions of other people with autism. "And after a while, it worked," Tranfaglia says. "We finally got their attention, and they were convinced that a drug trial using some of these compounds was worth doing."

That was a huge step because drug trials typically cost millions of dollars. An even bigger step was getting Andy into one of these drug trials.

At first it wasn't possible because the trials were taking place in cities a long way from the family's home in West Newbury, Mass. But after several years, Novartis began testing its drug near Boston and Andy was included in the trial. "I do believe he was the last patient enrolled," Clapp says.

Andy began taking pills. At the time, no one knew whether they were sugar pills or the drug. But both parents saw a change in their son. He wasn't cured, but he was less rigid and more talkative.

For years, Clapp and her son had shared a joke. She would say, "I like that house." Then Andy would say, "Nah, I don't like it." One day during the drug trial, Clapp told Andy about a house she liked. "And this time, he says, 'Yes, I like it too. It has red shutters,' " she says. "He responded to me like any person would."

Mike Tranfaglia works on a puzzle with Katie and their son Andy. The parents started a foundation to fund research in treatments for fragile X.

Ellen Webber for NPR

The couple would find out later that Andy had been receiving the drug, not a placebo. It looked like their 20-year search for a treatment was over. Then Novartis held a meeting to announce the results of its drug trial.

"We went into that meeting fully expecting great results because our son was just doing incredibly well," Tranfaglia says. "I thought, there's no way this doesn't work. This is amazing. And they presented these results, and the numbers were just unbelievably bad."

The drug may have been helping Andy. But overall, it didn't seem to work. "It was truly devastating," Clapp says. Then the couple learned that a second drug, the one from Roche, also failed in a large fragile X trial.

"The failures in these trials led us to question everything," Tranfaglia says. The couple wondered whether they had just seen what they wanted to see in their son's behavior. They even wondered whether it made sense for FRAXA to continue funding basic research in hopes of finding a drug for fragile X.

Shots - Health News Progress Made On Drug For Autism Symptoms

In the end, the couple decided their approach was sound and that the drug really had helped their son. As a scientist, Tranfaglia knew that was possible. "Most clinical trials have some people who do really well even when the overall result is not necessarily great," he says.

But the drug Andy took is no longer available, even to researchers. And the future of the drug made by Roche is unclear.

The results were a huge disappointment, Clapp says, but not a failure. "To actually see an Andy I never, ever thought I would ever see, that was a success," she says.

Another success is FRAXA itself. The foundation now involves thousands of parents and hundreds of scientists. It has funded more than $24 million in research on fragile X.

And that research isn't going to stop, Clapp says. "We can't give up, because we have Andy."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Why Does It Take A Movie Robot To Show What Nurses Really Do?

Sun, 12/21/2014 - 4:40am
Why Does It Take A Movie Robot To Show What Nurses Really Do? December 21, 2014 4:40 AM ET Kelli Dunham

I'm a proud nurse from a proud family of nurses, yet I would never claim that a layperson would enjoy watching mainstream medical dramas with us. We end up yelling at the screen: "There is nothing about that sexy get-up that remotely resembles a nursing uniform," and "Doctors don't fire nurses, nurse managers fire nurses," and "No emergency room nurse would ever have to be told by a doctor to start CPR!"

So when the Baymax, the nurse/robot in the hit Disney movie Big Hero Six turned out to be reasonable, competent and not dressed in fishnet stockings, I was thrilled.

“ "You know your profession has an image problem when you point to a balloonish animated robot doll and say 'Yes, that's good. That accurately reflects what I do on a daily basis. More representations like that, please.' "

You know your profession has an image problem when you point to a balloonish animated robot doll and say "Yes, that's good. That accurately reflects what I do on a daily basis. More representations like that, please."

Baymax might not look like any nurses you know, but unlike most nurse characters in the media he actually provides nursing care. He assesses the health condition of his charge, the boy-genius Hiro, makes recommendations related to his health and teaches him about his neurochemical processes.

Once Hiro reprograms Baymax with fighting capabilities, Baymax becomes Hiro's terrifying defender. If you've ever heard a nurse on the phone with an insurance company insisting that a patient get needed care paid for, you know this is not a misplaced metaphor.

Contrast this with the Nurse Dawn character in the HBO comedy Getting On. She has sex with a new nurse manager within hours of meeting him; doesn't seem to notice when a patient dies; cowers submissively in front of even the most incompetent doctors and never seems to provide any actual nursing care because she is too busy with self-created drama and paperwork.

Or the Nurse Beverly character in Fox's comedy The Mindy Project. She is fired from an office medical practice for incompetence, breaks a doctor's nose in angry response, and when she is rehired in a clerical position expresses relief that she finally has a job where she doesn't have to wash her hands.

Or the nurses in the Fox medical drama House. Rather than being sexually inappropriate or incompetent, these nurses all seem to be on a series-long coffee break. It is the doctors who are shown providing nursing care: starting IVs, doing patient teaching, negotiating complicated family dynamics at the bedside.

Additional Information:

Even when nurses are shown to be competent, compassionate patient-focused experts like Jackie Peyton, the main character in Showtime's Nurse Jackie, the creators aren't satisfied with the life-and-death drama of a high-level trauma center in a huge city. The nurse character has to be an unethical, lying, stealing, not quite-in-recovery drug addict as well.

The argument could be made that it's the job of Hollywood to create fiction of all the professions, and that popular culture gets everything about health care wrong.

Certainly examples of this exist: the new Fox teen drama Red Band Society is populated by exceedingly healthy looking, extremely attractive gravely ill teenagers who live for months in hospital rooms the size of two-bedroom apartments for no other apparent reason than to make it more convenient for them to kiss each other.

Any scenes in which the dying but randy teens are portrayed interacting with medical care (one patient is shown receiving dialysis for liver failure) are so ludicrous that it makes you wonder if the procedure for the show's writers is to ask their medical adviser how something might accurately be conveyed and then write the exact opposite.

Shots - Health News Nurses Want To Know How Safe Is Safe Enough With Ebola

But even though this is just entertainment, the stakes for the future of nursing are high. Research has repeatedly demonstrated that Americans believe what TV shows say about medical care and health policy.

For 13 years the non-profit advocacy organization Truth About Nursing has been researching and documenting nurse representations in popular culture and has come to the conclusion that "the vast gap between what skilled nurses really do and what the public thinks they do is a fundamental factor underlying most of the more immediate apparent causes of the [nursing] shortage [including], understaffing, poor work conditions, [and] inadequate resources for nursing research and education."

This is bad news for nurses, but worse news for patients. Nurses make the difference in good health care; increased RN staffing decreases the overall patient death rate as well as the rate of hospital acquired pneumonia, falls, pressure ulcers and blood clots after surgery. When nurses show more signs of burnout related to understaffing, postsurgical infections increase.

“ Baymax's programming won't allow him to disengage until the patient has answered, "Are you satisfied with your care?" in the affirmative.

And there's the hard-to-quantify but essential benefit of being cared for. When I was in the hospital this past January after a life-threatening complication of knee-replacement surgery, I woke up one night in pain and unable to figure out how to move within the many drains, tubes and wires attached to, or inserted in, my body. I muttered an expletive and from around the corner a nurse appeared.

"I'm right here," she said. Even before she started to untangle my IV and troubleshoot better pain management, my panic was instantly calmed.

Baymax's programming won't allow him to disengage until the patient has answered, "Are you satisfied with your care?" in the affirmative. This is inconvenient for the characters in an action adventure movie, but it's a good question to ask in a hospital. If you're satisfied with your care, you may well have a nurse to thank.

Kelli Dunham is a nurse, stand-up comic, LGBT health advocate and author of five books, including the recent tragicomic collection Freak of Nurture (Topside Press, 2013).

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Why Does It Take A Movie Robot To Show What Nurses Really Do?

Sun, 12/21/2014 - 4:40am
Why Does It Take A Movie Robot To Show What Nurses Really Do? December 21, 2014 4:40 AM ET Kelli Dunham

I'm a proud nurse from a proud family of nurses, yet I would never claim that a layperson would enjoy watching mainstream medical dramas with us. We end up yelling at the screen: "There is nothing about that sexy get-up that remotely resembles a nursing uniform," and "Doctors don't fire nurses, nurse managers fire nurses," and "No emergency room nurse would ever have to be told by a doctor to start CPR!"

So when the Baymax, the nurse/robot in the hit Disney movie Big Hero Six turned out to be reasonable, competent and not dressed in fishnet stockings, I was thrilled.

“ "You know your profession has an image problem when you point to a balloonish animated robot doll and say 'Yes, that's good. That accurately reflects what I do on a daily basis. More representations like that, please.' "

You know your profession has an image problem when you point to a balloonish animated robot doll and say, "Yes, that's good. That accurately reflects what I do on a daily basis. More representations like that, please."

Baymax might not look like any nurses you know, but unlike most nurse characters in the media he actually provides nursing care. He assesses the health condition of his charge, the boy-genius Hiro, makes recommendations related to his health and teaches him about his neurochemical processes.

Once Hiro reprograms Baymax with fighting capabilities, Baymax becomes Hiro's terrifying defender. If you've ever heard a nurse on the phone with an insurance company insisting that a patient get needed care paid for, you know this is not a misplaced metaphor.

Contrast this with the Nurse Dawn character in the HBO comedy Getting On. She has sex with a new nurse manager within hours of meeting him; doesn't seem to notice when a patient dies; cowers submissively in front of even the most incompetent doctors and never seems to provide any actual nursing care because she is too busy with self-created drama and paperwork.

Or the Nurse Beverly character in Fox's comedy The Mindy Project. She is fired from an office medical practice for incompetence, breaks a doctor's nose in angry response, and when she is rehired in a clerical position expresses relief that she finally has a job where she doesn't have to wash her hands.

Or the nurses in the Fox medical drama House. Rather than being sexually inappropriate or incompetent, these nurses all seem to be on a series-long coffee break. It is the doctors who are shown providing nursing care: starting IVs, doing patient teaching, negotiating complicated family dynamics at the bedside.

Additional Information:

Even when nurses are shown to be competent, compassionate patient-focused experts like Jackie Peyton, the main character in Showtime's Nurse Jackie, the creators aren't satisfied with the life-and-death drama of a high-level trauma center in a huge city. The nurse character has to be an unethical, lying, stealing, not quite-in-recovery drug addict as well.

The argument could be made that it's the job of Hollywood to create fiction of all the professions, and that popular culture gets everything about health care wrong.

Certainly examples of this exist: the new Fox teen drama Red Band Society is populated by exceedingly healthy looking, extremely attractive gravely ill teenagers who live for months in hospital rooms the size of two-bedroom apartments for no other apparent reason than to make it more convenient for them to kiss each other.

Any scenes in which the dying but randy teens are portrayed interacting with medical care (one patient is shown receiving dialysis for liver failure) are so ludicrous that it makes you wonder if the procedure for the show's writers is to ask their medical adviser how something might accurately be conveyed and then write the exact opposite.

Shots - Health News Nurses Want To Know How Safe Is Safe Enough With Ebola

But even though this is just entertainment, the stakes for the future of nursing are high. Research has repeatedly demonstrated that Americans believe what TV shows say about medical care and health policy.

For 13 years the non-profit advocacy organization Truth About Nursing has been researching and documenting nurse representations in popular culture and has come to the conclusion that "the vast gap between what skilled nurses really do and what the public thinks they do is a fundamental factor underlying most of the more immediate apparent causes of the [nursing] shortage [including], understaffing, poor work conditions, [and] inadequate resources for nursing research and education."

This is bad news for nurses, but worse news for patients. Nurses make the difference in good health care; increased RN staffing decreases the overall patient death rate as well as the rate of hospital acquired pneumonia, falls, pressure ulcers and blood clots after surgery. When nurses show more signs of burnout related to understaffing, postsurgical infections increase.

“ Baymax's programming won't allow him to disengage until the patient has answered, "Are you satisfied with your care?" in the affirmative.

And there's the hard-to-quantify but essential benefit of being cared for. When I was in the hospital this past January after a life-threatening complication of knee-replacement surgery, I woke up one night in pain and unable to figure out how to move within the many drains, tubes and wires attached to, or inserted in, my body. I muttered an expletive and from around the corner a nurse appeared.

"I'm right here," she said. Even before she started to untangle my IV and troubleshoot better pain management, my panic was instantly calmed.

Baymax's programming won't allow him to disengage until the patient has answered, "Are you satisfied with your care?" in the affirmative. This is inconvenient for the characters in an action adventure movie, but it's a good question to ask in a hospital. If you're satisfied with your care, you may well have a nurse to thank.

Kelli Dunham is a nurse, stand-up comic, LGBT health advocate and author of five books, including the recent tragicomic collection Freak of Nurture (Topside Press, 2013).

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

At Last, I Meet My Microbes

Fri, 12/19/2014 - 2:00pm
At Last, I Meet My Microbes December 19, 2014 2:00 PM ET Katherine Harmon Courage

Lactobacillus acidophilus, which is one variety of the genus Lactobacillus is one of the common active cultures found in yogurt and in the human gut.

Scimat Scimat/Getty Images/Photo Researchers

A veritable jungle of organisms is helping keep each of us alive. But we've been rather negligent hosts. For starters, we don't even know who has shown up for the party.

When I signed myself, my husband, our dog and my mother up for the American Gut Project to have our gut microbes analyzed last year, I had no idea what the results would turn up. And based on current research even Rob Knight, who helps run the project, couldn't predict whether I would share more microbes with my mom or with my husband.

So we waited for results. And waited. And waited. It turns out that being part of new research — no matter how well-planned — is an experience that requires a lot of patience.

Months after dropping off our samples at the post office, I got an email with a colorful, graphic display of my very own gut microbial communities. There were bar graphs, scatter plots and lots of unfamiliar names.

Katherine Harmon Courage's microbiome results. The distribution of major groups can be compared with others, including author Michael Pollan, in the top left graph. The chart on the top right lists some of the most common and the most unusual microbes found in her gut. The scatter plots below locate her particular sample against other populations.

Katherine Harmon Courage for NPR

So, after 31 years — and a few extra months of waiting — it was finally time to meet my microbes.

My gut is full of different species of Firmicutes, a whole phylum of bacteria. These can be incredibly diverse and include those in the order Lactobacillales (familiar to many from its member Lactobacillus, one kind of the bacteria that's active in some yogurts). I had many more of these bacteria than the average person, which was surprising. They've been linked to obesity, and I've always been lean.

The second most common were Bacteroidetes species (primarily in the Bacteroides genus), which help us mammals digest food. These guys indicate, according to a 2011 study in Science that Knight co-authored, that my diet is heavier on animal proteins and fats than on carbohydrates.

Shots - Health News Poo And You: A Journey Into The Guts Of A Microbiome Shots - Health News Behind The Scenes At The Lab That Fingerprints Microbiomes

I didn't expect that because at the time I, um, collected the samples I was eating a mostly plant-based diet. But perhaps the occasional pulled-pork sandwich or milkshake was enough to sway my bacterial profile. Although a different diet could change a person's microbe makeup within 24 hours, even a week on a different diet didn't entirely alter the profiles from long-term dietary patterns, the same study said.

Shots - Health News To Get To The Bottom Of Your Microbiome, Start With A Swab Of Poo

So maybe my relative levels were due to my generally meat-and-potatoes upbringing — or my birth by cesarean section. Research published last year found that infants born by C-section had lower levels of Bacteroides (as I had) than did babies born vaginally.

Even the researchers who have been practically swimming in gut samples couldn't yet tell me exactly what my sample said about me — or about my health.

"We don't have a good handle on the bounds for what a healthy gut looks like in the larger population, or how lifestyle and diet drive the gut," says Daniel McDonald, a graduate student working on the project and studying quantitative biology and computer science.

And what about the other guts in our family? The sample from our pooch, Raz, is still (yes, still) awaiting enough fellow pet entrants to be analyzed.

As for the humans, the beasties living in my gut were not much of a match to those in my mother's — despite quite a bit of research hinting at mothers' microbial influence.

She had about similar abundances of Bacteroides and Firmicutes, as well as 13 rare species that didn't even register on my chart.

Even though my diet mirrored hers for the majority of my life, in recent years it has shifted to a more vegetarian mix, away from meat and dairy.

Maybe 20 years ago, there would have been a more obvious overlap between Mom's microbiome and mine. And perhaps having been born via C-section sent my microbiome on its own trajectory.

Still, when compared with the rest of the study population, we clustered closer together than an average stranger, most of whom had a majority of Firmicutes.

My gut microbes were much more similar to my husband's. He and I both had higher Bacteroides and lower Firmicutes and four times the average of some genus called Lachnospira.

As McDonald notes, "cohabitating is the likely driver of similarity." But, he cautions, "there is a large amount of day-to-day variation within an individual." And that means "multiple samples are necessary to begin to assess if there is a significant similarity." That's probably not what my husband wanted to hear.

Once there are more samples gathered consecutively from the same people, Knight says, he and his team might be able to make predictions about how specific changes in the gut, say an overabundance of Bacteroidetes or the presence of a little known species, might affect health.

But, as in the early days of the human genome, we are still very much in the process of mapping this uncharted intestinal territory. Researchers are just starting to gather enough points of microbial and human data to decide what a sea of Firmicutes, for example, might mean for health and whether or not people with particular disorders have similar microbial maps.

Some of these designations, such as Firmicutes, are as broad as an entire phylum, which can contain organisms as far apart on the tree of life as humans and conger eels. So to truly start to get an estimate on the closeness of two people's microbes, researchers must calculate the evolutionary distance between different samples, adding yet another time-consuming step.

And we also still don't have the concrete knowledge to translate microbiome analyses into advice for people to get healthier. "That's why we started the study — to be able to make these recommendations," Knight tells me. For now, however, they're just trying to find a few meaningful patterns in the vast microbial ocean of thousands of fecal samples.

The gut is just part of the picture. Microbes live all over our skin, in our nose and mouth, on our pets, in the soil and even in the air.

And until we know more about these mysterious microbes, perhaps we should sit back and marvel at the jungles of life that we really are. And do our best to keep our beneficial beasties happy.

This is the final story in a four-part series.

Katherine Harmon Courage is a freelance health and science writer in Colorado. She is the author of Octopus! The Most Mysterious Creature In the Sea, now available in paperback.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Some Early Childhood Experiences Shape Adult Life, But Which Ones?

Fri, 12/19/2014 - 10:47am
Some Early Childhood Experiences Shape Adult Life, But Which Ones? December 19, 201410:47 AM ET

Having warm, supportive parents early on correlates with success in adulthood.

Agent Illustrateur/Ikon Images

Most of us don't remember our first two or three years of life — but our earliest experiences may stick with us for years and continue to influence us well into adulthood.

Just how they influence us and how much is a question that researchers are still trying to answer. Two studies look at how parents' behavior in those first years affects life decades later, and how differences in children's temperament play a role.

The first study, published Thursday in Child Development, found that the type of emotional support that a child receives during the first three and a half years has an effect on education, social life and romantic relationships even 20 or 30 years later.

Babies and toddlers raised in supportive and caring home environments tended to do better on standardized tests later on, and they were more likely to attain higher degrees as adults. They were also more likely to get along with their peers and feel satisfied in their romantic relationships.

13.7: Cosmos And Culture Why We Aren't The Parents We Know We Could Be

"It seems like, at least in these early years, the parents' role is to communicate with the child and let them know, 'I'm here for you when you're upset, when you need me. And when you don't need me, I'm your cheerleader,' " says Lee Raby, a psychologist and postdoctoral researcher at the University of Delaware who led the study.

Raby used data collected from 243 people who participated in the Minnesota Longitudinal Study of Risk. All the participants were followed from birth until they turned 32. "Researchers went into these kids' home at times. Other times they brought the children and their parents to the university and observed how they interacted with each other," Raby tells Shots.

Of course, parental behavior in the early years is just one of many influences, and it's not necessarily causing the benefits seen in the study. While tallying up the results, the researchers accounted for the participants' socioeconomic status and the environment in which they grew up.

Ultimately, they found that about 10 percent of someone's academic achievement was correlated with the quality of their home life at age three. Later experiences, genetic factors and even chance explain the other 90 percent, Raby says.

And a child's psychological makeup is a factor as well.

Shots - Health News Anxious Parents Can Learn How To Reduce Anxiety In Their Kids

The second study, also published in Child Development, found that children's early experiences help predict whether or not they end up developing social anxiety disorder as teenagers — but only for those who were especially sensitive and distrustful as babies.

For this study, researchers from the University of Maryland observed how 165 babies interacted with their parents. When separated from their parents, some got upset but quickly recovered when they were reunited. Other babies had a harder time trusting their parents after a brief separation, and they weren't able to calm down after being reunited.

Those extra-sensitive babies were more likely to report feeling anxious socializing and attending parties as teenagers.

So what does this all mean? For one, it means that human development is complicated, according to Jay Belsky, a professor of human development at the University of California, Davis who was not involved in either study.

We know that our early experiences likely affect all of us to a certain extent, Belsky says. And we know that due to variations in psychological makeup, some people are more sensitive to environmental factors than others.

But that doesn't mean people can't recover from bad childhood experiences. "For some, therapy or medication may help," Belsky says. "And it's interesting, because there's now other evidence suggesting that the very kids who succumb under bad conditions are the ones who really flourish under good ones."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Teaching Hospitals Hit Hardest By Medicare Fines For Patient Safety

Fri, 12/19/2014 - 9:50am
Teaching Hospitals Hit Hardest By Medicare Fines For Patient Safety December 19, 2014 9:50 AM ET

Partner content from

Jordan Rau

NYU Langone Medical Center is one of the teaching hospitals being penalized by Medicare for its rate of medical errors.

Joshua Bright/AP

Medicare has begun punishing 721 hospitals with high rates of infections and other medical errors, cutting payments to half of the nation's major teaching hospitals and many institutions that are marquee names.

Intermountain Medical Center in Utah, Ronald Reagan UCLA Medical Center in Los Angeles, the Cleveland Clinic, Geisinger Medical Center in Pennsylvania, Brigham and Women's Hospital in Boston, NYU Langone Medical Center and Northwestern Memorial Hospital in Chicago are all being docked 1 percent of their Medicare payments through next September, federal records show.

In total, hospitals will forfeit $373 million, Medicare estimates.

The federal health law required Medicare to lower payments for the quarter of hospitals with the highest rates of hospital-acquired conditions, or HACs.

These avoidable complications include infections from central-line catheters, blood clots and bedsores.

The penalties come as hospitals are showing some success in reducing harmful errors. A recent federal report found that the frequency of mistakes dropped by 17 percent between 2010 and 2013, an improvement that Health and Human Services Secretary Sylvia Burwell called "a big deal, but it's only a start." Even with the reduction, 1 in 8 hospital admissions in 2013 included a patient injury.

Dr. Eric Schneider, a Boston health researcher, said studies have shown that medical errors can be reduced through a number of techniques, such as entering physician orders into computers rather than scrawling them on paper, better hand-washing, and checklists on procedures to follow during surgeries. "Too many clinicians fail to use those techniques consistently," he said.

The quality penalties have "put attention to the issue of complications, and that attention wasn't everywhere," said Dr. John Bulger, chief quality officer at Geisinger Health System, based in Danville, Pa. However, he said hospitals like Geisinger's now must spend more time reviewing their Medicare billing records as the government uses those to evaluate patient safety. The penalty program, he said, "has the potential to take the time that could be spent on improvement and [spend it instead] making sure the coding is accurate."

Hospitals complain there may be almost no difference between hospitals that are penalized and those that narrowly escape fines. "Hospitals may be penalized on things they are getting safer on, and that sends a fairly mixed message," said Nancy Foster, a quality expert at the American Hospital Association.

The penalties come on top of other fines Medicare has been levying. With the HAC penalties now in place, the worst-performing hospitals this year risk losing more than 5 percent of their regular Medicare reimbursements.

About 1,400 hospitals are exempt from penalties because they provide specialized treatments such as psychiatry and rehabilitation or because they cater to a particular type of patient such as children and veterans. Small "critical access hospitals" that are mostly located in rural areas are also exempt, as are hospitals in Maryland, which have a special payment arrangement with the federal government.

In evaluating hospitals for the HAC penalties, the government adjusted infection rates by the type of hospital. When judging complications, it took into account the differing levels of sickness of each hospital's patients, their ages and other factors that might make the patients more fragile. Still, academic medical centers have been complaining that those adjustments are insufficient given the especially complicated cases they handle, such as organ transplants.

"To lump in all of those things that are very complex procedures with simple things like pneumonia or hip replacements may not be giving an accurate result," said Dr. Atul Grover, the chief public policy officer of the Association of American Medical Colleges.

Medicare levied penalties against a third or more of the hospitals it assessed in Colorado, Connecticut, Delaware, Nevada, New Jersey, New Mexico, Rhode Island, Utah, Washington and the District of Columbia, a Kaiser Health News analysis found.

A separate analysis of the penalties that Dr. Ashish Jha, a professor at the Harvard School of Public Health, conducted for Kaiser Health News found that penalties were assessed against 32 percent of the hospitals with the sickest patients. Only 12 percent of hospitals with the least complex cases were punished.

Hospitals with the poorest patients were also more likely to be penalized, Jha found. A fourth of the nation's publicly owned hospitals, which often are the safety net for poor, sick people, are being punished.

"I've worked in community hospitals. I've worked in teaching hospitals. My personal experience is teaching hospitals are at least as safe if not safer," Jha said. "But they take care of sicker populations and more complex cases that are going to have more complications. The HAC penalty program is really a teaching-hospital penalty program."

You can download the full list of hospital penalties here.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

NIH Allows Restart Of MERS Research That Had Been Questioned

Thu, 12/18/2014 - 2:20pm
NIH Allows Restart Of MERS Research That Had Been Questioned December 18, 2014 2:20 PM ET

A transmission electron micrograph shows Middle East respiratory syndrome coronavirus particles (colorized yellow).

NIAID

Some researchers who study the virus that causes Middle East respiratory syndrome got an early Christmas present: permission to resume experiments that the federal government abruptly halted in October.

The scientists were trying to modify the MERS virus so that it's better able to sicken mice. Their goal is to make a lab model that would let them test vaccines and drugs against this disease. MERS, which seems to normally infect camels, has sickened hundreds of people in the Middle East in recent years. Many have died.

Shots - Health News Scientists Debate If It's OK To Make Viruses More Dangerous In The Lab Shots - Health News How A Tilt Toward Safety Stopped A Scientist's Virus Research

Some experts worry that the virus could mutate, start spreading easily in people, and cause a pandemic. They say it's vital to get prepared.

But the U. S. government stopped those mouse experiments as part of a temporary moratorium on government-funded research that might make three viruses — influenza, MERS, and SARS (which causes a severe acute respiratory syndrome) — more contagious or deadly.

Officials said they wanted to reconsider the risks and benefits of the experiments in the wake of some high profile lab mishaps involving agents like anthrax and smallpox. The review process is expected to take about a year, and includes public meetings like one held at the National Academy of Sciences this week.

At the meeting, scientists who study coronaviruses like MERS defended their work. The modifications they're making to the virus aren't likely to make it worse for humans — just worse for mice, they said.

That argument convinced Thomas Inglesby of the UPMC Center for Health Security. He's been a prominent critic of past experiments that modified a dangerous bird flu virus in ways that might make it transmissible in people. But since no MERS or SARS scientists are trying to modify these viruses in ways that would make them more contagious in humans, Inglesby says "it seems reasonable and prudent to end the moratorium on coronavirus related work."

The day after the meeting, scientists including Matthew Frieman of the University of Maryland School of Medicine got word from the National Institutes of Health that their requests for waivers from the moratorium have been approved and that their mouse experiments with MERS could continue.

Other experiments, however, remain off-limits for federal funding. Virologist Ron Fouchier of Erasmus Medical Center in the Netherlands, whose lab did the controversial bird flu experiments with U.S. funding, told NPR in an email that he received stop-work orders from the NIH in October.

The point of his research is to understand how bird flu viruses might mutate in ways that would let them sicken people and start spreading like seasonal flu—information that could help public health workers prepare for the threat of a naturally occurring flu pandemic. Fouchier says he didn't apply for a waiver but has asked the government to better define the experiments of concern so that he can continue the non-concerning work.

Fouchier questioned whether the government's current effort to weight the benefits and risks of this kind of research is going to provide any new insights that haven't already been discussed over the last three years since the debate over his experiments first began. "I think that the quantitative risk and benefit analysis is going to be close to impossible," Fouchier told NPR. "Whatever the numbers are they come up with, in the end it will still be a judgment call by someone, somewhere."

Updated 3:23 p.m.: The National Institutes of Health confirmed the changes in an email. "All studies using a mouse model for MERS (five) have been excepted from the pause," a spokeswoman wrote. "In addition, exceptions were granted for two flu studies. Investigators have been (or will be shortly) informed and an official letter will be sent."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

California Whooping Cough Infections Run High Among Latino Babies

Thu, 12/18/2014 - 11:49am
California Whooping Cough Infections Run High Among Latino Babies December 18, 201411:49 AM ET

fromKQED

April Dembosky

Nurse Julietta Losoyo gives Derek Lucero a whooping cough vaccination at the San Diego Public Health Center on Dec. 10.

Chris Carlson/AP

California is battling the worst whooping cough epidemic in 70 years.

Nearly 10,000 cases have been reported in the state so far this year, and babies are especially prone to hospitalization or even death.

California's Whooping Cough Epidemic 5 min 34 sec   Shots - Health News Calif. Vaccination Gap And Whooping Cough

Six of 10 infants who have become ill during the current outbreak are Latino. There's no conclusive explanation, but there are a few theories that range from Latino cultural factors to a lack of health insurance.

"Hispanics have larger household sizes, and there may be cultural practices around visiting new infants that increase the number of contacts," says Dr. Gil Chavez, deputy director of California's department of public health.

Babies can't get their first dose of the vaccine until they are two months old. Some adults may be infected and not know it. The more siblings and extended family members that babies live or visit with, the more exposure they may have to whooping cough.

"Aunts, uncles, grandparents who may not have had a booster shot, they may be passing it on that way," says Michael Rodriguez, a family physician at UCLA.

However, he points out that several other ethnic groups have large family sizes or live together because financial resources are limited. These factors alone can't explain why Latino babies are disproportionately affected, he says.

"It really speaks to the lack of access to health insurance that's particularly predominant within the Latino community," says Sarah de Guia, executive director of the California Pan-Ethnic Health Network, an advocacy group.

Latinos make up 62 percent of the uninsured, she says, either because they can't afford to pay for health insurance, or because they're afraid that signing up for coverage will expose family members who aren't lawfully present in the U.S.

Many parents who entered the country illegally are afraid they will be discovered and deported if they enroll their children, who are legal immigrants or citizens, into government coverage, such as Medicaid.

"That's the primary reason why people are not getting the preventive care that they need," she says. "And then that impacts everyone."

Public health officials attribute the ongoing epidemic to several factors.

Whooping cough is cyclical in nature and tends to peak every three to five years. The last outbreak of the disease in California was in 2010.

But doctors are discovering that immunity from the current vaccine may be wearing off on a similar timeline. Medical recommendations suggest booster shots after eight years, but doctors are seeing kids who received a booster three years ago getting sick. Public health officials are considering an update to the recommendations to account for the dip in immunity seen after three years.

Plus, many kids in some areas aren't getting vaccinated at all. The highest rates of whooping cough are found in the Bay Area counties of Sonoma, Napa and Marin, which also have some of the highest rates of parents who opt out of vaccinating their children.

Doctors believe these kids are the root of the current and recent epidemics.

"We had a lot of unvaccinated children that acted as the kindling to start an outbreak," said Dr. Paul Katz, a pediatrician at Kaiser Permanente in San Rafael. "Those children were able to infect all the other children who were vaccinated but were too early for a booster –- they became the rest of the wood to start the fire."

All of these factors combine to put babies at risk, especially babies who are not old enough to be vaccinated.

And if Latino children and adults don't have health coverage, they are less likely to be visiting the doctor regularly and getting their booster shots, says Rodriguez.

California's public health department has done some outreach to encourage pregnant women to get vaccinated in the third trimester, in order to pass immunity on to the fetus. But little outreach has been done in Spanish, and most materials are distributed directly to doctors' offices. Latinos aren't likely to see that information if they don't have insurance and aren't going to the doctor.

Advocate Sarah de Guia says more work needs to be done so pregnant women –- and adults -– in Latino communities know they need to update their vaccinations.

"It's important for public officials to provide culturally and linguistically appropriate outreach to make sure people are getting the message in their language, and in a way they will understand," she says.

Copyright 2014 KQED Public Media. To see more, visit http://www.kqed.org.
Categories: NPR Blogs

Is Your State Ready For The Next Infectious Outbreak? Probably Not

Thu, 12/18/2014 - 10:30am
Is Your State Ready For The Next Infectious Outbreak? Probably Not December 18, 201410:30 AM ET $(function() { var pymParent = new pym.Parent( 'responsive-embed-state-outbreak-preparedness', 'http://apps.npr.org/dailygraphics/graphics/state-outbreak-preparedness/child.html', {} ); });

Ebola may have slid off the nation's worry list, but that doesn't mean the United States is ready to handle an outbreak of Ebola or another infectious disease, an analysis says. That includes naturally occurring outbreaks like dengue fever, tuberculosis and measles, as well as the use of bioterrorism agents like anthrax.

Goats and Soda Endless Ebola Epidemic? That's The 'Risk We Face Now,' CDC Says

The report issued Thursday gives half of the states and the District of Columbia failing grades on 10 measures of preparedness, which include maintaining funding for public health services from 2012; getting half the population vaccinated for flu; reducing the number of bloodstream infections caused by central lines for people in the hospital; testing the response time for emergency laboratory tests; and testing 90 percent of suspected E. coli 0157 infections within four days.

Maryland, Massachusetts, Tennessee, Vermont and Virginia did the best, scoring eight out of 10, while Arkansas, Idaho, Kansas, Kentucky, Louisiana, New Jersey, Ohio and Wyoming scored at or near the bottom.

That's not so good, considering that infectious diseases are the leading cause of death in people under age 60 worldwide, and cost the United States more than $120 billion a year. The list of diseases is long and growing, with old foes like tuberculosis and influenza, and newer threats like West Nile virus and Middle East Respiratory Syndrome.

Shots - Health News Is Enterovirus D68 Behind The Mysterious Paralysis In Children?

It doesn't take rocket science to combat infectious disease; the public health strategies required have been used successfully for decades. But public health preparedness often loses out in state and federal budgets, unless there's been a recent Ebola outbreak or anthrax attack.

An up-to-speed public health system will be able to manage these challenges:

  • Quickly diagnosing outbreaks with laboratory testing and investigators who can trace contacts. Testing and contract tracing were used to contain the Ebola cases in Texas, and are used routinely by state and local health departments to combat outbreaks of foodborne illness.
  • Containing outbreaks with vaccines, medications and other countermeasures, including quarantine.
  • Train hospitals so they can respond quickly and safely when a novel infection presents itself, whether it's Ebola or the mysterious enterovirus D68, which sickened hundreds of children this fall.
  • Reporting systems that can help investigators quickly recognize an outbreak in the making, whether with everyday infections like flu and West Nile virus or rarer pathogens like Ebola and chikungunya.
  • Communicate swiftly and clearly among health workers, government agencies and the public.
  • Rapidly develop new vaccines or medical treatments, which multiple companies and countries are attempting now with Ebola.

The report was issued by the Trust for America's Health and the Robert Wood Johnson Foundation (which also provides funding to NPR.)

Goats and Soda Experimental Vaccine For Chikungunya Passes First Test

"Infectious disease control requires constant vigilance," the report concludes. "This requires having systems in place and conducting continuous training and practice exercises. The Ebola outbreak is a reminder that we cannot afford to let our guard down or grow complacent when it comes to infectious disease threats."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs