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"content": "\u003cp>Women who have an abnormal mammogram should stay vigilant for cancer for the next decade, even when follow-up tests fail to detect cancer, a study released Wednesday finds.\u003c/p>\n\u003cp>That's because there's a \"modest\" risk that cancer will develop during the next decade, says lead author \u003ca href=\"https://www.med.unc.edu/bric/people/faculty-pages/louise-henderson\" target=\"_blank\">Louise M. Henderson\u003c/a> of the University of North Carolina School of Medicine in Chapel Hill.\u003c/p>\n\u003cp>The absolute increase in risk amounts to about one additional cancer in every 100 women who have a false positive mammogram over a 10-year period, she says.\u003c/p>\n\u003cp>But when put another way, the numbers may appear alarming. The study divided women into two groups — those who got additional imaging and those who also got biopsies.\u003c/p>\n\u003cp>Women with an abnormal screening mammogram had a 39 percent higher risk of cancer if they got additional imaging that turned out to be negative, too. That's compared with women who were truly negative and never developed breast cancer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For women who got biopsies that turned out negative, the chance of cancer was increased by 76 percent over the next 10 years.\u003c/p>\n\u003cp>\"We don't want women to read this and feel worried,\" Henderson says. Instead, the findings should be considered one more \"useful tool\" when weighing all the other factors that might be raising a particular woman's risk, such as age, race, breast density and family history of breast cancer.\u003c/p>\n\u003cp>Henderson says the study wasn't designed to figure out why a falsely positive mammogram is associated with an increased cancer risk.\u003c/p>\n\u003cp>It's possible, she says, that the increased risk \"could be the fact that the radiologist sees an abnormal pattern that's not cancerous, but it's a radio-graphic marker,\" and it could be that this is a precursor to some subsequent cancer diagnosis.\u003c/p>\n\u003cp>The study, done at several leading universities, looked back at more than 2.2 million screening mammograms considered to be false alarms between 1994 and 2009. It was \u003ca href=\"http://cebp.aacrjournals.org/content/early/2015/11/09/1055-9965.EPI-15-0623.abstract\" target=\"_blank\">published Wednesday\u003c/a> in \u003cem>Cancer Epidemiology, Biomarkers & Prevention. \u003c/em>The mammograms were done in 1.3 million women, ages 40 to 74.\u003c/p>\n\u003cp>Earlier studies have had conflicting results. But the size of this study makes researchers more confident that whatever is going on is a true phenomenon and not chance, says \u003ca href=\"http://pressroom.cancer.org/index.php?s=20&item=167\" target=\"_blank\">Dr. Richard Wender\u003c/a>, chief cancer control officer of the American Cancer Society.\u003c/p>\n\u003cp>\"If you've had a false positive, that is a risk factor,\" he says, \"so it's very important that a woman stay up to date with regular mammography.\"\u003c/p>\n\u003cp>As it is now, Wender says, at least one-third of women who should be getting routinely screened for breast cancer are falling behind schedule.\u003c/p>\n\u003cp>The cancer society \u003ca href=\"http://www.npr.org/sections/health-shots/2015/10/20/449920789/cancer-group-now-says-most-mammograms-can-wait-till-45\" target=\"_blank\">created controversy\u003c/a> in October, when it changed its guidelines to recommend that regular screening start at age 45. Other groups recommend starting earlier, at age 40, and some say it's OK to wait until age 50.\u003c/p>\n\u003cp>Studies have shown that the chance of getting an abnormal screening mammogram that is falsely positive is about 50 percent over the course of 10 years. That often leads to further testing, including more mammograms, possible ultrasound exams, MRIs and even biopsies.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=False+Alarm+Mammograms+May+Still+Signal+Higher+Breast+Cancer+Risk&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For women who got biopsies that turned out negative, the chance of cancer was increased by 76 percent over the next 10 years.\u003c/p>\n\u003cp>\"We don't want women to read this and feel worried,\" Henderson says. Instead, the findings should be considered one more \"useful tool\" when weighing all the other factors that might be raising a particular woman's risk, such as age, race, breast density and family history of breast cancer.\u003c/p>\n\u003cp>Henderson says the study wasn't designed to figure out why a falsely positive mammogram is associated with an increased cancer risk.\u003c/p>\n\u003cp>It's possible, she says, that the increased risk \"could be the fact that the radiologist sees an abnormal pattern that's not cancerous, but it's a radio-graphic marker,\" and it could be that this is a precursor to some subsequent cancer diagnosis.\u003c/p>\n\u003cp>The study, done at several leading universities, looked back at more than 2.2 million screening mammograms considered to be false alarms between 1994 and 2009. It was \u003ca href=\"http://cebp.aacrjournals.org/content/early/2015/11/09/1055-9965.EPI-15-0623.abstract\" target=\"_blank\">published Wednesday\u003c/a> in \u003cem>Cancer Epidemiology, Biomarkers & Prevention. \u003c/em>The mammograms were done in 1.3 million women, ages 40 to 74.\u003c/p>\n\u003cp>Earlier studies have had conflicting results. But the size of this study makes researchers more confident that whatever is going on is a true phenomenon and not chance, says \u003ca href=\"http://pressroom.cancer.org/index.php?s=20&item=167\" target=\"_blank\">Dr. Richard Wender\u003c/a>, chief cancer control officer of the American Cancer Society.\u003c/p>\n\u003cp>\"If you've had a false positive, that is a risk factor,\" he says, \"so it's very important that a woman stay up to date with regular mammography.\"\u003c/p>\n\u003cp>As it is now, Wender says, at least one-third of women who should be getting routinely screened for breast cancer are falling behind schedule.\u003c/p>\n\u003cp>The cancer society \u003ca href=\"http://www.npr.org/sections/health-shots/2015/10/20/449920789/cancer-group-now-says-most-mammograms-can-wait-till-45\" target=\"_blank\">created controversy\u003c/a> in October, when it changed its guidelines to recommend that regular screening start at age 45. Other groups recommend starting earlier, at age 40, and some say it's OK to wait until age 50.\u003c/p>\n\u003cp>Studies have shown that the chance of getting an abnormal screening mammogram that is falsely positive is about 50 percent over the course of 10 years. That often leads to further testing, including more mammograms, possible ultrasound exams, MRIs and even biopsies.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=False+Alarm+Mammograms+May+Still+Signal+Higher+Breast+Cancer+Risk&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Kaiser Recruits Members to Help Unlock Autism's Genetic Secrets",
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"content": "\u003cp>Thousands of Northern California families of children with autism are being recruited to join a new project to help scientists understand how heredity and environmental factors determine where each youngster falls on the spectrum of the disorder.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Teasing apart the [autism] spectrum, we might makes some leaps forward.'\u003cbr>\n\u003ccite>Lisa Croen, Ph.D., Kaiser Autism Research Program\u003c/cite>\u003c/aside>\n\u003cp>Kaiser Permanente aims to sign up 5,000 children and adults with autism -- along with their biological parents -- to contribute a blood or saliva sample to a “\u003ca href=\"http://autismfamilybiobank.kaiser.org/\" target=\"_blank\">biobank\u003c/a>” that will enable researchers to track and identify common factors in various types of autism.\u003c/p>\n\u003cp>Kaiser Permanente has 3.8 million members in Northern California, with 17,000 children and adults diagnosed with autism. Because participating children are Kaiser health plan members, researchers plan to evaluate their health records in conjunction with the genetic samples in an effort to unlock insights into autism causes, best treatments, medications and possible prevention strategies.\u003c/p>\n\u003cp>“We have a really incredible population to study,” said Lisa Croen, director of the Kaiser Permanente Autism Research Program and a senior research scientist at the Kaiser Permanente Northern California Division of Research. “We have lots of information for them like lab tests, medications taken –- a huge wealth of clinical information. We have the ability to re-contact these families and collect even more.”\u003c/p>\n\u003cp>The project, funded by a $4.6 million grant from the Simons Foundation, will create the autism research bank over the next three years. It will be available as a resource for any researcher. A review committee will consider requests for use of the specimens, Croen said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"VMeweA8IIaAbuyJ2sLjO5wsVwYgp93Yq\"]The rising rates of children being diagnosed with autism in the U.S. has been alarming to parents, doctors and educators struggling to understand the vast array of disorders that fall under this heading and how to provide the best care. Researchers believe genetics and environmental triggers combine to cause autism.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdc.gov/ncbddd/autism/index.html\" target=\"_blank\">Autism\u003c/a> is an umbrella term for a spectrum of neurodevelopmental disorders that emerge in early childhood, affecting social interaction, behavior and communication. Research has shown \u003ca href=\"http://www.cdc.gov/ncbddd/autism/treatment.html#ref\"> \u003c/a> early access to care and intervention can dramatically improve the progress, symptoms and daily functioning of kids with autism.\u003c/p>\n\u003cp>Last week the National Center for Health Statistics released a \u003ca href=\"http://www.cdc.gov/nchs/data/nhsr/nhsr087.pdf\" target=\"_blank\">survey\u003c/a> that found autism rates in children may be higher than experts had thought. The report found that one in 45 children ages 3 to 17 has autism. The U.S. Centers for Disease Control and Prevention had previously pegged the rate at \u003ca href=\"http://www.cdc.gov/ncbddd/autism/data.html\" target=\"_blank\">1 in 68\u003c/a> American children.\u003c/p>\n\u003cp>Over the years studies have identified different genes associated with autism, but much remains to be learned about the interaction between specific genes and environmental factors and how they influence the development of subtypes of autism.\u003c/p>\n\u003cp>Researchers have begun to focus on large-scale collections of data like Kaiser’s project. Such initiatives offer hope that certain factors in subtypes of autism can be identified.\u003c/p>\n\u003cp>“Being told your child has ‘autism’ doesn’t really tell you what you and your child will be dealing with for the rest of your lives,” said Mathew Pletcher, vice president and head of genomic discovery at Autism Speaks, an advocacy group for people with autism. “It’s a broad term that covers a huge number of kids and symptoms. It’s not like being told you have cancer, what type of cancer, what stage of cancer and which drugs best treat it.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"qCp3opWG17SIbFx9VtmUmv4tP1YuzqQv\"]Autism Speaks is working with Google to sequence the DNA of more than 10,000 families living with autism. The \u003ca href=\"https://www.mss.ng/\" target=\"_blank\">data\u003c/a> will be made available to researchers at no cost, Pletcher said.\u003c/p>\n\u003cp>“This data is now allowing us to break apart the spectrum into a much more meaningful diagnosis,” he said. “With trying to understand a complex disorder like autism, it comes down to numbers, the depth and breadth of data out there. There is never enough data. There’s always interest in another effort like the Kaiser study to bring more families in.”\u003c/p>\n\u003cp>The work at Kaiser’s biobank and Google could lead to more tailored treatments to treat autism, researchers say.\u003c/p>\n\u003cp>Autism frequently coexists with physical ailments like gastrointestinal problems, seizures or allergies. Researchers may find that certain genes drive certain combinations of those conditions, Croen said.\u003c/p>\n\u003cp>“Teasing apart the spectrum, we might makes some leaps forward,” she said.\u003c/p>\n\u003cp>For participating Kaiser patients with an autism diagnosis, their biological parents will provide samples of blood or saliva and complete questionnaires. All patient identifiers will be removed before the data is provided to researchers.\u003c/p>\n\u003cp>Joanna Jaeger, who has a 23-year-old son with autism, said she and her family agreed to participate in the study to help other parents.\u003c/p>\n\u003cp>Her son, Alex, who has an \u003ca href=\"http://www.big-als-best.com/big-al-s-best-dark-chocolate-almond-toffee.html\" target=\"_blank\">at-home toffee making business\u003c/a>, used to have difficulty cooperating during blood tests, she said. A blood draw once took “five people 45 minutes,” to make happen. But she says now it’s something he can do without difficulty, so she thought it was especially important to participate.\u003c/p>\n\u003cp>“It’s a great way for parents to give back and advance the information,” said Joanna Jaeger, who lives in Milpitas and is on the community advisory board for the Kaiser Permanente Autism Research Program. “So much of the time we are all overwhelmed and in the moment in day-to-day life. This is something we can do to make things a little easier for families who will deal with autism in the future.”\u003c/p>\n\u003cp>Since recruitment began in July, Kaiser has enrolled 270 families, health plan officials said.\u003c/p>\n\u003cp>“This resource can’t exist without families participating,” Croen said. “Hopefully, together we can all make a difference.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Learn more about \u003ca href=\"http://autismfamilybiobank.kaiser.org\" target=\"_blank\">Kaiser's autism biobank study\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Thousands of Northern California families of children with autism are being recruited to join a new project to help scientists understand how heredity and environmental factors determine where each youngster falls on the spectrum of the disorder.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Teasing apart the [autism] spectrum, we might makes some leaps forward.'\u003cbr>\n\u003ccite>Lisa Croen, Ph.D., Kaiser Autism Research Program\u003c/cite>\u003c/aside>\n\u003cp>Kaiser Permanente aims to sign up 5,000 children and adults with autism -- along with their biological parents -- to contribute a blood or saliva sample to a “\u003ca href=\"http://autismfamilybiobank.kaiser.org/\" target=\"_blank\">biobank\u003c/a>” that will enable researchers to track and identify common factors in various types of autism.\u003c/p>\n\u003cp>Kaiser Permanente has 3.8 million members in Northern California, with 17,000 children and adults diagnosed with autism. Because participating children are Kaiser health plan members, researchers plan to evaluate their health records in conjunction with the genetic samples in an effort to unlock insights into autism causes, best treatments, medications and possible prevention strategies.\u003c/p>\n\u003cp>“We have a really incredible population to study,” said Lisa Croen, director of the Kaiser Permanente Autism Research Program and a senior research scientist at the Kaiser Permanente Northern California Division of Research. “We have lots of information for them like lab tests, medications taken –- a huge wealth of clinical information. We have the ability to re-contact these families and collect even more.”\u003c/p>\n\u003cp>The project, funded by a $4.6 million grant from the Simons Foundation, will create the autism research bank over the next three years. It will be available as a resource for any researcher. A review committee will consider requests for use of the specimens, Croen said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The rising rates of children being diagnosed with autism in the U.S. has been alarming to parents, doctors and educators struggling to understand the vast array of disorders that fall under this heading and how to provide the best care. Researchers believe genetics and environmental triggers combine to cause autism.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdc.gov/ncbddd/autism/index.html\" target=\"_blank\">Autism\u003c/a> is an umbrella term for a spectrum of neurodevelopmental disorders that emerge in early childhood, affecting social interaction, behavior and communication. Research has shown \u003ca href=\"http://www.cdc.gov/ncbddd/autism/treatment.html#ref\"> \u003c/a> early access to care and intervention can dramatically improve the progress, symptoms and daily functioning of kids with autism.\u003c/p>\n\u003cp>Last week the National Center for Health Statistics released a \u003ca href=\"http://www.cdc.gov/nchs/data/nhsr/nhsr087.pdf\" target=\"_blank\">survey\u003c/a> that found autism rates in children may be higher than experts had thought. The report found that one in 45 children ages 3 to 17 has autism. The U.S. Centers for Disease Control and Prevention had previously pegged the rate at \u003ca href=\"http://www.cdc.gov/ncbddd/autism/data.html\" target=\"_blank\">1 in 68\u003c/a> American children.\u003c/p>\n\u003cp>Over the years studies have identified different genes associated with autism, but much remains to be learned about the interaction between specific genes and environmental factors and how they influence the development of subtypes of autism.\u003c/p>\n\u003cp>Researchers have begun to focus on large-scale collections of data like Kaiser’s project. Such initiatives offer hope that certain factors in subtypes of autism can be identified.\u003c/p>\n\u003cp>“Being told your child has ‘autism’ doesn’t really tell you what you and your child will be dealing with for the rest of your lives,” said Mathew Pletcher, vice president and head of genomic discovery at Autism Speaks, an advocacy group for people with autism. “It’s a broad term that covers a huge number of kids and symptoms. It’s not like being told you have cancer, what type of cancer, what stage of cancer and which drugs best treat it.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Autism Speaks is working with Google to sequence the DNA of more than 10,000 families living with autism. The \u003ca href=\"https://www.mss.ng/\" target=\"_blank\">data\u003c/a> will be made available to researchers at no cost, Pletcher said.\u003c/p>\n\u003cp>“This data is now allowing us to break apart the spectrum into a much more meaningful diagnosis,” he said. “With trying to understand a complex disorder like autism, it comes down to numbers, the depth and breadth of data out there. There is never enough data. There’s always interest in another effort like the Kaiser study to bring more families in.”\u003c/p>\n\u003cp>The work at Kaiser’s biobank and Google could lead to more tailored treatments to treat autism, researchers say.\u003c/p>\n\u003cp>Autism frequently coexists with physical ailments like gastrointestinal problems, seizures or allergies. Researchers may find that certain genes drive certain combinations of those conditions, Croen said.\u003c/p>\n\u003cp>“Teasing apart the spectrum, we might makes some leaps forward,” she said.\u003c/p>\n\u003cp>For participating Kaiser patients with an autism diagnosis, their biological parents will provide samples of blood or saliva and complete questionnaires. All patient identifiers will be removed before the data is provided to researchers.\u003c/p>\n\u003cp>Joanna Jaeger, who has a 23-year-old son with autism, said she and her family agreed to participate in the study to help other parents.\u003c/p>\n\u003cp>Her son, Alex, who has an \u003ca href=\"http://www.big-als-best.com/big-al-s-best-dark-chocolate-almond-toffee.html\" target=\"_blank\">at-home toffee making business\u003c/a>, used to have difficulty cooperating during blood tests, she said. A blood draw once took “five people 45 minutes,” to make happen. But she says now it’s something he can do without difficulty, so she thought it was especially important to participate.\u003c/p>\n\u003cp>“It’s a great way for parents to give back and advance the information,” said Joanna Jaeger, who lives in Milpitas and is on the community advisory board for the Kaiser Permanente Autism Research Program. “So much of the time we are all overwhelmed and in the moment in day-to-day life. This is something we can do to make things a little easier for families who will deal with autism in the future.”\u003c/p>\n\u003cp>Since recruitment began in July, Kaiser has enrolled 270 families, health plan officials said.\u003c/p>\n\u003cp>“This resource can’t exist without families participating,” Croen said. “Hopefully, together we can all make a difference.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Learn more about \u003ca href=\"http://autismfamilybiobank.kaiser.org\" target=\"_blank\">Kaiser's autism biobank study\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>For a child with attention deficit hyperactivity disorder, meeting the daily expectations of home and school life can be a struggle that extends to bedtime. The stimulant medications commonly used to treat ADHD can cause difficulty falling and staying asleep, a study finds. And that can make the next day that much harder.\u003c/p>\n\u003cp>As parents are well aware, sleep affects a child's emotional and physical well-being, and it is no different for those with ADHD. \"Poor sleep makes ADHD symptoms worse,\" says Katherine M. Kidwell, a doctoral student in clinical psychology at the University of Nebraska, Lincoln, who led the \u003ca href=\"https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/ADHD-Medications-Make-it-Harder-For-Children-to-Sleep.aspx\" target=\"_blank\">study\u003c/a>. \"When children with ADHD don't sleep well, they have problems paying attention the next day, and they are more impulsive and emotionally reactive.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"2MviotjpSvQhis11x4HmVRwXDvXd5AP3\"]Stimulant medications boost alertness, and some studies have found a detrimental effect on children's sleep. However, other studies have concluded that the stimulants' ameliorating effects improve sleep. The drugs include amphetamines such as Adderall and methylphenidate such as Ritalin.\u003c/p>\n\u003cp>To reconcile the mixed results on stimulants and children's sleep, Kidwell and her colleagues undertook a meta-analysis, a type of study that summarizes the results of existing research. The team found nine studies that met their criteria. These studies compared children who were taking stimulant medication with those who weren't. The studies also randomly assigned children to the experimental group or the control group and used objective measures of sleep quality and quantity, such as assessing sleep in a lab setting or with a wristwatch-like monitor at home rather than a parent's report.\u003c/p>\n\u003cp>Taking a stimulant medication leads to poor sleep overall for children, the researchers reported online Monday in \u003cem>Pediatrics\u003c/em>. They found that the more doses of medication a child took per day, the longer it took for that child to fall asleep at night. The study suggests that extended-release versions of stimulants, which are taken once a day, have less of an impact on how long it takes to fall asleep than immediate-release formulas, which are sometimes taken three times a day, with the last dose close to bedtime.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Furthermore, the quality of sleep, or sleep efficiency — the percentage of time one is asleep while in bed — was worse for those on stimulant medications, although those kids who had been on the drugs longer fared better than those who had just begun taking the medication. There was also a gender difference, with boys on stimulant medication getting poorer-quality sleep than girls.\u003c/p>\n\u003cp>Finally, stimulants reduced the total amount of sleep children got at night. \"Families and pediatricians need to be aware that sleep problems are a real effect of stimulant medication,\" says Kidwell.\u003c/p>\n\u003cp>\"It's really good to see this,\" says William E. Pelham, a clinical psychologist and director of the Center for Children and Families at Florida International University, who studies ADHD in children and adolescents. Pediatricians are often quick to prescribe a medication without adequate follow-up, he says, and \"assessing sleep side effects is important — it needs to be something that pediatricians routinely do.\"\u003c/p>\n\u003cp>For families, Kidwell says that the bedtime routines all parents use — reading stories, sharing news about the day, quiet activities like coloring — are very helpful for kids with ADHD too. \"But parents may need to provide more structure, support, and simpler reminders for children with ADHD.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Aimee Cunningham is a freelance science journalist based in the Washington, D.C., area.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Common+ADHD+Medications+Do+Indeed+Disturb+Children%27s+Sleep+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For a child with attention deficit hyperactivity disorder, meeting the daily expectations of home and school life can be a struggle that extends to bedtime. The stimulant medications commonly used to treat ADHD can cause difficulty falling and staying asleep, a study finds. And that can make the next day that much harder.\u003c/p>\n\u003cp>As parents are well aware, sleep affects a child's emotional and physical well-being, and it is no different for those with ADHD. \"Poor sleep makes ADHD symptoms worse,\" says Katherine M. Kidwell, a doctoral student in clinical psychology at the University of Nebraska, Lincoln, who led the \u003ca href=\"https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/ADHD-Medications-Make-it-Harder-For-Children-to-Sleep.aspx\" target=\"_blank\">study\u003c/a>. \"When children with ADHD don't sleep well, they have problems paying attention the next day, and they are more impulsive and emotionally reactive.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Stimulant medications boost alertness, and some studies have found a detrimental effect on children's sleep. However, other studies have concluded that the stimulants' ameliorating effects improve sleep. The drugs include amphetamines such as Adderall and methylphenidate such as Ritalin.\u003c/p>\n\u003cp>To reconcile the mixed results on stimulants and children's sleep, Kidwell and her colleagues undertook a meta-analysis, a type of study that summarizes the results of existing research. The team found nine studies that met their criteria. These studies compared children who were taking stimulant medication with those who weren't. The studies also randomly assigned children to the experimental group or the control group and used objective measures of sleep quality and quantity, such as assessing sleep in a lab setting or with a wristwatch-like monitor at home rather than a parent's report.\u003c/p>\n\u003cp>Taking a stimulant medication leads to poor sleep overall for children, the researchers reported online Monday in \u003cem>Pediatrics\u003c/em>. They found that the more doses of medication a child took per day, the longer it took for that child to fall asleep at night. The study suggests that extended-release versions of stimulants, which are taken once a day, have less of an impact on how long it takes to fall asleep than immediate-release formulas, which are sometimes taken three times a day, with the last dose close to bedtime.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Furthermore, the quality of sleep, or sleep efficiency — the percentage of time one is asleep while in bed — was worse for those on stimulant medications, although those kids who had been on the drugs longer fared better than those who had just begun taking the medication. There was also a gender difference, with boys on stimulant medication getting poorer-quality sleep than girls.\u003c/p>\n\u003cp>Finally, stimulants reduced the total amount of sleep children got at night. \"Families and pediatricians need to be aware that sleep problems are a real effect of stimulant medication,\" says Kidwell.\u003c/p>\n\u003cp>\"It's really good to see this,\" says William E. Pelham, a clinical psychologist and director of the Center for Children and Families at Florida International University, who studies ADHD in children and adolescents. Pediatricians are often quick to prescribe a medication without adequate follow-up, he says, and \"assessing sleep side effects is important — it needs to be something that pediatricians routinely do.\"\u003c/p>\n\u003cp>For families, Kidwell says that the bedtime routines all parents use — reading stories, sharing news about the day, quiet activities like coloring — are very helpful for kids with ADHD too. \"But parents may need to provide more structure, support, and simpler reminders for children with ADHD.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Aimee Cunningham is a freelance science journalist based in the Washington, D.C., area.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Common+ADHD+Medications+Do+Indeed+Disturb+Children%27s+Sleep+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Back in March of 2013, Natalie Price was going through some hard times. She had just lost her job, was going through a divorce, and she and her two kids had to move back into her parents' house.\u003c/p>\n\u003cp>“I was so stressed out,” says Price, who lives in San Diego. “I remember going to bed that night thinking, ‘Tomorrow when I wake up, I’m going to be stressing all day about how I can’t take care of everything I need to take care of.’ ”\u003c/p>\n\u003cp>Instead, she awoke at 2 a.m. with a pain in her hand and arm. She was having a heart attack.\u003c/p>\n\u003cp>Price recovered at the UC San Diego Medical Center. But the heart attack had weakened her heart enough to put her at risk for\u003ca href=\"http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp#\" target=\"_blank\"> heart failure\u003c/a>.\u003c/p>\n\u003cp>That's when she learned about an unusual study that might help her recovery. It wasn't about a new drug. Instead, researchers were looking at the experience of gratitude and how it might affect people at risk for heart failure. One of the things Price and the other participants were asked to do was to write journal entries about what they were grateful for each day.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For Price, it was hard. She says that on some days she felt like she had nothing to be grateful for. Still, the exercise got her thinking more about the things that made her happy, like walking on the beach and playing music at her church.\u003c/p>\n\u003cp>UC San Diego School of Medicine clinical research coordinator \u003ca href=\"http://fmph.ucsd.edu/integrative-health/coe/people-contacts.html\">Meredith Pung\u003c/a> was a co-author of the gratitude study. She says keeping a gratitude journal is like strength training for the heart. Altogether, researchers looked at 186 people at risk for heart failure.\u003c/p>\n\u003cp>“So they (had) some evidence of structural abnormalities that you can see on their heart if you use an echocardiogram,” Pung says of participants. “But they don’t yet have any signs or symptoms of heart failure.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/234739716\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]Heart failure happens when the heart isn’t getting enough blood. People who have had heart attacks, like Price, are at higher risk of developing it. And half of those with\u003ca href=\"http://www.cdc.gov/DHDSP/data_statistics/fact_sheets/fs_heart_failure.htm\"> heart failure die within five years of diagnosis\u003c/a>.\u003c/p>\n\u003cp>Pung says the study participants who kept a gratitude journal for eight weeks showed signs of a healthier heart afterward. Subjects who didn’t keep a journal did not show improvement. The results were\u003ca href=\"http://www.apa.org/pubs/journals/releases/scp-0000050.pdf\" target=\"_blank\"> published \u003c/a>by the American Psychological Association in its journal, Spirituality in Clinical Practice.\u003c/p>\n\u003cp>“So the heart just needs a break, right?” says Pung. “With grateful contemplation and gratitude journaling, that allows a little break, a physiological break for the heart, and it allows it to continue its job for as long as we need it.”\u003c/p>\n\u003cp>I visited Pung’s lab at UC San Diego to see how the study works.\u003c/p>\n\u003cp>First, participants put on a device called a bio harness, a device connected to a computer that monitored a participant's heart rate. Then Pung asked them to write in a journal for five minutes detailing what they were grateful for.\u003c/p>\n\u003cp>Then researchers looked at heart rate variability onscreen.\u003c/p>\n\u003cp>“While you’re journaling, what it would end up looking like on the screen is the peaks,\" Pung explains. \"Some would be closer together, some would be further apart. Instead of boom, boom, boom, all equal distances apart. And that [variability] is what we want to see in a healthy individual.”\u003c/p>\n\u003cp>Blood analysis from the UCSD study suggests that more grateful patients were at lower risk of heart failure. These patients also reported fewer symptoms of depression, better sleep, and they felt empowered to take care of their health.\u003c/p>\n\u003cp>Natalie Price says gratitude journaling got her out of her depression and back on her feet. Two years ago, she couldn’t walk down the street without gasping for breath. Today, she walks to work almost every day.\u003c/p>\n\u003cp>“And I joined a gym,” she says. “It was enjoyable. I started doing my physical activities, and I became more cognizant of my health, of what I ate. And I still am.”\u003c/p>\n\u003cp>Price’s life hasn’t become easy. She’s still in the middle of a nasty divorce, still trying to make ends meet. But now when she gets stressed out, she picks up a paper and pen and writes about the things she can be grateful for in her life.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This is story is a part of a \u003ca href=\"https://soundcloud.com/ben-manilla-productions/the-science-of-gratitude-full-episode\" target=\"_blank\">one-hour documentary\u003c/a> on the science of gratitude for Public Radio International. It will be broadcast in December on KQED.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Back in March of 2013, Natalie Price was going through some hard times. She had just lost her job, was going through a divorce, and she and her two kids had to move back into her parents' house.\u003c/p>\n\u003cp>“I was so stressed out,” says Price, who lives in San Diego. “I remember going to bed that night thinking, ‘Tomorrow when I wake up, I’m going to be stressing all day about how I can’t take care of everything I need to take care of.’ ”\u003c/p>\n\u003cp>Instead, she awoke at 2 a.m. with a pain in her hand and arm. She was having a heart attack.\u003c/p>\n\u003cp>Price recovered at the UC San Diego Medical Center. But the heart attack had weakened her heart enough to put her at risk for\u003ca href=\"http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp#\" target=\"_blank\"> heart failure\u003c/a>.\u003c/p>\n\u003cp>That's when she learned about an unusual study that might help her recovery. It wasn't about a new drug. Instead, researchers were looking at the experience of gratitude and how it might affect people at risk for heart failure. One of the things Price and the other participants were asked to do was to write journal entries about what they were grateful for each day.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For Price, it was hard. She says that on some days she felt like she had nothing to be grateful for. Still, the exercise got her thinking more about the things that made her happy, like walking on the beach and playing music at her church.\u003c/p>\n\u003cp>UC San Diego School of Medicine clinical research coordinator \u003ca href=\"http://fmph.ucsd.edu/integrative-health/coe/people-contacts.html\">Meredith Pung\u003c/a> was a co-author of the gratitude study. She says keeping a gratitude journal is like strength training for the heart. Altogether, researchers looked at 186 people at risk for heart failure.\u003c/p>\n\u003cp>“So they (had) some evidence of structural abnormalities that you can see on their heart if you use an echocardiogram,” Pung says of participants. “But they don’t yet have any signs or symptoms of heart failure.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/234739716&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/234739716'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>Heart failure happens when the heart isn’t getting enough blood. People who have had heart attacks, like Price, are at higher risk of developing it. And half of those with\u003ca href=\"http://www.cdc.gov/DHDSP/data_statistics/fact_sheets/fs_heart_failure.htm\"> heart failure die within five years of diagnosis\u003c/a>.\u003c/p>\n\u003cp>Pung says the study participants who kept a gratitude journal for eight weeks showed signs of a healthier heart afterward. Subjects who didn’t keep a journal did not show improvement. The results were\u003ca href=\"http://www.apa.org/pubs/journals/releases/scp-0000050.pdf\" target=\"_blank\"> published \u003c/a>by the American Psychological Association in its journal, Spirituality in Clinical Practice.\u003c/p>\n\u003cp>“So the heart just needs a break, right?” says Pung. “With grateful contemplation and gratitude journaling, that allows a little break, a physiological break for the heart, and it allows it to continue its job for as long as we need it.”\u003c/p>\n\u003cp>I visited Pung’s lab at UC San Diego to see how the study works.\u003c/p>\n\u003cp>First, participants put on a device called a bio harness, a device connected to a computer that monitored a participant's heart rate. Then Pung asked them to write in a journal for five minutes detailing what they were grateful for.\u003c/p>\n\u003cp>Then researchers looked at heart rate variability onscreen.\u003c/p>\n\u003cp>“While you’re journaling, what it would end up looking like on the screen is the peaks,\" Pung explains. \"Some would be closer together, some would be further apart. Instead of boom, boom, boom, all equal distances apart. And that [variability] is what we want to see in a healthy individual.”\u003c/p>\n\u003cp>Blood analysis from the UCSD study suggests that more grateful patients were at lower risk of heart failure. These patients also reported fewer symptoms of depression, better sleep, and they felt empowered to take care of their health.\u003c/p>\n\u003cp>Natalie Price says gratitude journaling got her out of her depression and back on her feet. Two years ago, she couldn’t walk down the street without gasping for breath. Today, she walks to work almost every day.\u003c/p>\n\u003cp>“And I joined a gym,” she says. “It was enjoyable. I started doing my physical activities, and I became more cognizant of my health, of what I ate. And I still am.”\u003c/p>\n\u003cp>Price’s life hasn’t become easy. She’s still in the middle of a nasty divorce, still trying to make ends meet. But now when she gets stressed out, she picks up a paper and pen and writes about the things she can be grateful for in her life.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This is story is a part of a \u003ca href=\"https://soundcloud.com/ben-manilla-productions/the-science-of-gratitude-full-episode\" target=\"_blank\">one-hour documentary\u003c/a> on the science of gratitude for Public Radio International. It will be broadcast in December on KQED.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Wishes for End-of-Life Care Are Common Across Ethnicities",
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"content": "\u003cp>What kind of care do you want at the end of your life?\u003c/p>\n\u003cp>Stanford University researchers put that question to members of three major ethnic groups in the Bay Area and, \u003ca href=\"http://online.liebertpub.com/doi/full/10.1089/jpm.2015.0403\" target=\"_blank\">in an analysis,\u003c/a> found little variation in their responses.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What this study tells us is that all of our patients want us to have these conversations.'\u003cbr>\n\u003ccite>Steven Pantilat, UCSF palliative care program\u003c/cite>\u003c/aside>\n\u003cp>“There is a common humanity –- people want to live as long as they have good quality of life. When it is their time, they want to be consulted so they die in a way that they are respected, and they don’t want their families burdened,” said the study’s lead author, Dr. V.J. Periyakoil, director of the Stanford Palliative Care Education and Training Program and associate director of palliative care services at the VA Palo Alto Health Care Center.\u003c/p>\n\u003cp>Regardless of ethnicity, however, the researchers found that access to high-quality end-of-life care is often hampered by lack of financial means, poor communication with health providers, cultural mores and family conflicts. The study, involving more than 300 white, Asian and African-American seniors, was published last week in the Journal of Palliative Medicine.\u003c/p>\n\u003cp>Periyakoil, whose earlier research focused on \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/22/ethnic-differences-thwart-end-of-life-conversations/\" target=\"_blank\">how doctors discuss end-of-life care\u003c/a> with patients from different cultures, said physicians often believe that talking about end-of-life care with patients of certain ethnic groups is taboo and that patients and their families are reluctant to have these sensitive conversations. The new study, though small and limited in geographic scope, suggests otherwise. The participants may have been more affluent and better educated than their counterparts nationwide, given the region’s demographics, Periyakoil noted.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers interviewed 315 people over 50 at senior centers in Fremont, Palo Alto, San Francisco, San Jose and Walnut Creek. The group included 38 African-Americans, 160 Asian-Americans and 117 Caucasians.\u003c/p>\n\u003cp>Interviews were conducted in multiple languages: English, Burmese, Hindi, Mandarin, Tagalog and Vietnamese. Researchers examined participants’ attitudes toward end-of-life care and whether they had experienced barriers to getting quality end-of-life care for relatives or others in their community.\u003c/p>\n\u003cp>\u003cstrong>Finances an Issue for Many\u003c/strong>\u003c/p>\n\u003cp>Researchers are still collecting data on Latino participants and plan to publish a separate study on their views, Periyakoil said.\u003c/p>\n\u003cp>While all of the participants in the study said they valued high-quality end-of-life care, about 60 percent said they had experienced barriers to getting it, most notably financial difficulties and a lack of adequate health insurance. Medicare typically covers only short-term nursing home care and offers hospice benefits to patients whose doctors certify they have six months or less to live and who are willing to forgo treatment intended to cure their terminal illness.\u003c/p>\n\u003cp>There were no statistically significant differences among ethnic groups in reporting barriers to care. But participants with less education were more likely to report that their biggest barrier to care was financial.\u003c/p>\n\u003cp>Patients with more education were more likely to cite doctor behaviors that hampered end-of-life communication. And women were more likely than men to cite barriers to care overall, perhaps because they were more likely to be direct caregivers and have more experience with end-of-life needs.\u003c/p>\n\u003cp>\u003cstrong>'Vague Responses' from Doctors\u003c/strong>\u003c/p>\n\u003cp>Regardless of ethnicity, patients felt that “doctors were just too busy to initiate [end-of-life] conversations, reluctant to listen to their concerns and questions about EOL decision making, and often gave vague responses, making it difficult for the patient to comprehend their choices and make informed decisions,” the researchers wrote.\u003c/p>\n\u003cp>An estimated 2.6 million Americans die every year, but how the American health care system handles their last days is problematic across ethnic groups, according to \u003ca href=\"http://iom.nationalacademies.org/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx\" target=\"_blank\">“Dying in America,”\u003c/a> a landmark report released in 2014 by the Institute of Medicine. Too many people end up having aggressive treatment that is ineffective and expensive and doesn’t contribute to the patient’s quality of life, the report found. Other research examining\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/25/a-racial-gap-in-attitudes-toward-hospice-care/\" target=\"_blank\"> racial gaps in attitudes toward hospice care\u003c/a> and other studies has found differences among ethnic and religious groups in how they approach end-of-life decisions.\u003c/p>\n\u003cp>[contextly_sidebar id=\"fDtiIK5xkI4TXA1JF0Lq6Kt8zKIAFZ4t\"]But people want to talk about it regardless of background, says Dr. Steven Pantilat, director of UC San Francisco's palliative care program. He was not involved in the study.\u003c/p>\n\u003cp>“What this study tells us is that \u003cem>all\u003c/em> of our patients want us to have these conversations,” Pantilat said. “They’re waiting for their doctors to bring it up, to not be rushed, to communicate sensitively.”\u003c/p>\n\u003cp>A new federal policy may make those conversations easier –- and more routine. Starting in January, \u003ca href=\"http://bigstory.ap.org/article/3c1463f23baa4b79b2f2462ee9fc29ff/medicare-cover-end-life-counseling\" target=\"_blank\">Medicare will reimburse physicians for discussing end-of-life care\u003c/a>. That policy infamously -- and incorrectly -- was derided as promoting “death panels” during the debate over the Affordable Care Act, and a version of it was dropped from the legislation. The counseling will cover what kind of medical care patients want to receive as they approach their last days.\u003c/p>\n\u003cp>Periyakoil urges patients of all backgrounds to prepare for these conversations, and new planning tools are available in different languages to help. Among them is the \u003ca href=\"http://med.stanford.edu/letter.html\" target=\"_blank\">Stanford Letter Project\u003c/a>, which helps patients write a letter to their doctors about the end-of-life care they do and don’t want in languages including English, Spanish, Mandarin, Vietnamese, Hindi, Urdu, Tagalog and Russian.\u003c/p>\n\u003cp>In one redacted letter provided by Periyakoil, a woman named Patricia writes: “I do not want my longevity to be more important than my comfort.”\u003c/p>\n\u003cp>Pantilat advises the doctors he trains that they don’t need deep knowledge of the beliefs of every religion and culture they might encounter, because every patient, of whatever ethnicity, has different goals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we come in with true curiosity, respect and openness, we can learn a lot about how to take care of someone in a sensitive way,” he said. We need to ask: “What do I need to know about your culture and your family to take good care of \u003cem>you\u003c/em>?”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>What kind of care do you want at the end of your life?\u003c/p>\n\u003cp>Stanford University researchers put that question to members of three major ethnic groups in the Bay Area and, \u003ca href=\"http://online.liebertpub.com/doi/full/10.1089/jpm.2015.0403\" target=\"_blank\">in an analysis,\u003c/a> found little variation in their responses.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What this study tells us is that all of our patients want us to have these conversations.'\u003cbr>\n\u003ccite>Steven Pantilat, UCSF palliative care program\u003c/cite>\u003c/aside>\n\u003cp>“There is a common humanity –- people want to live as long as they have good quality of life. When it is their time, they want to be consulted so they die in a way that they are respected, and they don’t want their families burdened,” said the study’s lead author, Dr. V.J. Periyakoil, director of the Stanford Palliative Care Education and Training Program and associate director of palliative care services at the VA Palo Alto Health Care Center.\u003c/p>\n\u003cp>Regardless of ethnicity, however, the researchers found that access to high-quality end-of-life care is often hampered by lack of financial means, poor communication with health providers, cultural mores and family conflicts. The study, involving more than 300 white, Asian and African-American seniors, was published last week in the Journal of Palliative Medicine.\u003c/p>\n\u003cp>Periyakoil, whose earlier research focused on \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/22/ethnic-differences-thwart-end-of-life-conversations/\" target=\"_blank\">how doctors discuss end-of-life care\u003c/a> with patients from different cultures, said physicians often believe that talking about end-of-life care with patients of certain ethnic groups is taboo and that patients and their families are reluctant to have these sensitive conversations. The new study, though small and limited in geographic scope, suggests otherwise. The participants may have been more affluent and better educated than their counterparts nationwide, given the region’s demographics, Periyakoil noted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers interviewed 315 people over 50 at senior centers in Fremont, Palo Alto, San Francisco, San Jose and Walnut Creek. The group included 38 African-Americans, 160 Asian-Americans and 117 Caucasians.\u003c/p>\n\u003cp>Interviews were conducted in multiple languages: English, Burmese, Hindi, Mandarin, Tagalog and Vietnamese. Researchers examined participants’ attitudes toward end-of-life care and whether they had experienced barriers to getting quality end-of-life care for relatives or others in their community.\u003c/p>\n\u003cp>\u003cstrong>Finances an Issue for Many\u003c/strong>\u003c/p>\n\u003cp>Researchers are still collecting data on Latino participants and plan to publish a separate study on their views, Periyakoil said.\u003c/p>\n\u003cp>While all of the participants in the study said they valued high-quality end-of-life care, about 60 percent said they had experienced barriers to getting it, most notably financial difficulties and a lack of adequate health insurance. Medicare typically covers only short-term nursing home care and offers hospice benefits to patients whose doctors certify they have six months or less to live and who are willing to forgo treatment intended to cure their terminal illness.\u003c/p>\n\u003cp>There were no statistically significant differences among ethnic groups in reporting barriers to care. But participants with less education were more likely to report that their biggest barrier to care was financial.\u003c/p>\n\u003cp>Patients with more education were more likely to cite doctor behaviors that hampered end-of-life communication. And women were more likely than men to cite barriers to care overall, perhaps because they were more likely to be direct caregivers and have more experience with end-of-life needs.\u003c/p>\n\u003cp>\u003cstrong>'Vague Responses' from Doctors\u003c/strong>\u003c/p>\n\u003cp>Regardless of ethnicity, patients felt that “doctors were just too busy to initiate [end-of-life] conversations, reluctant to listen to their concerns and questions about EOL decision making, and often gave vague responses, making it difficult for the patient to comprehend their choices and make informed decisions,” the researchers wrote.\u003c/p>\n\u003cp>An estimated 2.6 million Americans die every year, but how the American health care system handles their last days is problematic across ethnic groups, according to \u003ca href=\"http://iom.nationalacademies.org/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx\" target=\"_blank\">“Dying in America,”\u003c/a> a landmark report released in 2014 by the Institute of Medicine. Too many people end up having aggressive treatment that is ineffective and expensive and doesn’t contribute to the patient’s quality of life, the report found. Other research examining\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/25/a-racial-gap-in-attitudes-toward-hospice-care/\" target=\"_blank\"> racial gaps in attitudes toward hospice care\u003c/a> and other studies has found differences among ethnic and religious groups in how they approach end-of-life decisions.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But people want to talk about it regardless of background, says Dr. Steven Pantilat, director of UC San Francisco's palliative care program. He was not involved in the study.\u003c/p>\n\u003cp>“What this study tells us is that \u003cem>all\u003c/em> of our patients want us to have these conversations,” Pantilat said. “They’re waiting for their doctors to bring it up, to not be rushed, to communicate sensitively.”\u003c/p>\n\u003cp>A new federal policy may make those conversations easier –- and more routine. Starting in January, \u003ca href=\"http://bigstory.ap.org/article/3c1463f23baa4b79b2f2462ee9fc29ff/medicare-cover-end-life-counseling\" target=\"_blank\">Medicare will reimburse physicians for discussing end-of-life care\u003c/a>. That policy infamously -- and incorrectly -- was derided as promoting “death panels” during the debate over the Affordable Care Act, and a version of it was dropped from the legislation. The counseling will cover what kind of medical care patients want to receive as they approach their last days.\u003c/p>\n\u003cp>Periyakoil urges patients of all backgrounds to prepare for these conversations, and new planning tools are available in different languages to help. Among them is the \u003ca href=\"http://med.stanford.edu/letter.html\" target=\"_blank\">Stanford Letter Project\u003c/a>, which helps patients write a letter to their doctors about the end-of-life care they do and don’t want in languages including English, Spanish, Mandarin, Vietnamese, Hindi, Urdu, Tagalog and Russian.\u003c/p>\n\u003cp>In one redacted letter provided by Periyakoil, a woman named Patricia writes: “I do not want my longevity to be more important than my comfort.”\u003c/p>\n\u003cp>Pantilat advises the doctors he trains that they don’t need deep knowledge of the beliefs of every religion and culture they might encounter, because every patient, of whatever ethnicity, has different goals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we come in with true curiosity, respect and openness, we can learn a lot about how to take care of someone in a sensitive way,” he said. We need to ask: “What do I need to know about your culture and your family to take good care of \u003cem>you\u003c/em>?”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Francisco Judge Rules For Husband in Frozen Embryo Fight",
"title": "San Francisco Judge Rules For Husband in Frozen Embryo Fight",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>A woman must abide by an agreement with her ex-husband to destroy five frozen embryos if they got a divorce, despite her contention that they represent her last chance to have children, a San Francisco Superior Court judge ruled Wednesday.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/21/frozen-embryo-trial-highlights-gaps-in-law-ethics/\" target=\"_blank\">In the closely-watched case\u003c/a>, Judge Anne-Christine Massullo said in a tentative decision that the agreement trumps the woman's desire to now keep the embryos.\u003c/p>\n\u003cp>The couple's story began in 2010 as Mimi Lee and Stephen Findley were about to be married. Lee was diagnosed with breast cancer, and the couple decided to create embryos through in vitro fertilization in hopes of a future family.\u003c/p>\n\u003cp>Instead, the marriage fell apart, leaving the couple with five embryos. In 2013 the couple filed for divorce.\u003c/p>\n\u003cp>Findley wanted to discard the embryos in accordance with the agreement he and Lee signed while married. He worried in part that Lee would use any children to take financial advantage of him, according to the ruling.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lee's attorneys said no California court had previously ruled in such a case. A Pennsylvania court three years ago \u003ca href=\"http://articles.philly.com/2012-04-14/news/31342260_1_embryos-appeals-court-three-judge-superior-court-panel\" target=\"_blank\">awarded frozen embryos to a woman \u003c/a>who also said they may be her only way to have a child because of breast cancer treatment despite the objections of her ex-husband. An Illinois judge last year \u003ca href=\"http://www.chicagotribune.com/news/local/breaking/ct-embryos-court-ruling-met-20150612-story.html\" target=\"_blank\">also sided with a woman\u003c/a> who was infertile in her fight over embryos with an ex-boyfriend.\u003c/p>\n\u003cp>Massullo said California law is clear that couples must decide what to do with embryos they create in case of separation or divorce.\u003c/p>\n\u003cp>\"Decisions about family and children often are difficult, and can be wrenching when they become disputes,\" the judge wrote. \"The policy best suited to ensuring that these disputes are resolved in a clear-eyed manner ... is to give effect to the intentions of the parties at the time of the decision at issue.\"\u003c/p>\n\u003cp>An attorney for Lee, Peter Skinner, said in a statement his client was disappointed and was evaluating her legal options. Lee had argued that she had a right to change the agreement, and that she had a right to procreate.\u003c/p>\n\u003cp>While Lee might have a right to procreate in other circumstances, she doesn't have a right to procreate with Findley, the judge said.\u003c/p>\n\u003cp>The embryos were being held at UC San Francisco, which in accordance with state law gave Lee and Findley a consent agreement before the fertility treatments. In the agreement, they both said they would like the embryos \"thawed and discarded\" in case they divorced, according to court documents.\u003c/p>\n\u003cp>Lee argued that she thought the agreement was not legally binding. The judge ruled otherwise.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The tentative nature of the ruling gives the parties time to file objections, but such rulings generally become final.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A woman must abide by an agreement with her ex-husband to destroy five frozen embryos if they got a divorce, despite her contention that they represent her last chance to have children, a San Francisco Superior Court judge ruled Wednesday.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/21/frozen-embryo-trial-highlights-gaps-in-law-ethics/\" target=\"_blank\">In the closely-watched case\u003c/a>, Judge Anne-Christine Massullo said in a tentative decision that the agreement trumps the woman's desire to now keep the embryos.\u003c/p>\n\u003cp>The couple's story began in 2010 as Mimi Lee and Stephen Findley were about to be married. Lee was diagnosed with breast cancer, and the couple decided to create embryos through in vitro fertilization in hopes of a future family.\u003c/p>\n\u003cp>Instead, the marriage fell apart, leaving the couple with five embryos. In 2013 the couple filed for divorce.\u003c/p>\n\u003cp>Findley wanted to discard the embryos in accordance with the agreement he and Lee signed while married. He worried in part that Lee would use any children to take financial advantage of him, according to the ruling.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lee's attorneys said no California court had previously ruled in such a case. A Pennsylvania court three years ago \u003ca href=\"http://articles.philly.com/2012-04-14/news/31342260_1_embryos-appeals-court-three-judge-superior-court-panel\" target=\"_blank\">awarded frozen embryos to a woman \u003c/a>who also said they may be her only way to have a child because of breast cancer treatment despite the objections of her ex-husband. An Illinois judge last year \u003ca href=\"http://www.chicagotribune.com/news/local/breaking/ct-embryos-court-ruling-met-20150612-story.html\" target=\"_blank\">also sided with a woman\u003c/a> who was infertile in her fight over embryos with an ex-boyfriend.\u003c/p>\n\u003cp>Massullo said California law is clear that couples must decide what to do with embryos they create in case of separation or divorce.\u003c/p>\n\u003cp>\"Decisions about family and children often are difficult, and can be wrenching when they become disputes,\" the judge wrote. \"The policy best suited to ensuring that these disputes are resolved in a clear-eyed manner ... is to give effect to the intentions of the parties at the time of the decision at issue.\"\u003c/p>\n\u003cp>An attorney for Lee, Peter Skinner, said in a statement his client was disappointed and was evaluating her legal options. Lee had argued that she had a right to change the agreement, and that she had a right to procreate.\u003c/p>\n\u003cp>While Lee might have a right to procreate in other circumstances, she doesn't have a right to procreate with Findley, the judge said.\u003c/p>\n\u003cp>The embryos were being held at UC San Francisco, which in accordance with state law gave Lee and Findley a consent agreement before the fertility treatments. In the agreement, they both said they would like the embryos \"thawed and discarded\" in case they divorced, according to court documents.\u003c/p>\n\u003cp>Lee argued that she thought the agreement was not legally binding. The judge ruled otherwise.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The tentative nature of the ruling gives the parties time to file objections, but such rulings generally become final.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It's the time of year when the flu starts circulating more widely and with it -- the myths about the flu shot start circulating, too.\u003c/p>\n\u003cp>In just over 2 minutes, \u003ca href=\"http://www.slate.com/articles/health_and_science/science/2014/12/flu_from_a_flu_shot_why_it_s_impossible_to_get_sick_from_the_vaccination.html\" target=\"_blank\">The Slate\u003c/a> does a highly entertaining job of debunking one of the most tenacious myths of all -- that you can get the flu from the flu shot. You can't.\u003c/p>\n\u003cp>[contextly_sidebar id=\"9y0bGYul6YOWIysqD0LulPn3VJ178Iqg\"]The Centers for Disease Control recommends that \u003ca href=\"http://www.cdc.gov/flu/consumer/vaccinations.htm\" target=\"_blank\">everyone over 6 months \u003c/a>get the flu shot. While effectiveness varies from year to year, this year's version is expected to be a good match against the specific strains of influenza that are circulating this season.\u003c/p>\n\u003cp>It is impossible to predict if this year's flu season will be particularly bad or not, but the California Department of Public Health reports that two people have already died of complications from the flu, \u003ca href=\"https://www.cdph.ca.gov/Pages/NR15-083.aspx\" target=\"_blank\">an adult in Santa Clara County \u003c/a>and a \u003ca href=\"https://www.cdph.ca.gov/Pages/NR15-085.aspx\" target=\"_blank\">Stanislaus County infant. \u003c/a>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's the time of year when the flu starts circulating more widely and with it -- the myths about the flu shot start circulating, too.\u003c/p>\n\u003cp>In just over 2 minutes, \u003ca href=\"http://www.slate.com/articles/health_and_science/science/2014/12/flu_from_a_flu_shot_why_it_s_impossible_to_get_sick_from_the_vaccination.html\" target=\"_blank\">The Slate\u003c/a> does a highly entertaining job of debunking one of the most tenacious myths of all -- that you can get the flu from the flu shot. You can't.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The Centers for Disease Control recommends that \u003ca href=\"http://www.cdc.gov/flu/consumer/vaccinations.htm\" target=\"_blank\">everyone over 6 months \u003c/a>get the flu shot. While effectiveness varies from year to year, this year's version is expected to be a good match against the specific strains of influenza that are circulating this season.\u003c/p>\n\u003cp>It is impossible to predict if this year's flu season will be particularly bad or not, but the California Department of Public Health reports that two people have already died of complications from the flu, \u003ca href=\"https://www.cdph.ca.gov/Pages/NR15-083.aspx\" target=\"_blank\">an adult in Santa Clara County \u003c/a>and a \u003ca href=\"https://www.cdph.ca.gov/Pages/NR15-085.aspx\" target=\"_blank\">Stanislaus County infant. \u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Almost 8 percent of Americans 12 and older dealt with depression at some point between 2009 and 2012. With that many of us feeling blue, wouldn't it be nice if we could simply hop on the computer in our pajamas, without any of the stigma of asking for help, and find real relief?\u003c/p>\n\u003caside class=\"pullquote alignright\">\n\"It's an important, cautionary note that we shouldn't get too carried away with the idea that a computer system can replace doctors and therapists.\"\u003cbr>\n\u003ccite>Dr. Christopher Dowrick, University of Liverpool \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>Online programs to fight depression are already commercially available, and while they sound efficient and cost-saving, a study out of the U.K. reports that they're not effective, primarily because depressed patients aren't likely to engage with them or stick with them.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.bmj.com/cgi/doi/10.1136/bmj.h5627\" target=\"_blank\">study\u003c/a>, which was published in \u003cem>The BMJ\u003c/em> on Wednesday, looked at computer-assisted cognitive behavioral therapy and found that it was no more effective in treating depression than the usual care patients receive from a primary care doctor.\u003c/p>\n\u003cp>Traditional cognitive behavioral therapy (CBT) is considered an effective form of talk therapy for depression, helping people challenge negative thoughts and change the way they think in order to change their mood and behaviors. Online CBT programs have been \u003ca href=\"http://opinionator.blogs.nytimes.com/2015/06/19/depressed-try-therapy-without-the-therapist/\" target=\"_blank\">gaining popularity\u003c/a>, with the allure of providing low-cost help wherever someone has access to a computer.\u003c/p>\n\u003cp>A team of researchers from the University of York conducted a randomized control trial with 691 depressed patients from 83 physician practices across England. The patients were split into three groups: one group received only usual care from a physician while the other two groups received usual care from a physician plus one of two computerized CBT programs, either \"Beating the Blues\" or \"MoodGYM.\" Participants were balanced across the three groups for age, sex, educational background, severity and duration of depression, and use of antidepressants.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>After four months, the patients using the computerized CBT programs, or cCBT, had no improvement in depression levels over the patients who were only getting usual care from their doctors. \"Uptake and use of cCBT was low, despite regular telephone support,\" the study authors wrote. Almost a quarter of participants dropped out within four months, and patients noted the \"difficulty in repeatedly logging on to computer systems when they are clinically depressed.\"\u003c/p>\n\u003cp>\"It's an important, cautionary note that we shouldn't get too carried away with the idea that a computer system can replace doctors and therapists,\" says \u003ca href=\"https://www.liv.ac.uk/psychology-health-and-society/staff/christopher-dowrick/\" target=\"_blank\">Christopher Dowrick\u003c/a>, a professor of primary medical care at the University of Liverpool, who wrote an accompanying \u003ca href=\"http://www.bmj.com/content/351/bmj.h5942\" target=\"_blank\">editorial\u003c/a>. \"We do still need the human touch or the human interaction, particularly when people are depressed.\"\u003c/p>\n\u003cp>The lack of patient engagement in this study means these programs aren't the panacea that busy doctors and cost-conscious health care officials might be hoping for, Dowrick wrote in the editorial. Yet it's important to note that the study was conducted in a primary care setting, he says, because many other studies on cCBT that show some benefit have been conducted in psychological settings, where patients might be more motivated to engage with these kinds of online programs.\u003c/p>\n\u003cp>Despite the unenthusiastic findings of the study, Dowrick says that do-it-yourself treatments like cCBT can still be effective. But they're more likely to succeed when people have relatively mild symptoms of depression or are in a recovery stage – the participants in this study were mostly in the category of moderate to severe depression, he says. Computerized CBT is also more likely to succeed, he adds, if the patients are open to seeking help on a computer and when they have a \"reasonable amount\" of guidance as they go through the program, preferably from a therapist. In this study, he says, participants each totaled roughly six minutes of telephone support and guidance.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Being depressed can mean feeling \"lost in your own little small, negative, dark world,\" Dowrick says. Having a person, instead of a computer, reach out to you is particularly important in combating that sense of isolation. \"When you're emotionally vulnerable, you're even more in need of a caring human being,\" he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2015 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">http://www.kaiserhealthnews.org/\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Depressed%3F+Look+For+Help+From+A+Human%2C+Not+A+Computer&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/em>\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Almost 8 percent of Americans 12 and older dealt with depression at some point between 2009 and 2012. With that many of us feeling blue, wouldn't it be nice if we could simply hop on the computer in our pajamas, without any of the stigma of asking for help, and find real relief?\u003c/p>\n\u003caside class=\"pullquote alignright\">\n\"It's an important, cautionary note that we shouldn't get too carried away with the idea that a computer system can replace doctors and therapists.\"\u003cbr>\n\u003ccite>Dr. Christopher Dowrick, University of Liverpool \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>Online programs to fight depression are already commercially available, and while they sound efficient and cost-saving, a study out of the U.K. reports that they're not effective, primarily because depressed patients aren't likely to engage with them or stick with them.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.bmj.com/cgi/doi/10.1136/bmj.h5627\" target=\"_blank\">study\u003c/a>, which was published in \u003cem>The BMJ\u003c/em> on Wednesday, looked at computer-assisted cognitive behavioral therapy and found that it was no more effective in treating depression than the usual care patients receive from a primary care doctor.\u003c/p>\n\u003cp>Traditional cognitive behavioral therapy (CBT) is considered an effective form of talk therapy for depression, helping people challenge negative thoughts and change the way they think in order to change their mood and behaviors. Online CBT programs have been \u003ca href=\"http://opinionator.blogs.nytimes.com/2015/06/19/depressed-try-therapy-without-the-therapist/\" target=\"_blank\">gaining popularity\u003c/a>, with the allure of providing low-cost help wherever someone has access to a computer.\u003c/p>\n\u003cp>A team of researchers from the University of York conducted a randomized control trial with 691 depressed patients from 83 physician practices across England. The patients were split into three groups: one group received only usual care from a physician while the other two groups received usual care from a physician plus one of two computerized CBT programs, either \"Beating the Blues\" or \"MoodGYM.\" Participants were balanced across the three groups for age, sex, educational background, severity and duration of depression, and use of antidepressants.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After four months, the patients using the computerized CBT programs, or cCBT, had no improvement in depression levels over the patients who were only getting usual care from their doctors. \"Uptake and use of cCBT was low, despite regular telephone support,\" the study authors wrote. Almost a quarter of participants dropped out within four months, and patients noted the \"difficulty in repeatedly logging on to computer systems when they are clinically depressed.\"\u003c/p>\n\u003cp>\"It's an important, cautionary note that we shouldn't get too carried away with the idea that a computer system can replace doctors and therapists,\" says \u003ca href=\"https://www.liv.ac.uk/psychology-health-and-society/staff/christopher-dowrick/\" target=\"_blank\">Christopher Dowrick\u003c/a>, a professor of primary medical care at the University of Liverpool, who wrote an accompanying \u003ca href=\"http://www.bmj.com/content/351/bmj.h5942\" target=\"_blank\">editorial\u003c/a>. \"We do still need the human touch or the human interaction, particularly when people are depressed.\"\u003c/p>\n\u003cp>The lack of patient engagement in this study means these programs aren't the panacea that busy doctors and cost-conscious health care officials might be hoping for, Dowrick wrote in the editorial. Yet it's important to note that the study was conducted in a primary care setting, he says, because many other studies on cCBT that show some benefit have been conducted in psychological settings, where patients might be more motivated to engage with these kinds of online programs.\u003c/p>\n\u003cp>Despite the unenthusiastic findings of the study, Dowrick says that do-it-yourself treatments like cCBT can still be effective. But they're more likely to succeed when people have relatively mild symptoms of depression or are in a recovery stage – the participants in this study were mostly in the category of moderate to severe depression, he says. Computerized CBT is also more likely to succeed, he adds, if the patients are open to seeking help on a computer and when they have a \"reasonable amount\" of guidance as they go through the program, preferably from a therapist. In this study, he says, participants each totaled roughly six minutes of telephone support and guidance.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Being depressed can mean feeling \"lost in your own little small, negative, dark world,\" Dowrick says. Having a person, instead of a computer, reach out to you is particularly important in combating that sense of isolation. \"When you're emotionally vulnerable, you're even more in need of a caring human being,\" he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2015 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">http://www.kaiserhealthnews.org/\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Depressed%3F+Look+For+Help+From+A+Human%2C+Not+A+Computer&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>For Linnea Duvall, a marriage and family therapist who lives and works in Santa Monica, Calif., the symptoms of menopause started when she turned 50. She felt more irritable, a smidge heavier and she started waking up two to three times a night.\u003c/p>\n\u003cp>And then she had a hot flash.\u003c/p>\n\u003cp>\"It felt like a nuclear bomb went off right behind my belly button,\" she says. \"The radiation went out to my fingertips, the tops of my toes, the top of my head and the ends of my hair.\"\u003c/p>\n\u003cp>But Duvall would not consider \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/007111.htm\">hormone therapy\u003c/a> to control the flashes. She was terrified. She says she can sum up her fear in two words: \"breast cancer.\"\u003c/p>\n\u003cp>To understand why she feels this way, we have to look back a few decades to a time when many postmenopausal women were taking hormones to treat symptoms. At the time, hormones were thought of as something of an elixir of youth that could also prevent chronic disease. So women took hormones indefinitely. But a huge \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1745676\">study\u003c/a> in 2002 changed everything.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Known as the Women's Health Initiative, it found that taking estrogen plus progestin hormone replacement therapy actually increased a woman's risk of heart disease and breast cancer. The study had a huge effect. Within months the number of women taking hormones in the U.S. dropped by almost half. Today, only about 10 percent of women aged 50 or over are on hormone therapy.\u003c/p>\n\u003cp>That was a huge overreaction, according to \u003ca href=\"http://www.utianllc.com/\">Dr. Wulf Utian\u003c/a>, director of the \u003ca href=\"http://www.menopause.org/\">North American Menopause Society\u003c/a>, particularly in light of more recent findings. A more detailed \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24084921\">analysis\u003c/a> of the Women's Health Initiative data found that age really made a difference in heart disease risk. For women who started hormone therapy between the ages of 50 and 59, there was a protective \u003ca href=\"http://www.futuremedicine.com/doi/full/10.2217/whe.15.24\">benefit\u003c/a>, says \u003ca href=\"http://www.hsph.harvard.edu/joann-manson/\">Dr. JoAnn Manson\u003c/a>, one of the lead investigators of the study and a professor of medicine at the Harvard T.H. Chan School of Public Health.\u003c/p>\n\u003cp>Women who take hormones earlier after the onset of menopause may experience less plaque, blood vessel blockage, and \u003ca href=\"http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis\">atherosclerosis,\u003c/a> Manson says, \"And possibly even a reduced risk of heart attack. But for women over the age of 60 the benefit seems to disappear. This is probably because older women already have plaque buildup, Manson says.\u003c/p>\n\u003cp>Researchers in Denmark also \u003ca href=\"http://www.bmj.com/content/345/bmj.e6409\">found\u003c/a> that age makes a difference. They looked at 1,000 healthy women between the ages of 45 and 58. The women who took hormones experienced significantly reduced risk of mortality, heart failure and heart attack.\u003c/p>\n\u003cp>Today, menopausal women are young in the scale of things, says Dr. Wulf Utian, noting that menopause typically starts between age 45 and 60. If women start hormones within in a few years of menopause or even a few years before, he says there are numerous benefits beyond controlling hot flashes. These benefits include reduced risk of bone fractures, reduced risk of diabetes and for many women, an overall boost in their quality of life — meaning better sleep, maintenance of libido and more comfortable sex.\u003c/p>\n\u003cp>\"In my opinion, the best recommendation would be for some form of hormone therapy,\" says Utian.\u003c/p>\n\u003cp>But here's the worry. Studies do confirm an increased risk of breast cancer among women taking hormones, regardless of age. Manson says any risk is worrisome, but it's important to put this risk in perspective and understand that it is actually small.\u003c/p>\n\u003cp>\"For every 1,000 women per year not using hormone therapy about 3 would develop breast cancer,\" Manson says. \"And among every 1,000 women using hormone therapy about 4 of them would develop breast cancer, so that's about 1 extra case of breast cancer per 1,000 women per year on hormone therapy.\"\u003c/p>\n\u003cp>This is where things get tricky. There is no consensus in the medical community on whether the symptom relief is worth the extra risk. Different doctors interpret risk differently. And if you're a breast oncologist like \u003ca href=\"http://www.labiomed.org/researchers/rowan-t-chlebowski-md-phd\">Dr. Rowan Chlebowski\u003c/a> at Harbor UCLA Medical Center, any risk is too much.\u003c/p>\n\u003cp>\"It's a disease that I see every day,\" Chlebowsi says. \"So I think that's something to be avoided.\"\u003c/p>\n\u003cp>Chlebowski a\u003ca href=\"#_msocom_1\" name=\"_msoanchor_1\">\u003c/a>dds that hormone therapy also makes it more difficult to read mammograms, since hormones make the breast denser. If mammograms are more difficult to read, it's harder to diagnose breast cancer in its earliest stage when it's most treatable.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So bottom line — this really \u003cem>is\u003c/em> an individual decision between a woman and her doctor, a decision based on how much risk a woman can tolerate in favor of symptom control and other potential benefits. Researcher Joann Manson says if a woman chooses hormone therapy, then the lowest possible dose for the shortest amount of time is probably safe for most women.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hormones+May+Help+Younger+Women+With+Menopause+Symptoms&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For Linnea Duvall, a marriage and family therapist who lives and works in Santa Monica, Calif., the symptoms of menopause started when she turned 50. She felt more irritable, a smidge heavier and she started waking up two to three times a night.\u003c/p>\n\u003cp>And then she had a hot flash.\u003c/p>\n\u003cp>\"It felt like a nuclear bomb went off right behind my belly button,\" she says. \"The radiation went out to my fingertips, the tops of my toes, the top of my head and the ends of my hair.\"\u003c/p>\n\u003cp>But Duvall would not consider \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/007111.htm\">hormone therapy\u003c/a> to control the flashes. She was terrified. She says she can sum up her fear in two words: \"breast cancer.\"\u003c/p>\n\u003cp>To understand why she feels this way, we have to look back a few decades to a time when many postmenopausal women were taking hormones to treat symptoms. At the time, hormones were thought of as something of an elixir of youth that could also prevent chronic disease. So women took hormones indefinitely. But a huge \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1745676\">study\u003c/a> in 2002 changed everything.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Known as the Women's Health Initiative, it found that taking estrogen plus progestin hormone replacement therapy actually increased a woman's risk of heart disease and breast cancer. The study had a huge effect. Within months the number of women taking hormones in the U.S. dropped by almost half. Today, only about 10 percent of women aged 50 or over are on hormone therapy.\u003c/p>\n\u003cp>That was a huge overreaction, according to \u003ca href=\"http://www.utianllc.com/\">Dr. Wulf Utian\u003c/a>, director of the \u003ca href=\"http://www.menopause.org/\">North American Menopause Society\u003c/a>, particularly in light of more recent findings. A more detailed \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24084921\">analysis\u003c/a> of the Women's Health Initiative data found that age really made a difference in heart disease risk. For women who started hormone therapy between the ages of 50 and 59, there was a protective \u003ca href=\"http://www.futuremedicine.com/doi/full/10.2217/whe.15.24\">benefit\u003c/a>, says \u003ca href=\"http://www.hsph.harvard.edu/joann-manson/\">Dr. JoAnn Manson\u003c/a>, one of the lead investigators of the study and a professor of medicine at the Harvard T.H. Chan School of Public Health.\u003c/p>\n\u003cp>Women who take hormones earlier after the onset of menopause may experience less plaque, blood vessel blockage, and \u003ca href=\"http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis\">atherosclerosis,\u003c/a> Manson says, \"And possibly even a reduced risk of heart attack. But for women over the age of 60 the benefit seems to disappear. This is probably because older women already have plaque buildup, Manson says.\u003c/p>\n\u003cp>Researchers in Denmark also \u003ca href=\"http://www.bmj.com/content/345/bmj.e6409\">found\u003c/a> that age makes a difference. They looked at 1,000 healthy women between the ages of 45 and 58. The women who took hormones experienced significantly reduced risk of mortality, heart failure and heart attack.\u003c/p>\n\u003cp>Today, menopausal women are young in the scale of things, says Dr. Wulf Utian, noting that menopause typically starts between age 45 and 60. If women start hormones within in a few years of menopause or even a few years before, he says there are numerous benefits beyond controlling hot flashes. These benefits include reduced risk of bone fractures, reduced risk of diabetes and for many women, an overall boost in their quality of life — meaning better sleep, maintenance of libido and more comfortable sex.\u003c/p>\n\u003cp>\"In my opinion, the best recommendation would be for some form of hormone therapy,\" says Utian.\u003c/p>\n\u003cp>But here's the worry. Studies do confirm an increased risk of breast cancer among women taking hormones, regardless of age. Manson says any risk is worrisome, but it's important to put this risk in perspective and understand that it is actually small.\u003c/p>\n\u003cp>\"For every 1,000 women per year not using hormone therapy about 3 would develop breast cancer,\" Manson says. \"And among every 1,000 women using hormone therapy about 4 of them would develop breast cancer, so that's about 1 extra case of breast cancer per 1,000 women per year on hormone therapy.\"\u003c/p>\n\u003cp>This is where things get tricky. There is no consensus in the medical community on whether the symptom relief is worth the extra risk. Different doctors interpret risk differently. And if you're a breast oncologist like \u003ca href=\"http://www.labiomed.org/researchers/rowan-t-chlebowski-md-phd\">Dr. Rowan Chlebowski\u003c/a> at Harbor UCLA Medical Center, any risk is too much.\u003c/p>\n\u003cp>\"It's a disease that I see every day,\" Chlebowsi says. \"So I think that's something to be avoided.\"\u003c/p>\n\u003cp>Chlebowski a\u003ca href=\"#_msocom_1\" name=\"_msoanchor_1\">\u003c/a>dds that hormone therapy also makes it more difficult to read mammograms, since hormones make the breast denser. If mammograms are more difficult to read, it's harder to diagnose breast cancer in its earliest stage when it's most treatable.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So bottom line — this really \u003cem>is\u003c/em> an individual decision between a woman and her doctor, a decision based on how much risk a woman can tolerate in favor of symptom control and other potential benefits. Researcher Joann Manson says if a woman chooses hormone therapy, then the lowest possible dose for the shortest amount of time is probably safe for most women.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hormones+May+Help+Younger+Women+With+Menopause+Symptoms&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "Cancer Patients on Medi-Cal Do Worse Than Those with Other Insurance",
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"content": "\u003cp>Cancer patients with Medi-Cal are less likely to get recommended treatment and also have lower survival rates than patients with other types of insurance, according to a \u003ca href=\"https://www.ucdmc.ucdavis.edu/iphi/resources/1117737_CancerHI_100615.pdf\" target=\"_blank\">study\u003c/a> by UC Davis researchers. Medi-Cal is California's version of Medicaid, health insurance for people who are low income.\u003c/p>\n\u003caside class=\"pullquote alignright\">“What’s particularly poignant is that we’re seeing these big disparate outcomes among groups in cancers where we have strong playbooks.\"\u003cbr>\n\u003ccite>Christina Clarke, Cancer Prevention Institute of California\u003c/cite>\u003c/aside>\n\u003cp>While other \u003ca href=\"http://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/medicaid-patients-get-worse-cancer-care-studies-contend-688451.html\" target=\"_blank\">studies\u003c/a> have linked Medicaid insurance status to worse cancer outcomes, the UC Davis study appears to be the first to examine the impact of various kinds of health insurance across more than one kind of cancer.\u003c/p>\n\u003cp>Understanding how well Medi-Cal serves cancer patients is crucial, experts say, because as much as 10 percent of Medi-Cal expenditures go to cancer care. And under the Affordable Care Act, the program has grown to cover more than 12 million Californians – nearly a third of the state’s population.\u003c/p>\n\u003cp>“What’s striking is how similar the findings were for Medi-Cal members and the uninsured,” said Dr. Kenneth Kizer, director of the UC Davis’ Institute for Population Health Improvement, which conducted the study. “If we weren’t spending billions of Medi-Cal dollars on cancer care perhaps that would not be surprising, but you’d think that the outcomes might be better when you’re spending that much money.”\u003c/p>\n\u003cp>The UC Davis researchers used \u003ca href=\"http://www.ccrcal.org/\" target=\"_blank\">California Cancer Registry\u003c/a> data to study the experiences of approximately 700,000 Californians diagnosed with breast, colon, rectal, lung, and prostate cancer between 2004 and 2012. They tracked how early these patients were diagnosed, their quality of treatment and their five-year relative survival rates according to their type of insurance. The types were Medi-Cal, Medicare, dual Medi-Cal/Medicare (for lowest-income seniors), private insurance, Department of Defense (DOD) insurance and Department of Veterans Affairs (VA) insurance.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Among the findings:\u003c/p>\n\u003cul>\n\u003cli>Medi-Cal patients were diagnosed with advanced (stage IV) prostate cancer more than three times as often as patients with private insurance or DOD coverage.\u003c/li>\n\u003cli>Medi-Cal patients with breast, colon or rectal cancer were more likely to be diagnosed at an advanced stage and to have worse five-year survival rates than people with other types of insurance.\u003c/li>\n\u003cli>Low-income seniors covered by Medicare and Medi-Cal, known as “dual-eligible patients,” were the least likely to receive recommended treatment for breast and colon cancer.\u003c/li>\n\u003cli>VA patients waited the longest to be treated for breast, colon, rectal, lung and prostate cancers, but their outcomes compared favorably to patients with other types of health insurance and they were generally more likely to receive recommended treatment.\u003c/li>\n\u003c/ul>\n\u003cp>What researchers still don’t know, Kizer said, is the reason for these disparities. It’s possible that Medi-Cal patients drop on and off the rolls, missing preventive screenings that could help detect cancers earlier. \u003ca href=\"http://khn.org/news/state-auditor-slams-californias-oversight-of-medi-cal-plans-used-by-9-million/\" target=\"_blank\">Audits\u003c/a> and studies also have shown that some of the state’s Medi-Cal patients have difficulty getting access to doctors and specialists.\u003c/p>\n\u003cp>Researchers also can’t explain why Medi-Cal patients are less likely than patients with other kinds of insurance to receive recommended treatment after they are diagnosed. And they also don’t know whether cancer patients fare better or worse in Medi-Cal managed care programs, which now cover most of the Medi-Cal population.\u003c/p>\n\u003cp>“It’s not acceptable to have these variations” based on insurance coverage, particularly regarding breast and colon cancers for which preventive screenings are well-established and effective, said Christina Clarke, a research scientist at the Cancer Prevention Institute of California and a consulting associate professor at the Stanford University School of Medicine. She was not involved in the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“What’s particularly poignant is that we’re seeing these big disparate outcomes among groups in cancers where we have strong playbooks. That’s the tragic thing here,” Clarke said. “There’s a body count and we’d like to figure out a better way to insure that all Californians are getting the recommended screening for these deadly cancers and treatment according to guidelines. We have a lot of work to do.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cancer patients with Medi-Cal are less likely to get recommended treatment and also have lower survival rates than patients with other types of insurance, according to a \u003ca href=\"https://www.ucdmc.ucdavis.edu/iphi/resources/1117737_CancerHI_100615.pdf\" target=\"_blank\">study\u003c/a> by UC Davis researchers. Medi-Cal is California's version of Medicaid, health insurance for people who are low income.\u003c/p>\n\u003caside class=\"pullquote alignright\">“What’s particularly poignant is that we’re seeing these big disparate outcomes among groups in cancers where we have strong playbooks.\"\u003cbr>\n\u003ccite>Christina Clarke, Cancer Prevention Institute of California\u003c/cite>\u003c/aside>\n\u003cp>While other \u003ca href=\"http://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/medicaid-patients-get-worse-cancer-care-studies-contend-688451.html\" target=\"_blank\">studies\u003c/a> have linked Medicaid insurance status to worse cancer outcomes, the UC Davis study appears to be the first to examine the impact of various kinds of health insurance across more than one kind of cancer.\u003c/p>\n\u003cp>Understanding how well Medi-Cal serves cancer patients is crucial, experts say, because as much as 10 percent of Medi-Cal expenditures go to cancer care. And under the Affordable Care Act, the program has grown to cover more than 12 million Californians – nearly a third of the state’s population.\u003c/p>\n\u003cp>“What’s striking is how similar the findings were for Medi-Cal members and the uninsured,” said Dr. Kenneth Kizer, director of the UC Davis’ Institute for Population Health Improvement, which conducted the study. “If we weren’t spending billions of Medi-Cal dollars on cancer care perhaps that would not be surprising, but you’d think that the outcomes might be better when you’re spending that much money.”\u003c/p>\n\u003cp>The UC Davis researchers used \u003ca href=\"http://www.ccrcal.org/\" target=\"_blank\">California Cancer Registry\u003c/a> data to study the experiences of approximately 700,000 Californians diagnosed with breast, colon, rectal, lung, and prostate cancer between 2004 and 2012. They tracked how early these patients were diagnosed, their quality of treatment and their five-year relative survival rates according to their type of insurance. The types were Medi-Cal, Medicare, dual Medi-Cal/Medicare (for lowest-income seniors), private insurance, Department of Defense (DOD) insurance and Department of Veterans Affairs (VA) insurance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Among the findings:\u003c/p>\n\u003cul>\n\u003cli>Medi-Cal patients were diagnosed with advanced (stage IV) prostate cancer more than three times as often as patients with private insurance or DOD coverage.\u003c/li>\n\u003cli>Medi-Cal patients with breast, colon or rectal cancer were more likely to be diagnosed at an advanced stage and to have worse five-year survival rates than people with other types of insurance.\u003c/li>\n\u003cli>Low-income seniors covered by Medicare and Medi-Cal, known as “dual-eligible patients,” were the least likely to receive recommended treatment for breast and colon cancer.\u003c/li>\n\u003cli>VA patients waited the longest to be treated for breast, colon, rectal, lung and prostate cancers, but their outcomes compared favorably to patients with other types of health insurance and they were generally more likely to receive recommended treatment.\u003c/li>\n\u003c/ul>\n\u003cp>What researchers still don’t know, Kizer said, is the reason for these disparities. It’s possible that Medi-Cal patients drop on and off the rolls, missing preventive screenings that could help detect cancers earlier. \u003ca href=\"http://khn.org/news/state-auditor-slams-californias-oversight-of-medi-cal-plans-used-by-9-million/\" target=\"_blank\">Audits\u003c/a> and studies also have shown that some of the state’s Medi-Cal patients have difficulty getting access to doctors and specialists.\u003c/p>\n\u003cp>Researchers also can’t explain why Medi-Cal patients are less likely than patients with other kinds of insurance to receive recommended treatment after they are diagnosed. And they also don’t know whether cancer patients fare better or worse in Medi-Cal managed care programs, which now cover most of the Medi-Cal population.\u003c/p>\n\u003cp>“It’s not acceptable to have these variations” based on insurance coverage, particularly regarding breast and colon cancers for which preventive screenings are well-established and effective, said Christina Clarke, a research scientist at the Cancer Prevention Institute of California and a consulting associate professor at the Stanford University School of Medicine. She was not involved in the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“What’s particularly poignant is that we’re seeing these big disparate outcomes among groups in cancers where we have strong playbooks. That’s the tragic thing here,” Clarke said. “There’s a body count and we’d like to figure out a better way to insure that all Californians are getting the recommended screening for these deadly cancers and treatment according to guidelines. We have a lot of work to do.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How Overtreatment in Health Care Harms Us All",
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"headTitle": "State of Health | KQED News",
"content": "\u003cp>As Obamacare's open enrollment kicks off for the third year, in California, there are still almost \u003ca href=\"http://kff.org/uninsured/issue-brief/new-estimates-of-eligibility-for-aca-coverage-among-the-uninsured/\" target=\"_blank\">4 million people who are uninsured,\u003c/a> part of the many more millions nationally who lack reliable access to health care.\u003c/p>\n\u003caside class=\"pullquote alignright\">Let's be clear about what overtreatment is not: it's not rationing.\u003c/aside>\n\u003cp>But at the same time that so many are underserved, many more are overserved. This is a hard concept for many Americans to wrap their minds around, the notion that they might be \"overtreated.\" It's against this backdrop that I spoke with Shannon Brownlee at \u003ca href=\"http://www.berkeleyideas.com\" target=\"_blank\">Berkeley Uncharted\u003c/a>, the annual ideas festival.\u003c/p>\n\u003cp>Brownlee literally wrote the book on the topic with \u003ca href=\"http://www.amazon.com/Overtreated-Medicine-Making-Sicker-Poorer/dp/1582345791\" target=\"_blank\">Overtreated: Why Too Much Medicine is Making us Sicker and Poorer\u003c/a>. Let's be clear about what overtreatment is not: it's not rationing. Rationing is denying care that people need to make them better. Overtreatment is about \"getting care you don't need and that can harm you,\" Brownlee told the audience.\u003c/p>\n\u003cp>She recounted the story of a friend's 89-year-old father, an active man and avid golfer. After he developed shortness of breath, his cardiologist determined he needed a heart valve replaced. The man \"sailed through the surgery,\" Brownlee said. But the pre-operative work-up had also revealed colon cancer.\u003c/p>\n\u003cp>His family tried to dissuade the man from doing anything, Brownlee went on. \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening\" target=\"_blank\">Current guidelines \u003c/a>say that people older than 85 do not need to be screened for colon cancer -- the cancer is so slow growing, a person is significantly more likely to die with it, not from it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the man could not be dissuaded. He had the surgery and contracted an infection -- with C-difficile, an antibiotic-resistant bacteria that's very difficult to treat. It left him with chronic diarrhea.\u003c/p>\n\u003cp>\"He died six months later,\" Brownlee said, \"in a nursing home, having uncontrolled diarrhea for the last six months of his life, in despair.\"\u003c/p>\n\u003cp>It's tempting to think of these stories as isolated incidents, but they're disturbingly common. Analyses show \u003ca href=\"http://annals.org/article.aspx?articleid=744298\" target=\"_blank\">about one-third\u003c/a> of everything we do in medicine is unnecessary. It happens across the system -- in hospitals, nursing homes, in all specialties of care.\u003c/p>\n\u003cp>\"Overuse is pervasive,\" Brownlee says, \"it's in the air we breathe.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"37yGQs0b8Fd9UvYBhCRmXYOulu1j0uNn\"]Brownlee said multiple forces contribute to overuse, but most of the ones that spring promptly to mind are not the big drivers. Doctors often point to \"defensive medicine\" -- that they do more to leave no stone unturned to avoid a potential lawsuit -- or they say that it is patients who demand to do everything possible.\u003c/p>\n\u003cp>Brownlee says these are certainly factors, but they're small. The big driver is money. \"We treat health care like a business,\" Brownlee says. \"We don't treat it like a public good.\" The payment system -- \u003ca href=\"https://www.healthcare.gov/glossary/fee-for-service/\" target=\"_blank\">fee-for-service medicine\u003c/a> -- has always favored doing more, as opposed to doing things that might make the patient better.\u003c/p>\n\u003cp>And while medicine is based in science, that does not mean that everything your doctor recommends is based on scientific evidence. \"About 50 percent of what physicians do is backed up by valid evidence,\" Brownlee says. \"I think about that in the context of airplane safety: the pilot comes out from the cockpit and says, 'I don't know what half of these dials do, but I think I can fly the plane anyway.' \"\u003c/p>\n\u003cp>By this point I was flooded with questions from the audience -- sent up to me on index cards -- and plenty of people wanted to know how they were supposed to determine which half of the treatments their doctors recommended were actually backed up by evidence. After all, your doctor is the one who went to medical school. Most patients have not.\u003c/p>\n\u003cp>But even if you have no medical background, you \"can be informed, as most patients can, of what the tradeoffs are of different treatment choices,\" Brownlee said. She pointed to an approach called \u003ca href=\"http://www.informedmedicaldecisions.org/what-is-share%E2%80%A6\" target=\"_blank\">shared decision making\u003c/a>, a collaborative process between doctors and patients where they weigh together both the scientific evidence -- and a patients' values and preferences.\u003c/p>\n\u003cp>The easiest place to think of weighing evidence and values is in end-of-life care. But it applies in many areas of medicine from cancer screening to knee surgery to gall bladder surgery and more, Brownlee says.\u003c/p>\n\u003cp>There are\u003ca href=\"http://www.informedmedicaldecisions.org/patient-resources/\" target=\"_blank\"> online tools and other decision aids\u003c/a> where patients can review their choices and \"understand ... what the tradeoffs are, what the potential benefits are, what the potential harms are,\" Brownlee says, and then have a detailed conversation with their doctors about a treatment path.\u003c/p>\n\u003cp>The shared decision making approach is something patients themselves can start demanding, but fundamentally, Brownlee says, we need a different payment model. Right now, overall, the more doctors or hospitals do, the more they get paid. Hospitals \"don't know how to care for a population of patients within a budget,\" she says.\u003c/p>\n\u003cp>The U.S. national health care spend is an almost-impossible-to-imagine \u003ca href=\"http://www.cdc.gov/nchs/fastats/health-expenditures.htm\" target=\"_blank\">$3 trillion,\u003c/a> more than \u003ca href=\"http://www.cdc.gov/nchs/fastats/health-expenditures.htm\" target=\"_blank\">$9,200 per person\u003c/a>, and, again, half of that is not backed up by evidence.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"By wasting money, resources and time on care people don't need,\" Brownlee says, \"we are robbing many, many Americans of care they really do need.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As Obamacare's open enrollment kicks off for the third year, in California, there are still almost \u003ca href=\"http://kff.org/uninsured/issue-brief/new-estimates-of-eligibility-for-aca-coverage-among-the-uninsured/\" target=\"_blank\">4 million people who are uninsured,\u003c/a> part of the many more millions nationally who lack reliable access to health care.\u003c/p>\n\u003caside class=\"pullquote alignright\">Let's be clear about what overtreatment is not: it's not rationing.\u003c/aside>\n\u003cp>But at the same time that so many are underserved, many more are overserved. This is a hard concept for many Americans to wrap their minds around, the notion that they might be \"overtreated.\" It's against this backdrop that I spoke with Shannon Brownlee at \u003ca href=\"http://www.berkeleyideas.com\" target=\"_blank\">Berkeley Uncharted\u003c/a>, the annual ideas festival.\u003c/p>\n\u003cp>Brownlee literally wrote the book on the topic with \u003ca href=\"http://www.amazon.com/Overtreated-Medicine-Making-Sicker-Poorer/dp/1582345791\" target=\"_blank\">Overtreated: Why Too Much Medicine is Making us Sicker and Poorer\u003c/a>. Let's be clear about what overtreatment is not: it's not rationing. Rationing is denying care that people need to make them better. Overtreatment is about \"getting care you don't need and that can harm you,\" Brownlee told the audience.\u003c/p>\n\u003cp>She recounted the story of a friend's 89-year-old father, an active man and avid golfer. After he developed shortness of breath, his cardiologist determined he needed a heart valve replaced. The man \"sailed through the surgery,\" Brownlee said. But the pre-operative work-up had also revealed colon cancer.\u003c/p>\n\u003cp>His family tried to dissuade the man from doing anything, Brownlee went on. \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening\" target=\"_blank\">Current guidelines \u003c/a>say that people older than 85 do not need to be screened for colon cancer -- the cancer is so slow growing, a person is significantly more likely to die with it, not from it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the man could not be dissuaded. He had the surgery and contracted an infection -- with C-difficile, an antibiotic-resistant bacteria that's very difficult to treat. It left him with chronic diarrhea.\u003c/p>\n\u003cp>\"He died six months later,\" Brownlee said, \"in a nursing home, having uncontrolled diarrhea for the last six months of his life, in despair.\"\u003c/p>\n\u003cp>It's tempting to think of these stories as isolated incidents, but they're disturbingly common. Analyses show \u003ca href=\"http://annals.org/article.aspx?articleid=744298\" target=\"_blank\">about one-third\u003c/a> of everything we do in medicine is unnecessary. It happens across the system -- in hospitals, nursing homes, in all specialties of care.\u003c/p>\n\u003cp>\"Overuse is pervasive,\" Brownlee says, \"it's in the air we breathe.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Brownlee said multiple forces contribute to overuse, but most of the ones that spring promptly to mind are not the big drivers. Doctors often point to \"defensive medicine\" -- that they do more to leave no stone unturned to avoid a potential lawsuit -- or they say that it is patients who demand to do everything possible.\u003c/p>\n\u003cp>Brownlee says these are certainly factors, but they're small. The big driver is money. \"We treat health care like a business,\" Brownlee says. \"We don't treat it like a public good.\" The payment system -- \u003ca href=\"https://www.healthcare.gov/glossary/fee-for-service/\" target=\"_blank\">fee-for-service medicine\u003c/a> -- has always favored doing more, as opposed to doing things that might make the patient better.\u003c/p>\n\u003cp>And while medicine is based in science, that does not mean that everything your doctor recommends is based on scientific evidence. \"About 50 percent of what physicians do is backed up by valid evidence,\" Brownlee says. \"I think about that in the context of airplane safety: the pilot comes out from the cockpit and says, 'I don't know what half of these dials do, but I think I can fly the plane anyway.' \"\u003c/p>\n\u003cp>By this point I was flooded with questions from the audience -- sent up to me on index cards -- and plenty of people wanted to know how they were supposed to determine which half of the treatments their doctors recommended were actually backed up by evidence. After all, your doctor is the one who went to medical school. Most patients have not.\u003c/p>\n\u003cp>But even if you have no medical background, you \"can be informed, as most patients can, of what the tradeoffs are of different treatment choices,\" Brownlee said. She pointed to an approach called \u003ca href=\"http://www.informedmedicaldecisions.org/what-is-share%E2%80%A6\" target=\"_blank\">shared decision making\u003c/a>, a collaborative process between doctors and patients where they weigh together both the scientific evidence -- and a patients' values and preferences.\u003c/p>\n\u003cp>The easiest place to think of weighing evidence and values is in end-of-life care. But it applies in many areas of medicine from cancer screening to knee surgery to gall bladder surgery and more, Brownlee says.\u003c/p>\n\u003cp>There are\u003ca href=\"http://www.informedmedicaldecisions.org/patient-resources/\" target=\"_blank\"> online tools and other decision aids\u003c/a> where patients can review their choices and \"understand ... what the tradeoffs are, what the potential benefits are, what the potential harms are,\" Brownlee says, and then have a detailed conversation with their doctors about a treatment path.\u003c/p>\n\u003cp>The shared decision making approach is something patients themselves can start demanding, but fundamentally, Brownlee says, we need a different payment model. Right now, overall, the more doctors or hospitals do, the more they get paid. Hospitals \"don't know how to care for a population of patients within a budget,\" she says.\u003c/p>\n\u003cp>The U.S. national health care spend is an almost-impossible-to-imagine \u003ca href=\"http://www.cdc.gov/nchs/fastats/health-expenditures.htm\" target=\"_blank\">$3 trillion,\u003c/a> more than \u003ca href=\"http://www.cdc.gov/nchs/fastats/health-expenditures.htm\" target=\"_blank\">$9,200 per person\u003c/a>, and, again, half of that is not backed up by evidence.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"By wasting money, resources and time on care people don't need,\" Brownlee says, \"we are robbing many, many Americans of care they really do need.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Deep Dive into California's Mental Hospitals Reveals More Questions Than Answers",
"title": "Deep Dive into California's Mental Hospitals Reveals More Questions Than Answers",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>My nine-month investigation into California's state mental hospitals began with a simple question: \"What happens to people found 'not guilty by reason of insanity' or 'incompetent to stand trial'?\"\u003c/p>\n\u003cp>Turns out the answers -- and the issues raised -- are complicated.\u003c/p>\n\u003cp>This week marks a grim anniversary for Napa State Hospital. Five years ago Saturday, hospital psychiatric technician Donna Gross was murdered by a patient there. I focused my reporting in Napa, as opposed to the other four state mental hospitals (Atascadero, Coalinga, Metropolitan and Patton) because I wanted to know what impact Gross's murder had on the hospital and how security and policies have changed since then. I needed to talk to hospital staff, patients and their families to find out.\u003c/p>\n\u003cp>It wasn't easy.\u003c/p>\n\u003cp>In some ways Napa is a very troubled institution. And the trouble started long before Donna Gross was murdered.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In 2004, the hospital denied access to the U.S. Department of Justice (DOJ), which was investigating conditions at the hospital. The DOJ was looking at potential violations of the \u003ca href=\"http://www.justice.gov/crt/civil-rights-institutionalized-persons\" target=\"_blank\">Civil Rights of Institutionalized Persons Act\u003c/a>. Denying the U.S. Attorney General access -- that's rather astonishing. Despite this lack of access, the DOJ interviewed hospital staff and others and \u003ca href=\"http://www.justice.gov/sites/default/files/crt/legacy/2010/12/15/napa_findlet_6-27-05.pdf\" target=\"_blank\">found\u003c/a>, among other things, failure \"to protect patients from harm and abuse.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"6PLenFAZTbDgeJeArqVR3exzy3n7xR8d\"]In 2010, a few months before \u003ca href=\"http://www.sfgate.com/health/article/Napa-State-Hospital-psychiatric-worker-slain-3248688.php\" target=\"_blank\">Donna Gross \u003c/a>was murdered, the hospital's executive director Claude E. Foulk was \u003ca href=\"http://articles.latimes.com/2010/feb/25/local/la-me-hospital-director25-2010feb25\" target=\"_blank\">fired\u003c/a> after being arrested and charged with child molestation. He was later \u003ca href=\"http://www.presstelegram.com/technology/20110223/foulk-gets-248-years-for-sex-crimes\" target=\"_blank\">sentenced to 248 years in prison\u003c/a>.\u003c/p>\n\u003cp>His replacement, Dolly Matteucci, was soon confronted with Gross's brutal murder by a patient, \u003ca href=\"http://www.sfgate.com/crime/article/Napa-mental-patient-pleads-no-contest-to-murder-2336565.php\" target=\"_blank\">Jess Massey\u003c/a>, who had been allowed to walk around unattended on hospital grounds even though he had a history of violence. He later pleaded no contest to one count of murder and is now in Corcoran State Prison.\u003c/p>\n\u003cp>Less than two months later another hospital therapist was severely beaten as he escorted a different patient on the grounds.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/19/five-years-after-brutal-murder-napa-hospital-seeks-to-balance-treatment-with-security/\" target=\"_blank\">I reported earlier this week \u003c/a>that since these incidents, there have been many changes at the Napa hospital:\u003c/p>\n\u003cul>\n\u003cli>Personal distress alarms with GPS replaced the old alarms, which didn't work outside where Gross was murdered\u003c/li>\n\u003cli>More hospital police have been hired\u003c/li>\n\u003cli>Policies have been changed to protect vulnerable staff, and\u003c/li>\n\u003cli>Gov. Jerry Brown signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1340\" target=\"_blank\">AB 1340\u003c/a>, which will allow Napa and other state hospitals to segregate the most dangerous patients and give them \"enhanced treatment\" -- including risk assessment for violent behavior and concentrated clinical therapy -- in a secure setting. Construction has not yet started on this additional housing.\u003c/li>\n\u003c/ul>\n\u003cp>It was in this context that I asked to interview hospital director Matteucci. At first I was told \"maybe,\" then I was told she could only do the interview on the phone. After pushing, I was granted an in-person interview with her in the administration building \"outside the security fence.\"\u003c/p>\n\u003cp>The hospital had more than 1,800 physical assaults last year. To be fair, \"assault\" can be anything from pushing away the hand of a nurse who's giving out medication to getting punched or worse.\u003c/p>\n\u003cp>Yet it is patients, not staff, who are usually the victims of this violence from other patients. A small number of them cause most of the problems.\u003c/p>\n\u003cp>I wanted to visit the hospital and talk with a patient. The public information officer for the Department of State Hospitals told me I was free to write to any patient I knew was there (such as perpetrators of very high profile crimes, like \u003ca href=\"http://www.nytimes.com/2013/03/31/magazine/should-it-matter-that-the-shooter-at-oikos-university-was-korean.html\" target=\"_blank\">One L. Goh\u003c/a>, the shooter at Oikos University in Oakland in 2013) to ask if they would talk to me. I knew this would be a long shot, so instead I reached out to the hospital's family support group. Eventually I visited Napa with Frank and Barbara Brackin, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/23/violence-and-healing-at-napa-state-hospital-tale-of-two-families/\" target=\"_blank\">as I described in my story on Friday.\u003c/a>\u003c/p>\n\u003cp>Their son Shawn ended up in Napa after a tragic incident in a Roseville. During an attempt by Shawn of \"suicide by cop,\" he walked into a police station waving a gun. In the melee, a police officer shot and killed another policeman by mistake.\u003c/p>\n\u003cp>Shawn was found not guilty by reason of insanity and sentenced to time in a state mental hospital.\u003c/p>\n\u003cp>In the nearly 20 years he's been there, Shawn has been brutally assaulted, most recently in 2014 when another patient slammed his head into a wall so hard his hair was stuck in the wall. The Brackins are suing the hospital for failing to protect him.\u003c/p>\n\u003cp>One thing emphasized to me over and over is that people sent to state mental hospitals are patients, not prisoners. That means they have certain rights and privileges, even if they're violent.\u003c/p>\n\u003cp>I'll never forget my visit to Napa with the Brackins. It felt like I had entered a kind of \"forbidden zone\" where outsiders rarely went. And meeting Shawn after hearing so much about him from his parents was very poignant.\u003c/p>\n\u003cp>On my visit, we were met in the parking lot by a media representative from the Department of State Hospitals. We were warned not to videotape or photograph the barbed-wired security fence, the tight security at the main gate, or people coming and going (including reporters, like me).\u003c/p>\n\u003cp>We passed through multiple locked gates, doors and a metal detector before we were told to surrender cell phones and wallets.\u003c/p>\n\u003cp>I was warned not to talk to or interview any other patients. I was asked to turn over my audio recordings of Shawn Brackin so the Department of State Hospitals could review them to make sure he didn't say anything compromising the privacy of other patients. I negotiated a much more narrow accommodation.\u003c/p>\n\u003cp>I was also denied any access to record audio of music therapy classes. I was told this could jeopardize patient privacy.\u003c/p>\n\u003cp>I found all these requests to be overly strict. I've been to numerous state prisons, including San Quentin. The Department of Corrections has allowed me to freely photograph the gate, inmates, the cell blocks -- pretty much anything except Death Row. I have attended classes, religious services and therapy classes and was allowed to record, videotape and take photos.\u003c/p>\n\u003cp>To keep us away from other patients at Napa (who were meeting with family members nearby) the four of us were escorted to a tiny (perhaps 10 feet by 10 feet) room with no air conditioning and no apparent ventilation. (I was told this is where attorneys can meet privately with patients and their families.) At one point Shawn, who appears to have severe brain damage from assaults he suffered at Napa, asked to open the door to let some air in.\u003c/p>\n\u003cp>But not all families criticize Napa. Some say their loved ones are finally getting the treatment they should have gotten in the community before they committed tragic crimes.\u003c/p>\n\u003cp>And even strong critics acknowledge there’s a role for state hospitals to play in our criminal justice system, especially for violent defendants.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>But some advocates for the mentally ill say we need to make more treatment available in the community whenever possible -- rather than in locked state hospitals like Napa.\u003c/p>\n\n",
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"excerpt": "Scott Shafer reflects on the challenges he faced in his nine-month investigation of Napa State Hospital, five years after a staff member was murdered by a patient.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>My nine-month investigation into California's state mental hospitals began with a simple question: \"What happens to people found 'not guilty by reason of insanity' or 'incompetent to stand trial'?\"\u003c/p>\n\u003cp>Turns out the answers -- and the issues raised -- are complicated.\u003c/p>\n\u003cp>This week marks a grim anniversary for Napa State Hospital. Five years ago Saturday, hospital psychiatric technician Donna Gross was murdered by a patient there. I focused my reporting in Napa, as opposed to the other four state mental hospitals (Atascadero, Coalinga, Metropolitan and Patton) because I wanted to know what impact Gross's murder had on the hospital and how security and policies have changed since then. I needed to talk to hospital staff, patients and their families to find out.\u003c/p>\n\u003cp>It wasn't easy.\u003c/p>\n\u003cp>In some ways Napa is a very troubled institution. And the trouble started long before Donna Gross was murdered.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In 2004, the hospital denied access to the U.S. Department of Justice (DOJ), which was investigating conditions at the hospital. The DOJ was looking at potential violations of the \u003ca href=\"http://www.justice.gov/crt/civil-rights-institutionalized-persons\" target=\"_blank\">Civil Rights of Institutionalized Persons Act\u003c/a>. Denying the U.S. Attorney General access -- that's rather astonishing. Despite this lack of access, the DOJ interviewed hospital staff and others and \u003ca href=\"http://www.justice.gov/sites/default/files/crt/legacy/2010/12/15/napa_findlet_6-27-05.pdf\" target=\"_blank\">found\u003c/a>, among other things, failure \"to protect patients from harm and abuse.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In 2010, a few months before \u003ca href=\"http://www.sfgate.com/health/article/Napa-State-Hospital-psychiatric-worker-slain-3248688.php\" target=\"_blank\">Donna Gross \u003c/a>was murdered, the hospital's executive director Claude E. Foulk was \u003ca href=\"http://articles.latimes.com/2010/feb/25/local/la-me-hospital-director25-2010feb25\" target=\"_blank\">fired\u003c/a> after being arrested and charged with child molestation. He was later \u003ca href=\"http://www.presstelegram.com/technology/20110223/foulk-gets-248-years-for-sex-crimes\" target=\"_blank\">sentenced to 248 years in prison\u003c/a>.\u003c/p>\n\u003cp>His replacement, Dolly Matteucci, was soon confronted with Gross's brutal murder by a patient, \u003ca href=\"http://www.sfgate.com/crime/article/Napa-mental-patient-pleads-no-contest-to-murder-2336565.php\" target=\"_blank\">Jess Massey\u003c/a>, who had been allowed to walk around unattended on hospital grounds even though he had a history of violence. He later pleaded no contest to one count of murder and is now in Corcoran State Prison.\u003c/p>\n\u003cp>Less than two months later another hospital therapist was severely beaten as he escorted a different patient on the grounds.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/19/five-years-after-brutal-murder-napa-hospital-seeks-to-balance-treatment-with-security/\" target=\"_blank\">I reported earlier this week \u003c/a>that since these incidents, there have been many changes at the Napa hospital:\u003c/p>\n\u003cul>\n\u003cli>Personal distress alarms with GPS replaced the old alarms, which didn't work outside where Gross was murdered\u003c/li>\n\u003cli>More hospital police have been hired\u003c/li>\n\u003cli>Policies have been changed to protect vulnerable staff, and\u003c/li>\n\u003cli>Gov. Jerry Brown signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1340\" target=\"_blank\">AB 1340\u003c/a>, which will allow Napa and other state hospitals to segregate the most dangerous patients and give them \"enhanced treatment\" -- including risk assessment for violent behavior and concentrated clinical therapy -- in a secure setting. Construction has not yet started on this additional housing.\u003c/li>\n\u003c/ul>\n\u003cp>It was in this context that I asked to interview hospital director Matteucci. At first I was told \"maybe,\" then I was told she could only do the interview on the phone. After pushing, I was granted an in-person interview with her in the administration building \"outside the security fence.\"\u003c/p>\n\u003cp>The hospital had more than 1,800 physical assaults last year. To be fair, \"assault\" can be anything from pushing away the hand of a nurse who's giving out medication to getting punched or worse.\u003c/p>\n\u003cp>Yet it is patients, not staff, who are usually the victims of this violence from other patients. A small number of them cause most of the problems.\u003c/p>\n\u003cp>I wanted to visit the hospital and talk with a patient. The public information officer for the Department of State Hospitals told me I was free to write to any patient I knew was there (such as perpetrators of very high profile crimes, like \u003ca href=\"http://www.nytimes.com/2013/03/31/magazine/should-it-matter-that-the-shooter-at-oikos-university-was-korean.html\" target=\"_blank\">One L. Goh\u003c/a>, the shooter at Oikos University in Oakland in 2013) to ask if they would talk to me. I knew this would be a long shot, so instead I reached out to the hospital's family support group. Eventually I visited Napa with Frank and Barbara Brackin, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/23/violence-and-healing-at-napa-state-hospital-tale-of-two-families/\" target=\"_blank\">as I described in my story on Friday.\u003c/a>\u003c/p>\n\u003cp>Their son Shawn ended up in Napa after a tragic incident in a Roseville. During an attempt by Shawn of \"suicide by cop,\" he walked into a police station waving a gun. In the melee, a police officer shot and killed another policeman by mistake.\u003c/p>\n\u003cp>Shawn was found not guilty by reason of insanity and sentenced to time in a state mental hospital.\u003c/p>\n\u003cp>In the nearly 20 years he's been there, Shawn has been brutally assaulted, most recently in 2014 when another patient slammed his head into a wall so hard his hair was stuck in the wall. The Brackins are suing the hospital for failing to protect him.\u003c/p>\n\u003cp>One thing emphasized to me over and over is that people sent to state mental hospitals are patients, not prisoners. That means they have certain rights and privileges, even if they're violent.\u003c/p>\n\u003cp>I'll never forget my visit to Napa with the Brackins. It felt like I had entered a kind of \"forbidden zone\" where outsiders rarely went. And meeting Shawn after hearing so much about him from his parents was very poignant.\u003c/p>\n\u003cp>On my visit, we were met in the parking lot by a media representative from the Department of State Hospitals. We were warned not to videotape or photograph the barbed-wired security fence, the tight security at the main gate, or people coming and going (including reporters, like me).\u003c/p>\n\u003cp>We passed through multiple locked gates, doors and a metal detector before we were told to surrender cell phones and wallets.\u003c/p>\n\u003cp>I was warned not to talk to or interview any other patients. I was asked to turn over my audio recordings of Shawn Brackin so the Department of State Hospitals could review them to make sure he didn't say anything compromising the privacy of other patients. I negotiated a much more narrow accommodation.\u003c/p>\n\u003cp>I was also denied any access to record audio of music therapy classes. I was told this could jeopardize patient privacy.\u003c/p>\n\u003cp>I found all these requests to be overly strict. I've been to numerous state prisons, including San Quentin. The Department of Corrections has allowed me to freely photograph the gate, inmates, the cell blocks -- pretty much anything except Death Row. I have attended classes, religious services and therapy classes and was allowed to record, videotape and take photos.\u003c/p>\n\u003cp>To keep us away from other patients at Napa (who were meeting with family members nearby) the four of us were escorted to a tiny (perhaps 10 feet by 10 feet) room with no air conditioning and no apparent ventilation. (I was told this is where attorneys can meet privately with patients and their families.) At one point Shawn, who appears to have severe brain damage from assaults he suffered at Napa, asked to open the door to let some air in.\u003c/p>\n\u003cp>But not all families criticize Napa. Some say their loved ones are finally getting the treatment they should have gotten in the community before they committed tragic crimes.\u003c/p>\n\u003cp>And even strong critics acknowledge there’s a role for state hospitals to play in our criminal justice system, especially for violent defendants.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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},
"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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