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"content": "\u003cp>African-American women can be at risk of heart disease even if they don't have metabolic syndrome, a study finds.\u003c/p>\n\u003cp>That's a problem, because the current thinking is that metabolic syndrome — defined as high triglycerides, bad cholesterol, abdominal fat, high blood pressure and impaired glucose metabolism — is the big risk factor for heart attacks and strokes.\u003c/p>\n\u003cp>The picture with women appears to be a lot more complicated, especially when you compare women in different racial or ethnic groups.\u003c/p>\n\u003cp>This \u003ca href=\"http://jaha.ahajournals.org/content/4/5/e001695.abstract?sid=d5e8b267-0c63-4a4f-8602-a7343e97523b\" target=\"_blank\">study\u003c/a>, published Wednesday in the \u003cem>Journal of the American Heart Association\u003c/em>, found that having just having two metabolic abnormalities raised heart disease risk in African-American women. Being overweight or obese with two or three metabolic factors almost doubled their heart disease risk.\u003c/p>\n\u003cp>That wasn't true for white women. For them, being overweight or obese didn't boost their risk unless they had full-on \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/More/MetabolicSyndrome/About-Metabolic-Syndrome_UCM_301920_Article.jsp\" target=\"_blank\">metabolic syndrome\u003c/a>, too.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The metabolic health concept has only been investigated in the white population,\" says Dr. Michelle Schmiegelow of Copenhagen University Hospital Gentofte in Denmark. She led the research while at Stanford University. \"We found that it cannot be directly applied to black individuals.\"\u003c/p>\n\u003cp>Looking just at metabolic syndrome will underestimate risk in African-American women and overestimate it in white women, Schmiegelow says.\u003c/p>\n\u003cp>This study looked at data from 14,364 postmenopausal women who participated in the Women's Health Initiative, tracking their health for 13 years. Hispanic women were included, but there weren't enough of them to come to any firm conclusions.\u003c/p>\n\u003cp>\"There's a lot we don't know,\" says Dr. Robert Eckel, a professor at the University of Colorado's Anschutz School of Medicine who was not involved in the study. \"Does culture or race, environmentally or genetically, have impacts that we can't quite assess accurately?\"\u003c/p>\n\u003cp>It also raises the question of how the health effects of race and culture vary around the globe, Eckel says.\u003c/p>\n\u003cp>And it shows that a one-size-fits-all approach to health risks doesn't cut it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"You have to make an individual risk assessment,\" Schmiegelow told Shots. \"I'm really hoping this study will motivate other groups to see if they can replicate our finding in men or in other races and ethnicities.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>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=Heart+Risk+Factors+May+Affect+Black+Women+More+Than+White+Women&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/em>\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>African-American women can be at risk of heart disease even if they don't have metabolic syndrome, a study finds.\u003c/p>\n\u003cp>That's a problem, because the current thinking is that metabolic syndrome — defined as high triglycerides, bad cholesterol, abdominal fat, high blood pressure and impaired glucose metabolism — is the big risk factor for heart attacks and strokes.\u003c/p>\n\u003cp>The picture with women appears to be a lot more complicated, especially when you compare women in different racial or ethnic groups.\u003c/p>\n\u003cp>This \u003ca href=\"http://jaha.ahajournals.org/content/4/5/e001695.abstract?sid=d5e8b267-0c63-4a4f-8602-a7343e97523b\" target=\"_blank\">study\u003c/a>, published Wednesday in the \u003cem>Journal of the American Heart Association\u003c/em>, found that having just having two metabolic abnormalities raised heart disease risk in African-American women. Being overweight or obese with two or three metabolic factors almost doubled their heart disease risk.\u003c/p>\n\u003cp>That wasn't true for white women. For them, being overweight or obese didn't boost their risk unless they had full-on \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/More/MetabolicSyndrome/About-Metabolic-Syndrome_UCM_301920_Article.jsp\" target=\"_blank\">metabolic syndrome\u003c/a>, too.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The metabolic health concept has only been investigated in the white population,\" says Dr. Michelle Schmiegelow of Copenhagen University Hospital Gentofte in Denmark. She led the research while at Stanford University. \"We found that it cannot be directly applied to black individuals.\"\u003c/p>\n\u003cp>Looking just at metabolic syndrome will underestimate risk in African-American women and overestimate it in white women, Schmiegelow says.\u003c/p>\n\u003cp>This study looked at data from 14,364 postmenopausal women who participated in the Women's Health Initiative, tracking their health for 13 years. Hispanic women were included, but there weren't enough of them to come to any firm conclusions.\u003c/p>\n\u003cp>\"There's a lot we don't know,\" says Dr. Robert Eckel, a professor at the University of Colorado's Anschutz School of Medicine who was not involved in the study. \"Does culture or race, environmentally or genetically, have impacts that we can't quite assess accurately?\"\u003c/p>\n\u003cp>It also raises the question of how the health effects of race and culture vary around the globe, Eckel says.\u003c/p>\n\u003cp>And it shows that a one-size-fits-all approach to health risks doesn't cut it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"You have to make an individual risk assessment,\" Schmiegelow told Shots. \"I'm really hoping this study will motivate other groups to see if they can replicate our finding in men or in other races and ethnicities.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>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=Heart+Risk+Factors+May+Affect+Black+Women+More+Than+White+Women&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Calming Dementia Patients -- Without Powerful Drugs",
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"content": "\u003cp class=\"\">Diane Schoenfeld is a weekly visitor at the Chaparral House nursing home in Berkeley.\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">She comes every Friday to spend time with her aunt, Lillie Manger.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“Hi Aunt Lill!” she says, squatting down next to her aunt’s wheelchair, meeting her at eye level.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Manger is 97. She has straight white hair pulled back in a neat bun today. It’s tied with a green scarf, an homage to the dancer she used to be.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">They go together to the dining room to look over family pictures. Manger needs to be reminded who is in them. Including one of herself.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“That’s me?” asks Manger\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“That’s you,” her niece confirms.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“Am I supposed to remember?” says Manger.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Schoenfeld smiles at her encouragingly. \u003c/span>\u003cspan class=\"\">“I don’t know if you’re supposed to. It’s OK either way.”\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Manger has dementia. Schoenfeld is her \"surrogate decision maker\" meaning that, legally, she is the person who makes decisions about Manger's health care. Schoenfeld has filled me in on her story. This is the second nursing home where Manger has lived. The first was 45 minutes away, and Schoenfeld wasn’t able to visit as often. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">At that first nursing home, staff had recommended antipsychotic sedatives for Manger’s behaviors, like crying out and outbursts. Schoenfeld shared staff notes with me about the recommendations. She says she wasn’t thrilled but agreed. She thought her aunt might get better care, \u003c/span>\u003cspan class=\"\">“rather than (staff) being unhappy with her behavior.”\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cstrong>\u003cspan class=\"\">Coming Out of a Fog\u003c/span>\u003c/strong>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Two years later Schoenfeld had moved her aunt to Chaparral House, to have her closer. By this time, Manger appeared to be in a fog. Eventually, Schoenfeld broached the idea of weaning her aunt from the medication with Chaparral House. As soon as they did, she says things turned around. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“I could see her personality again, I was so happy,\" Schoenfeld said. \"My sister came to visit and (Lillie) used my sister’s name and clearly recognized her, which we had not seen in the years that she was on the medication. I only wish I had done that sooner.\"\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Schoenfeld says it just didn’t feel right to have her aunt sedated.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“If a baby is crying, I mean most people will go to a baby and comfort them. They won’t try to ignore them and drug them,” she says.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">[soundcloud url=\"https://api.soundcloud.com/tracks/206401562\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">KJ Page, administrator of Chaparral House, shares that philosophy. Page says in many cases dementia patients came to their facility with a prescription to be given antipsychotics half an hour before bathtime. Then, a number of years ago she read a book called \u003ca href=\"http://bathingwithoutabattle.unc.edu/\" target=\"_blank\">Bathing Without a Battle\u003c/a> about bathing dementia patients and why it can be such a challenge.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">She asks people to imagine putting yourself in the place of the nursing home resident. “A person they didn’t know, couldn’t recognize, comes to take off their clothes,\" she says. \"Ah! No wonder they’re screaming and fighting and kicking!”\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Page says after that “Aha!” moment, the staff came to a new agreement. The residents were not out running marathons, for instance, or other sweat-inducing activities, so regular showers weren't necessary. Instead, residents would have a regular caregiver do simple sponge baths. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Page says the results inspired further changes.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“It just rolled into what else are they fighting for, and why do we need to have a fight?\" Page says, \"What can we do to make it easier for people and the staff? And that’s how we approached it from there on.\"\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">It worked. While Page says antipsychotics do have a place for some people, not one of Chaparral House’s dementia patients is currently taking the medications. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cstrong>Grading Nursing Homes on Avoiding Antipsychotic Drugs\u003c/strong>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Federal Changes Chaparral House's experience is unusual. In California nursing homes, just over 15 percent of dementia patients are on these drugs. That’s far more than advocates say is necessary. But that number is actually down from almost 22 percent just three years ago. That’s when the \u003ca href=\"http://oig.hhs.gov/oei/reports/oei-07-08-00151.pdf\" target=\"_blank\">federal government \u003c/a>began regulating \u003c/span>\u003cspan class=\"\">their use for dementia in nursing homes. This came in response to several studies warning the medicines had \u003ca href=\"http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124830.htm\" target=\"_blank\">serious risks\u003c/a> including, strokes, falls and even death.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">The new guidelines stipulate that nursing homes are graded on the percent of their dementia patients receiving antipsychotic medications. That figure becomes part of their rating on \u003ca href=\"http://www.medicare.gov/NursingHomeCompare/About/HowWeCalculate.html\" target=\"_blank\">Nursing Home Compare\u003c/a>, a tool from Medicare that helps consumers compare information about nursing homes. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">The drugs are traditionally deployed to control what is seen as problem behaviors. Reducing the medication requires new approaches and retraining staff to deal with people with dementia. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Enter Caroline Stephens, a\u003c/span>\u003cspan class=\"\">ssistant professor at the UCSF school of nursing, who specializes in psychiatric care for the elderly and long term care policy.\u003c/span>\u003c/p>\n\u003cp class=\"\">She says that the new regulations have had a positive impact on staff. \"\u003cspan class=\"\">They’re now realizing we don’t have to reach for the medication and they’re getting to think creatively about what we can do for this resident.\"\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cstrong>Clinicians Become 'Good Detectives'\u003c/strong>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">I meet Stephens at the Hayward Healthcare & Wellness Center nursing home, where she consults. She helps train nurses and staff on person-centered care, being attentive to the cues that people give and trying to understand what is bothering them, even if they can’t communicate it directly.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Stephens tells me the new regulations have given more credence to this medical approach. She describes one of her success stories helping a dementia patient who was always fighting to leave the facility at the end of the day.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“They felt they needed to catch the bus, they had to get home because they need to take care of their daughter,” she says.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Instead of physically restraining the person or prescribing medication, Stephens says they put a sign on the door that said, simply, \"It’s a holiday; buses aren’t running today.\" The sign worked. The person stopped fighting to leave and there was no need for antipsychotic medication.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">At another nursing home, Stephens consulted with staff about a resident who was disruptive and constantly wandered at night -- including into other patients’ rooms. He had been given an antipsychotic to control his behavior. But in a deeper look at his background, staff learned that he’d worked as a night security guard for most of his adult life. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">The staff came up with a new plan. They gave the resident a badge and clipboard and walked with him on an abbreviated set of “evening rounds.” Sure enough, after that he’d willingly go to bed, and they were able to take him off medication.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Stephens says when the patients themselves can’t communicate it’s vital to talk to family, to find out what the person did for a living, what they enjoyed in life. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">\"It is our job as clinicians to be good detectives,” she explains.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">This is especially important as nursing homes serve an increasingly diverse clientele. Stephens says the nursing home model was built around an older, white, female patient. Today, the demographics have changed.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">At Hayward Healthcare and Wellness, she says, \"There are probably 15 different racial groups and a minimum of five languages spoken.\"\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cb>Risk of Cherry-Picking Patients\u003c/b>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">One of the big advocates for the federal regulations was Tony Chicotel, staff attorney with California Advocates for Nursing Home Reform. He welcomes the guidelines, but says he has noticed a concerning unintended consequence. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">While across the state the overall rate has dropped, he says he has noticed that several hundred nursing homes have rates that have either stayed the same or increased, in some cases almost doubled.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Chicotel says that in an effort to decrease their patients on antipsychotics to get better ratings, some facilities may be cherry-picking patients, essentially warehousing the hardest to wean from anti-psychotics in the bleakest facilities.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Chicotel says for families and caregivers can look up a nursing home’s antipsychotic drug use rates as well as other drug usage on websites including \u003ca href=\"https://www.medicare.gov/nursinghomecompare/?AspxAutoDetectCookieSupport=1\" target=\"_blank\">Nursing Home Compare\u003c/a>.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Still, these guidelines and ratings only cover nursing homes.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Chicotel says increasingly he is fielding calls from families worried about the use of antipsychotics in assisted living and home care settings, which don’t fall under the regulations.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“We need to be more proactive about trying to get data for assisted living facilities and reconfiguring our message so it’s more applicable to assisted-living facilities,” Chicotel says.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">It seems likely, though that that is coming. Earlier this year, the GAO released \u003ca href=\"http://www.gao.gov/products/GAO-15-211\" target=\"_blank\">a report\u003c/a> urging HHS to expand their regulation of antipsychotics in dementia patients to settings other than just nursing homes.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">UCSF professor Stephens says this points to retraining ever more medical professionals in patient-centered care, eliminating the need for patients to be medicated as a form of restraint.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“If we can train generalists I think we can make some headway,” she says.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cem>\u003cspan class=\"\">Rachel Dornhelm wrote this piece with support from the \u003ca href=\"https://www.geron.org/press-room/journalists-in-aging-fellows-program\" target=\"_blank\">Journalists in Aging Fellows Program\u003c/a> of the Gerontological Society of America and New America Media, sponsored by the AARP.\u003c/span>\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "\"I could see her personality again, I was so happy,\" a niece says of her 97-year-old aunt. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"\">Diane Schoenfeld is a weekly visitor at the Chaparral House nursing home in Berkeley.\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">She comes every Friday to spend time with her aunt, Lillie Manger.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“Hi Aunt Lill!” she says, squatting down next to her aunt’s wheelchair, meeting her at eye level.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Manger is 97. She has straight white hair pulled back in a neat bun today. It’s tied with a green scarf, an homage to the dancer she used to be.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">They go together to the dining room to look over family pictures. Manger needs to be reminded who is in them. Including one of herself.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“That’s me?” asks Manger\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“That’s you,” her niece confirms.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“Am I supposed to remember?” says Manger.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Schoenfeld smiles at her encouragingly. \u003c/span>\u003cspan class=\"\">“I don’t know if you’re supposed to. It’s OK either way.”\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Manger has dementia. Schoenfeld is her \"surrogate decision maker\" meaning that, legally, she is the person who makes decisions about Manger's health care. Schoenfeld has filled me in on her story. This is the second nursing home where Manger has lived. The first was 45 minutes away, and Schoenfeld wasn’t able to visit as often. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">At that first nursing home, staff had recommended antipsychotic sedatives for Manger’s behaviors, like crying out and outbursts. Schoenfeld shared staff notes with me about the recommendations. She says she wasn’t thrilled but agreed. She thought her aunt might get better care, \u003c/span>\u003cspan class=\"\">“rather than (staff) being unhappy with her behavior.”\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cstrong>\u003cspan class=\"\">Coming Out of a Fog\u003c/span>\u003c/strong>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Two years later Schoenfeld had moved her aunt to Chaparral House, to have her closer. By this time, Manger appeared to be in a fog. Eventually, Schoenfeld broached the idea of weaning her aunt from the medication with Chaparral House. As soon as they did, she says things turned around. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“I could see her personality again, I was so happy,\" Schoenfeld said. \"My sister came to visit and (Lillie) used my sister’s name and clearly recognized her, which we had not seen in the years that she was on the medication. I only wish I had done that sooner.\"\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Schoenfeld says it just didn’t feel right to have her aunt sedated.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“If a baby is crying, I mean most people will go to a baby and comfort them. They won’t try to ignore them and drug them,” she says.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">\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/206401562&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/206401562'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">KJ Page, administrator of Chaparral House, shares that philosophy. Page says in many cases dementia patients came to their facility with a prescription to be given antipsychotics half an hour before bathtime. Then, a number of years ago she read a book called \u003ca href=\"http://bathingwithoutabattle.unc.edu/\" target=\"_blank\">Bathing Without a Battle\u003c/a> about bathing dementia patients and why it can be such a challenge.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">She asks people to imagine putting yourself in the place of the nursing home resident. “A person they didn’t know, couldn’t recognize, comes to take off their clothes,\" she says. \"Ah! No wonder they’re screaming and fighting and kicking!”\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Page says after that “Aha!” moment, the staff came to a new agreement. The residents were not out running marathons, for instance, or other sweat-inducing activities, so regular showers weren't necessary. Instead, residents would have a regular caregiver do simple sponge baths. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Page says the results inspired further changes.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“It just rolled into what else are they fighting for, and why do we need to have a fight?\" Page says, \"What can we do to make it easier for people and the staff? And that’s how we approached it from there on.\"\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">It worked. While Page says antipsychotics do have a place for some people, not one of Chaparral House’s dementia patients is currently taking the medications. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cstrong>Grading Nursing Homes on Avoiding Antipsychotic Drugs\u003c/strong>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Federal Changes Chaparral House's experience is unusual. In California nursing homes, just over 15 percent of dementia patients are on these drugs. That’s far more than advocates say is necessary. But that number is actually down from almost 22 percent just three years ago. That’s when the \u003ca href=\"http://oig.hhs.gov/oei/reports/oei-07-08-00151.pdf\" target=\"_blank\">federal government \u003c/a>began regulating \u003c/span>\u003cspan class=\"\">their use for dementia in nursing homes. This came in response to several studies warning the medicines had \u003ca href=\"http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124830.htm\" target=\"_blank\">serious risks\u003c/a> including, strokes, falls and even death.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">The new guidelines stipulate that nursing homes are graded on the percent of their dementia patients receiving antipsychotic medications. That figure becomes part of their rating on \u003ca href=\"http://www.medicare.gov/NursingHomeCompare/About/HowWeCalculate.html\" target=\"_blank\">Nursing Home Compare\u003c/a>, a tool from Medicare that helps consumers compare information about nursing homes. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">The drugs are traditionally deployed to control what is seen as problem behaviors. Reducing the medication requires new approaches and retraining staff to deal with people with dementia. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Enter Caroline Stephens, a\u003c/span>\u003cspan class=\"\">ssistant professor at the UCSF school of nursing, who specializes in psychiatric care for the elderly and long term care policy.\u003c/span>\u003c/p>\n\u003cp class=\"\">She says that the new regulations have had a positive impact on staff. \"\u003cspan class=\"\">They’re now realizing we don’t have to reach for the medication and they’re getting to think creatively about what we can do for this resident.\"\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cstrong>Clinicians Become 'Good Detectives'\u003c/strong>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">I meet Stephens at the Hayward Healthcare & Wellness Center nursing home, where she consults. She helps train nurses and staff on person-centered care, being attentive to the cues that people give and trying to understand what is bothering them, even if they can’t communicate it directly.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Stephens tells me the new regulations have given more credence to this medical approach. She describes one of her success stories helping a dementia patient who was always fighting to leave the facility at the end of the day.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“They felt they needed to catch the bus, they had to get home because they need to take care of their daughter,” she says.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Instead of physically restraining the person or prescribing medication, Stephens says they put a sign on the door that said, simply, \"It’s a holiday; buses aren’t running today.\" The sign worked. The person stopped fighting to leave and there was no need for antipsychotic medication.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">At another nursing home, Stephens consulted with staff about a resident who was disruptive and constantly wandered at night -- including into other patients’ rooms. He had been given an antipsychotic to control his behavior. But in a deeper look at his background, staff learned that he’d worked as a night security guard for most of his adult life. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">The staff came up with a new plan. They gave the resident a badge and clipboard and walked with him on an abbreviated set of “evening rounds.” Sure enough, after that he’d willingly go to bed, and they were able to take him off medication.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Stephens says when the patients themselves can’t communicate it’s vital to talk to family, to find out what the person did for a living, what they enjoyed in life. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">\"It is our job as clinicians to be good detectives,” she explains.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">This is especially important as nursing homes serve an increasingly diverse clientele. Stephens says the nursing home model was built around an older, white, female patient. Today, the demographics have changed.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">At Hayward Healthcare and Wellness, she says, \"There are probably 15 different racial groups and a minimum of five languages spoken.\"\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cb>Risk of Cherry-Picking Patients\u003c/b>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">One of the big advocates for the federal regulations was Tony Chicotel, staff attorney with California Advocates for Nursing Home Reform. He welcomes the guidelines, but says he has noticed a concerning unintended consequence. \u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">While across the state the overall rate has dropped, he says he has noticed that several hundred nursing homes have rates that have either stayed the same or increased, in some cases almost doubled.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Chicotel says that in an effort to decrease their patients on antipsychotics to get better ratings, some facilities may be cherry-picking patients, essentially warehousing the hardest to wean from anti-psychotics in the bleakest facilities.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Chicotel says for families and caregivers can look up a nursing home’s antipsychotic drug use rates as well as other drug usage on websites including \u003ca href=\"https://www.medicare.gov/nursinghomecompare/?AspxAutoDetectCookieSupport=1\" target=\"_blank\">Nursing Home Compare\u003c/a>.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Still, these guidelines and ratings only cover nursing homes.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">Chicotel says increasingly he is fielding calls from families worried about the use of antipsychotics in assisted living and home care settings, which don’t fall under the regulations.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“We need to be more proactive about trying to get data for assisted living facilities and reconfiguring our message so it’s more applicable to assisted-living facilities,” Chicotel says.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">It seems likely, though that that is coming. Earlier this year, the GAO released \u003ca href=\"http://www.gao.gov/products/GAO-15-211\" target=\"_blank\">a report\u003c/a> urging HHS to expand their regulation of antipsychotics in dementia patients to settings other than just nursing homes.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">UCSF professor Stephens says this points to retraining ever more medical professionals in patient-centered care, eliminating the need for patients to be medicated as a form of restraint.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cspan class=\"\">“If we can train generalists I think we can make some headway,” she says.\u003c/span>\u003c/p>\n\u003cp class=\"\">\u003cem>\u003cspan class=\"\">Rachel Dornhelm wrote this piece with support from the \u003ca href=\"https://www.geron.org/press-room/journalists-in-aging-fellows-program\" target=\"_blank\">Journalists in Aging Fellows Program\u003c/a> of the Gerontological Society of America and New America Media, sponsored by the AARP.\u003c/span>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Not All Women with Dense Breasts Are at High Risk of Cancer",
"title": "Not All Women with Dense Breasts Are at High Risk of Cancer",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Almost half the states -- including \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">California \u003c/a>-- now require doctors to tell women if they have dense breasts. That's because women with dense breast are both at higher risk of breast cancer and those cancers are harder to find.\u003c/p>\n\u003cp>But not all women with dense breasts have the same risks, a study says.\u003c/p>\n\u003cp>Those differences need to be taken into account when figuring out each woman's risk of breast cancer, the study says, and also weighed against other factors, including family history, age and ethnicity.\u003c/p>\n\u003cp>The researchers looked at the records of 365,426 women who had a normal mammogram, then looked to see which ones were diagnosed with breast cancer within a year — an \"interval cancer\" that may have been missed by the mammogram.\u003c/p>\n\u003cp>All told, 47 percent of the women in the study had dense breasts. But just half of those women had a higher cancer risk. The women who got cancer were more likely to be older and white, have a family history of breast cancer, and to have \"heterogeneously\" or \"extremely\" dense breasts, the top two categories of breast density.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The \u003ca href=\"http://annals.org/article.aspx?articleid=2293233\" target=\"_blank\">results\u003c/a> were published this week in Annals of Internal Medicine.\u003c/p>\n\u003cp>Breast cancer advocates have been \u003ca href=\"http://www.areyoudenseadvocacy.org\" target=\"_blank\">pushing for state and federal laws\u003c/a> requiring that women be told if they have dense breasts, so they can get extra screening with ultrasound or MRI. That screening can find more cancers in dense breasts, but it can also lead to \u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/16/399946509/letters-about-dense-breasts-can-lead-to-more-questions-than-answers\" target=\"_blank\">more false positives and needless surgery.\u003c/a>\u003c/p>\n\u003cp>This study makes the point that women need to know not just about breast density, but what kind of breast density, and other risk factors, too.\u003c/p>\n\u003cp>To help explain these factors more fully, we called up Dr. Karla Kerlikowske, a professor of medicine at UC San Francisco and lead author of the study. The conversation has been edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>Your study looks at breast cancer risk using not just breast density but also family history, age and ethnicity. Why is that?\u003c/strong>\u003c/p>\n\u003cp>About 45 percent of women have dense breasts; that's a large number of women. But the sensitivity of mammograms is such that we're not missing 45 percent of cancers. So can we narrow it down to women who are at higher risk of cancer, and especially women at higher risk of advanced cancer? Then if we did supplemental imaging of women in that group, it might help them.\u003c/p>\n\u003cp>\u003cstrong>How would I figure out the other risk factors besides breast density?\u003c/strong>\u003c/p>\n\u003cp>You can use our \u003ca href=\"https://tools.bcsc-scc.org/BC5yearRisk/intro.htm\" target=\"_blank\">Breast Cancer Surveillance Consortium Risk Calculator\u003c/a>; it looks at age, race, family history, history of biopsy and breast density. Ours is the only risk calculator that has breast density in it. We actually validated it in another mammography population. And it's an \u003ca href=\"https://itunes.apple.com/us/app/bcsc-risk-calculator/id919034661?mt=8\" target=\"_blank\">app\u003c/a>; just type in \"BCSC Risk Calculator\" and download.\u003c/p>\n\u003cp>\u003cstrong>I looked at the calculator, and even though I've been told I have dense breasts I realize I have no idea if they're heterogenous or extremely dense, which are the higher-risk categories. How do I find that out?\u003c/strong>\u003c/p>\n\u003cp>The provider who ordered the test will get that information. You'd have to ask the provider; it's in the mammography report. My understanding from the bills in Congress is that you'd actually be told what your density is; if you're fatty or scattered or heterogenous or extremely dense. All women would be informed, and they would know the category. If I have fatty breasts I'd like to know that, too, because then I'm at really low risk.\u003c/p>\n\u003cp>\u003cstrong>Are you telling your patients that?\u003c/strong>\u003c/p>\n\u003cp>It sort of depends. If I don't think they're at high risk of an interval cancer I tend not to worry them too much. If they're at high risk then I have a discussion with them. If they have fatty breasts I let them know, wow, you're really at low risk for cancer.\u003c/p>\n\u003cp>\u003cstrong>It feels like we're still struggling with who really needs the extra scans. How will we figure that out?\u003c/strong>\u003c/p>\n\u003cp>Now that we know who these high-risk groups are, we need to know how supplemental screening works in those high-risk groups. If we add ultrasound, do we miss less cancer? If we add MRI, do we miss less cancer? We have data on both of them, and we're in the process of analyzing them.\u003c/p>\n\u003cp>\u003cstrong>When will we find out?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>I'm hoping sometime this summer.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Almost half the states -- including \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">California \u003c/a>-- now require doctors to tell women if they have dense breasts. That's because women with dense breast are both at higher risk of breast cancer and those cancers are harder to find.\u003c/p>\n\u003cp>But not all women with dense breasts have the same risks, a study says.\u003c/p>\n\u003cp>Those differences need to be taken into account when figuring out each woman's risk of breast cancer, the study says, and also weighed against other factors, including family history, age and ethnicity.\u003c/p>\n\u003cp>The researchers looked at the records of 365,426 women who had a normal mammogram, then looked to see which ones were diagnosed with breast cancer within a year — an \"interval cancer\" that may have been missed by the mammogram.\u003c/p>\n\u003cp>All told, 47 percent of the women in the study had dense breasts. But just half of those women had a higher cancer risk. The women who got cancer were more likely to be older and white, have a family history of breast cancer, and to have \"heterogeneously\" or \"extremely\" dense breasts, the top two categories of breast density.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The \u003ca href=\"http://annals.org/article.aspx?articleid=2293233\" target=\"_blank\">results\u003c/a> were published this week in Annals of Internal Medicine.\u003c/p>\n\u003cp>Breast cancer advocates have been \u003ca href=\"http://www.areyoudenseadvocacy.org\" target=\"_blank\">pushing for state and federal laws\u003c/a> requiring that women be told if they have dense breasts, so they can get extra screening with ultrasound or MRI. That screening can find more cancers in dense breasts, but it can also lead to \u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/16/399946509/letters-about-dense-breasts-can-lead-to-more-questions-than-answers\" target=\"_blank\">more false positives and needless surgery.\u003c/a>\u003c/p>\n\u003cp>This study makes the point that women need to know not just about breast density, but what kind of breast density, and other risk factors, too.\u003c/p>\n\u003cp>To help explain these factors more fully, we called up Dr. Karla Kerlikowske, a professor of medicine at UC San Francisco and lead author of the study. The conversation has been edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>Your study looks at breast cancer risk using not just breast density but also family history, age and ethnicity. Why is that?\u003c/strong>\u003c/p>\n\u003cp>About 45 percent of women have dense breasts; that's a large number of women. But the sensitivity of mammograms is such that we're not missing 45 percent of cancers. So can we narrow it down to women who are at higher risk of cancer, and especially women at higher risk of advanced cancer? Then if we did supplemental imaging of women in that group, it might help them.\u003c/p>\n\u003cp>\u003cstrong>How would I figure out the other risk factors besides breast density?\u003c/strong>\u003c/p>\n\u003cp>You can use our \u003ca href=\"https://tools.bcsc-scc.org/BC5yearRisk/intro.htm\" target=\"_blank\">Breast Cancer Surveillance Consortium Risk Calculator\u003c/a>; it looks at age, race, family history, history of biopsy and breast density. Ours is the only risk calculator that has breast density in it. We actually validated it in another mammography population. And it's an \u003ca href=\"https://itunes.apple.com/us/app/bcsc-risk-calculator/id919034661?mt=8\" target=\"_blank\">app\u003c/a>; just type in \"BCSC Risk Calculator\" and download.\u003c/p>\n\u003cp>\u003cstrong>I looked at the calculator, and even though I've been told I have dense breasts I realize I have no idea if they're heterogenous or extremely dense, which are the higher-risk categories. How do I find that out?\u003c/strong>\u003c/p>\n\u003cp>The provider who ordered the test will get that information. You'd have to ask the provider; it's in the mammography report. My understanding from the bills in Congress is that you'd actually be told what your density is; if you're fatty or scattered or heterogenous or extremely dense. All women would be informed, and they would know the category. If I have fatty breasts I'd like to know that, too, because then I'm at really low risk.\u003c/p>\n\u003cp>\u003cstrong>Are you telling your patients that?\u003c/strong>\u003c/p>\n\u003cp>It sort of depends. If I don't think they're at high risk of an interval cancer I tend not to worry them too much. If they're at high risk then I have a discussion with them. If they have fatty breasts I let them know, wow, you're really at low risk for cancer.\u003c/p>\n\u003cp>\u003cstrong>It feels like we're still struggling with who really needs the extra scans. How will we figure that out?\u003c/strong>\u003c/p>\n\u003cp>Now that we know who these high-risk groups are, we need to know how supplemental screening works in those high-risk groups. If we add ultrasound, do we miss less cancer? If we add MRI, do we miss less cancer? We have data on both of them, and we're in the process of analyzing them.\u003c/p>\n\u003cp>\u003cstrong>When will we find out?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>I'm hoping sometime this summer.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Suffering From Sciatica? Common Treatment May Be Little Help",
"title": "Suffering From Sciatica? Common Treatment May Be Little Help",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>If you’ve ever felt a sharp, debilitating pain shoot from your lower back and down your legs along the sciatic nerve, you might have been prescribed steroids. And it might have seemed the steroids stopped the pain. But they probably didn’t.\u003c/p>\n\u003cp>One in ten people will experience this radiating pain, called radiculopathy or sciatica , at some point in their lives, but oral steroids, one of the most commonly prescribed treatments for this pain, apparently are not as effective as previously thought, \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2293294\" target=\"_blank\">new research suggests\u003c/a>. In fact, they are no better than a placebo, found the first randomized trial to test oral steroids to treat for sciatica caused by a herniated disk.\u003c/p>\n\u003cp>The findings offer another example of a standard treatment lacking solid evidence, said the study’s lead author, Dr. Harley Goldberg, director of the Spine Care Program at Kaiser Permanente San Jose Medical Center.\u003c/p>\n\u003cp>“It is certainly well known that the practice of medicine doesn’t always, or even often, follow the evidence,” Goldberg said. “At the same time, many, many things don’t have evidence, and this is one of those examples. People have been using steroids for well reasoned physiologic belief, and we did the study because of the impression clinically that patients get so much better.”\u003c/p>\n\u003cp>Clinicians have suspected inflammation was a primary cause of sciatic pain, making anti-inflammatories a reasonable treatment choice – and one that appeared to work in practice. This study now calls that idea into question.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In the trial, 269 adults, all suffering from sciatica for less than three months, received either a placebo or a course of prednisone, an oral steroid, for two weeks. Then researchers assessed the study participants’ function and pain at three weeks and one year later.\u003c/p>\n\u003cp>All participants showed improvement, but those in the prednisone group experienced slightly better function. Both groups had the same level of pain relief. The study, funded by the National Institutes of Health, was published Tuesday in the journal JAMA.\u003c/p>\n\u003cp>“Sometimes treating a condition with medication actually leads to improvements in pain and function,” Goldberg said. “Other times, however, simply letting time pass leads to improvement on its own.”\u003c/p>\n\u003cp>Letting that time pass without prednisone may mean eventually feeling better without suffering the side effects of oral steroids.\u003c/p>\n\u003cp>Most side effects from steroids are mild, short-term and well-tolerated, Goldberg said, but they can include agitation, insomnia, tremors, gastritis, headaches and, for diabetics, increased blood sugar. Other treatment options include non-steroidal anti-inflammatories or other medications, epidural steroids, surgery or even no treatment at all.\u003c/p>\n\u003cp>“Now we have good evidence, and now we can have a better discussion about what’s appropriate for a particular patient and weigh whether a little bit of improvement in function is worth the risk of a steroid,” Goldberg said.\u003c/p>\n\u003cp>The findings echo what has been found with other interventions for sciatica. Clinicians previously believed the direct compression on the nerve root by a herniated disk caused the pain, so surgery was a common treatment option, Goldberg said.\u003c/p>\n\u003cp>While studies have shown that surgery for a herniated disk does lead to immediate short-term relief, patients’ pain is no different a year later than that of patients who didn’t receive surgery.\u003c/p>\n\u003cp>The results also explain the push in recent years to test more and more treatments previously regarded as standard practice.\u003c/p>\n\u003cp>“Many interventions we use in clinical medicine today are there primarily because of traditional and long-term use, not because they have a solid evidence base to justify their use in the clinical setting,” said the study’s senior author, Dr. Andrew L. Avins, a research scientist at the Kaiser Permanente Northern California Division of Research.\u003c/p>\n\u003cp>So there's been increasing interest in testing such beliefs with randomized-controlled trial, the gold standard of medical study. “We do find that many therapies in which we’ve placed great trust over the years actually have very little benefit for patients, compared to a placebo,” Avins said.\u003c/p>\n\u003cp>What these findings mean for individual patients, however, will depend on the patients themselves and their doctors.\u003c/p>\n\u003cp>“This result, most practitioners will probably tell you, is surprising,” said Dr. Gowriharan Thaiyananthan, a neurosurgeon and founder of the Brain and Spine Institute of California in Newport Beach. “Often evidence-based medicine is not practiced because the evidence has not been established yet. The hope is that physicians will be cognizant and dynamic enough to incorporate new evidence into changing their practice habits appropriately.”\u003c/p>\n\u003cp>But these findings don’t necessarily take oral steroids off the table as a treatment option. It just means the risk-benefit calculation changes as patients weigh their options, Thaiyananthan said. “Modest improvements in patients with no contraindications for steroid use may suffice to treat these patients with steroids,” he said, or clinicians may discuss other treatments options with patients.\u003c/p>\n\u003cp>\u003cspan style=\"line-height: 1.5\">Meanwhile, this research adds to the trend of finding out whether what was thought to be true about a particular treatment or condition, actually is true.\u003c/span>\u003c/p>\n\u003cp>“This is a great example of the dangers of practicing 'anecdotal medicine.' For years, we’ve been giving oral steroids because we see many of our patients get so much better so quickly when we do it, and we pat ourselves on the back for being such great clinicians offering great therapies, and patients believe in what we do,” Avins said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Now what we’ve discovered is that mostly what we’re watching is the natural course of the condition, maybe with some element of placebo effect as well,” he continued. “And the great benefit of this kind of study is to finally give patients and their providers some hard evidence with which they can now have an informed decision about whether it makes sense to try oral steroids as an option.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you’ve ever felt a sharp, debilitating pain shoot from your lower back and down your legs along the sciatic nerve, you might have been prescribed steroids. And it might have seemed the steroids stopped the pain. But they probably didn’t.\u003c/p>\n\u003cp>One in ten people will experience this radiating pain, called radiculopathy or sciatica , at some point in their lives, but oral steroids, one of the most commonly prescribed treatments for this pain, apparently are not as effective as previously thought, \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2293294\" target=\"_blank\">new research suggests\u003c/a>. In fact, they are no better than a placebo, found the first randomized trial to test oral steroids to treat for sciatica caused by a herniated disk.\u003c/p>\n\u003cp>The findings offer another example of a standard treatment lacking solid evidence, said the study’s lead author, Dr. Harley Goldberg, director of the Spine Care Program at Kaiser Permanente San Jose Medical Center.\u003c/p>\n\u003cp>“It is certainly well known that the practice of medicine doesn’t always, or even often, follow the evidence,” Goldberg said. “At the same time, many, many things don’t have evidence, and this is one of those examples. People have been using steroids for well reasoned physiologic belief, and we did the study because of the impression clinically that patients get so much better.”\u003c/p>\n\u003cp>Clinicians have suspected inflammation was a primary cause of sciatic pain, making anti-inflammatories a reasonable treatment choice – and one that appeared to work in practice. This study now calls that idea into question.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In the trial, 269 adults, all suffering from sciatica for less than three months, received either a placebo or a course of prednisone, an oral steroid, for two weeks. Then researchers assessed the study participants’ function and pain at three weeks and one year later.\u003c/p>\n\u003cp>All participants showed improvement, but those in the prednisone group experienced slightly better function. Both groups had the same level of pain relief. The study, funded by the National Institutes of Health, was published Tuesday in the journal JAMA.\u003c/p>\n\u003cp>“Sometimes treating a condition with medication actually leads to improvements in pain and function,” Goldberg said. “Other times, however, simply letting time pass leads to improvement on its own.”\u003c/p>\n\u003cp>Letting that time pass without prednisone may mean eventually feeling better without suffering the side effects of oral steroids.\u003c/p>\n\u003cp>Most side effects from steroids are mild, short-term and well-tolerated, Goldberg said, but they can include agitation, insomnia, tremors, gastritis, headaches and, for diabetics, increased blood sugar. Other treatment options include non-steroidal anti-inflammatories or other medications, epidural steroids, surgery or even no treatment at all.\u003c/p>\n\u003cp>“Now we have good evidence, and now we can have a better discussion about what’s appropriate for a particular patient and weigh whether a little bit of improvement in function is worth the risk of a steroid,” Goldberg said.\u003c/p>\n\u003cp>The findings echo what has been found with other interventions for sciatica. Clinicians previously believed the direct compression on the nerve root by a herniated disk caused the pain, so surgery was a common treatment option, Goldberg said.\u003c/p>\n\u003cp>While studies have shown that surgery for a herniated disk does lead to immediate short-term relief, patients’ pain is no different a year later than that of patients who didn’t receive surgery.\u003c/p>\n\u003cp>The results also explain the push in recent years to test more and more treatments previously regarded as standard practice.\u003c/p>\n\u003cp>“Many interventions we use in clinical medicine today are there primarily because of traditional and long-term use, not because they have a solid evidence base to justify their use in the clinical setting,” said the study’s senior author, Dr. Andrew L. Avins, a research scientist at the Kaiser Permanente Northern California Division of Research.\u003c/p>\n\u003cp>So there's been increasing interest in testing such beliefs with randomized-controlled trial, the gold standard of medical study. “We do find that many therapies in which we’ve placed great trust over the years actually have very little benefit for patients, compared to a placebo,” Avins said.\u003c/p>\n\u003cp>What these findings mean for individual patients, however, will depend on the patients themselves and their doctors.\u003c/p>\n\u003cp>“This result, most practitioners will probably tell you, is surprising,” said Dr. Gowriharan Thaiyananthan, a neurosurgeon and founder of the Brain and Spine Institute of California in Newport Beach. “Often evidence-based medicine is not practiced because the evidence has not been established yet. The hope is that physicians will be cognizant and dynamic enough to incorporate new evidence into changing their practice habits appropriately.”\u003c/p>\n\u003cp>But these findings don’t necessarily take oral steroids off the table as a treatment option. It just means the risk-benefit calculation changes as patients weigh their options, Thaiyananthan said. “Modest improvements in patients with no contraindications for steroid use may suffice to treat these patients with steroids,” he said, or clinicians may discuss other treatments options with patients.\u003c/p>\n\u003cp>\u003cspan style=\"line-height: 1.5\">Meanwhile, this research adds to the trend of finding out whether what was thought to be true about a particular treatment or condition, actually is true.\u003c/span>\u003c/p>\n\u003cp>“This is a great example of the dangers of practicing 'anecdotal medicine.' For years, we’ve been giving oral steroids because we see many of our patients get so much better so quickly when we do it, and we pat ourselves on the back for being such great clinicians offering great therapies, and patients believe in what we do,” Avins said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Now what we’ve discovered is that mostly what we’re watching is the natural course of the condition, maybe with some element of placebo effect as well,” he continued. “And the great benefit of this kind of study is to finally give patients and their providers some hard evidence with which they can now have an informed decision about whether it makes sense to try oral steroids as an option.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>While a move to abolish the vaccine \"personal belief exemption\" has \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/14/california-senate-approves-bill-that-would-end-vaccine-opt-out/\" target=\"_blank\">dominated headlines\u003c/a> in the last weeks across California, two other vaccine-related bills are making their way through the Legislature a bit more quietly. One would require preschool and child care workers to have certain vaccinations; another seeks to improve vaccination rates for 2-year-olds.\u003c/p>\n\u003cp>If\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml\" target=\"_blank\"> SB792\u003c/a> becomes law, California will be the first state in the country to require that all preschool and child care workers be immunized against measles, pertussis and the flu.\u003c/p>\n\u003cp>Sen. Tony Mendoza (D-Montebello) says that most people are startled to find out such a mandate is not already in place. \"Most people … say 'We don't do that now?' \" he said. \"So this is something that's needed.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"3ZiLNP2OfJLo4njF7AQF09RIwVdEuYT2\"]Mendoza says that the bill is designed to protect children who cannot be vaccinated or fully vaccinated because of their age or medical condition. Ensuring that adults in close contact with the children are vaccinated will help protect these children.\u003c/p>\n\u003cp>As the bill currently reads, violations would be a criminal offense. Mendoza says lawmakers are working to change that.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Kat DeBurgh is the executive director of the Health Officers Association of California, which sponsored SB792. She said the bill is about disease control.\u003c/p>\n\u003cp>“We certainly aren’t out to arrest people who aren’t vaccinated,” DeBurgh said. “We wanted to make this just like any other violation of code that an inspector would look for. If you don’t remediate, then there is a fine to the day care center.”\u003c/p>\n\u003cp>Child care workers who cannot show proof of vaccination would be given 90 days to comply -- or employers would be required to fire them. If the employer failed to fire an unvaccinated worker, the company would face a fine of $25-$50 per day. The fines would begin after 90 days.\u003c/p>\n\u003cp>Mendoza compared the requirement to tuberculosis tests, which are already required for child care workers.\u003c/p>\n\u003cp>“If you don't come back with proof that you took the [tuberculosis] test and show that you’re negative, you can't come back to work,” he said. “It’s the same.”\u003c/p>\n\u003cp>If the bill becomes law, it would affect more than 300,000 child care workers in more than 40,000 child care centers across the state, according to Community Care Licensing Division of the California Department of Social Services (CDSS).\u003c/p>\n\u003cp>While philosophical and religious exemptions to immunization have been discussed when amending other vaccination bills, Mendoza said, lawmakers drafting SB792 are only allowing for medical exemption.\u003c/p>\n\u003cp>“I haven’t seen any religion against [vaccination,]” Mendoza said. ”If people want to read into their religion in a certain way to make it seem like they're against this as a religious right, I'm not sure how they do that.”\u003c/p>\n\u003cp>Another bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1117\" target=\"_blank\">AB1117,\u003c/a> aims to promote vaccination of 2-year-olds who are insured under Medi-Cal managed care plans. In 2013, 39,000 2-year-olds lacked one or more recommended immunizations.\u003c/p>\n\u003cp>The bill proposes a five-year demonstration project to be reviewed under a contract with the University of California and other researchers. AB1117 is currently on hold in the Assembly suspense file.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>SB792 was scheduled to be heard by the Senate Appropriations Committee Monday, but since there are few costs associated with the bill, it is likely to bypass Appropriations and head to the Senate floor.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>While a move to abolish the vaccine \"personal belief exemption\" has \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/14/california-senate-approves-bill-that-would-end-vaccine-opt-out/\" target=\"_blank\">dominated headlines\u003c/a> in the last weeks across California, two other vaccine-related bills are making their way through the Legislature a bit more quietly. One would require preschool and child care workers to have certain vaccinations; another seeks to improve vaccination rates for 2-year-olds.\u003c/p>\n\u003cp>If\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml\" target=\"_blank\"> SB792\u003c/a> becomes law, California will be the first state in the country to require that all preschool and child care workers be immunized against measles, pertussis and the flu.\u003c/p>\n\u003cp>Sen. Tony Mendoza (D-Montebello) says that most people are startled to find out such a mandate is not already in place. \"Most people … say 'We don't do that now?' \" he said. \"So this is something that's needed.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Mendoza says that the bill is designed to protect children who cannot be vaccinated or fully vaccinated because of their age or medical condition. Ensuring that adults in close contact with the children are vaccinated will help protect these children.\u003c/p>\n\u003cp>As the bill currently reads, violations would be a criminal offense. Mendoza says lawmakers are working to change that.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Kat DeBurgh is the executive director of the Health Officers Association of California, which sponsored SB792. She said the bill is about disease control.\u003c/p>\n\u003cp>“We certainly aren’t out to arrest people who aren’t vaccinated,” DeBurgh said. “We wanted to make this just like any other violation of code that an inspector would look for. If you don’t remediate, then there is a fine to the day care center.”\u003c/p>\n\u003cp>Child care workers who cannot show proof of vaccination would be given 90 days to comply -- or employers would be required to fire them. If the employer failed to fire an unvaccinated worker, the company would face a fine of $25-$50 per day. The fines would begin after 90 days.\u003c/p>\n\u003cp>Mendoza compared the requirement to tuberculosis tests, which are already required for child care workers.\u003c/p>\n\u003cp>“If you don't come back with proof that you took the [tuberculosis] test and show that you’re negative, you can't come back to work,” he said. “It’s the same.”\u003c/p>\n\u003cp>If the bill becomes law, it would affect more than 300,000 child care workers in more than 40,000 child care centers across the state, according to Community Care Licensing Division of the California Department of Social Services (CDSS).\u003c/p>\n\u003cp>While philosophical and religious exemptions to immunization have been discussed when amending other vaccination bills, Mendoza said, lawmakers drafting SB792 are only allowing for medical exemption.\u003c/p>\n\u003cp>“I haven’t seen any religion against [vaccination,]” Mendoza said. ”If people want to read into their religion in a certain way to make it seem like they're against this as a religious right, I'm not sure how they do that.”\u003c/p>\n\u003cp>Another bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1117\" target=\"_blank\">AB1117,\u003c/a> aims to promote vaccination of 2-year-olds who are insured under Medi-Cal managed care plans. In 2013, 39,000 2-year-olds lacked one or more recommended immunizations.\u003c/p>\n\u003cp>The bill proposes a five-year demonstration project to be reviewed under a contract with the University of California and other researchers. AB1117 is currently on hold in the Assembly suspense file.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>SB792 was scheduled to be heard by the Senate Appropriations Committee Monday, but since there are few costs associated with the bill, it is likely to bypass Appropriations and head to the Senate floor.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How One Hospital Brought Its C-Section Rate Down In A Hurry",
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"content": "\u003cp>NEWPORT BEACH, Calif.— Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly.\u003c/p>\n\u003cp>A big insurer had warned that its maternity costs were too high and it might be cut from the plan’s network. The reason? Too many cesarean sections.\u003c/p>\n\u003cp>“We were under intense scrutiny,” said Dr. Allyson Brooks, executive medical director of Hoag’s women’s health institute.\u003c/p>\n\u003cp>The C-section rate at the time, in early 2012, was about 38 percent. That was higher than the state average of 33 percent and above most others in the area, according to the California Maternal Quality Care Collaborative, which seeks to use data to improve birth outcomes.\u003c/p>\n\u003cp>Within three years, Hoag had lowered its cesarean section rates for all women to just over a third of all births. For low-risk births (first-time moms with single, normal pregnancies), the rate dropped to about a quarter of births. Hoag also increased the percentage of women who had vaginal births after delivering previous children by C-section.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In medicine, this qualifies as a quick turnaround. And the story of how Hoag changed sheds light on what it takes to rapidly improve a hospital’s performance of crucial services, to the benefit of patients, insurers and taxpayers.\u003c/p>\n\u003cfigure id=\"attachment_25740\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-4.jpg\">\u003cimg class=\"size-thumbnail wp-image-25740\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-4-400x267.jpg\" alt=\"According to the Pacific Business Group on Health, surgical births cost about $7,000 more than vaginal births.\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-960x641.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">According to the Pacific Business Group on Health, surgical births cost about $7,000 more than vaginal births. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Decreasing C-sections results in “better health to mothers and better health to babies and lower costs,” said Stephanie Teleki, senior program officer at the California HealthCare Foundation, which helped fund the data collection and analysis by the California Maternal Quality Care Collaborative. “That’s like a nirvana moment in health care.”\u003c/p>\n\u003cp>Experts have long been troubled by the wide variation of C-sections among hospitals nationally. (In California, the rates range from 18 percent to 56 percent.) Certainly there are instances in which C-sections are typically recommended – such as a baby in breech position. But the disparities suggest that decisions are being driven by factors other than medical necessity – such as doctors’ time constraints and malpractice concerns.\u003c/p>\n\u003cp>Over the past few years, there has been a coordinated push to cut C-section rates in other states and in \u003ca title=\"http://kaiserhealthnews.org/news/early-elective-deliveries-leapfrog-group/\" href=\"http://kaiserhealthnews.org/news/early-elective-deliveries-leapfrog-group/\" target=\"_blank\">births covered by Medicaid\u003c/a>, the health coverage program for low-income Americans.\u003c/p>\n\u003cp>Across California, \u003ca title=\"http://www.chcf.org/publications/2014/11/tale-two-births http://www.pbgh.org/storage/documents/PBGH_C-Section_NTSV_Variation_Report.pdf\" href=\"http://www.chcf.org/publications/2014/11/tale-two-births%20http://www.pbgh.org/storage/documents/PBGH_C-Section_NTSV_Variation_Report.pdf\" target=\"_blank\">data publicly released\u003c/a> by the California HealthCare Foundation, the Pacific Business Group on Health and others in the past few years have underscored the differences in how hospitals handle maternity care.\u003c/p>\n\u003cp>Despite the increased transparency, however, many hospitals don’t act until dollars are at stake, said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative. That’s what happened with Hoag, which Main said is now becoming a model for others.\u003c/p>\n\u003cp>“In quality improvement, we call it ‘the burning bridge,’” he said. “You can’t just stay still. You’ve got to move.”\u003c/p>\n\u003cp>\u003cstrong>Focus on Physicians\u003c/strong>\u003c/p>\n\u003cp>At Hoag, where more than 6,000 babies are born each year, Brooks and other administrators knew that they had to focus on changing the mindset and behavior of physicians. “Hospitals don’t do C-sections, doctors do,” she said.\u003c/p>\n\u003cfigure id=\"attachment_25742\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-2-e1431122104603.jpg\">\u003cimg class=\"size-thumbnail wp-image-25742\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-2-400x267.jpg\" alt=\"Hoag Memorial Hospital in Newport Beach. In 2012, its c-section date was about 38 percent -- 5 percent higher than the state average.\" width=\"400\" height=\"267\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hoag Memorial Hospital in Newport Beach. In 2012, its c-section date was about 38 percent -- 5 percent higher than the state average. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So they took some aggressive steps. First, they shared the data with all the physicians in the department without names -- then decided to reveal the names. Suddenly, everyone knew who had exceeded or come in under the average.\u003c/p>\n\u003cp>“There was a lot of upheaval,” Dr. Jeffrey Illeck, a community OB-GYN and the hospital’s obstetrics department chair. “None of us want to look bad in front of our peers. … And some looked horrible.”\u003c/p>\n\u003cp>Some physicians reacted with surprise and frustration. Initially, many attributed the high rates to the patients, saying they were older, had more complicated pregnancies or demanded scheduled C-sections.\u003c/p>\n\u003cp>Dr. Amy VanBlaricom, an OB-GYN who delivers about 25 to 30 babies a month, said she wasn’t opposed to sharing the data. But she said doctors were worried that the rates would be used to penalize them rather than to drive improvement.\u003c/p>\n\u003cp>“It’s very heated,” she said. “We should use this data as an opportunity rather than a polarizing topic.”\u003c/p>\n\u003cp>VanBlaricom already tracked her own rates, which she said fell in the middle of the pack, and has only seen a small drop since. But she said being aware that Hoag is monitoring the C-sections has changed how she thinks about her practice and has encouraged her to let women remain in labor longer.\u003c/p>\n\u003cp>That’s what Hoag administrators were aiming for – a realization among doctors that C-sections should not be undertaken lightly. They carry surgical risks, including serious infection and blood clots, and require longer hospital stays.\u003c/p>\n\u003cp>“Doctors and patients look at cesareans as an easy way to time the birth,” said Dr. Marlin Mills, chief of perinatology at the hospital. “But a C-section is not benign. It’s a big surgery.”\u003c/p>\n\u003cp>The costs are also well-documented. Surgical births cost nearly $19,000, compared to about $11,500 for vaginal births, according to the Pacific Business Group on Health, (PBGH) an organization of employers that is also working to bring down C-section rates around the state.\u003c/p>\n\u003cp>PBGH worked with the hospital on the financial side. It enlisted the help of some of the biggest local employers, including Disney, and another insurer, Blue Shield, to adjust payments so the hospital didn’t earn more from elective C-sections than vaginal births.\u003c/p>\n\u003cp>Hoag took other steps, too:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>New scheduling rules:\u003c/strong> In the past, doctors could simply call in with the woman’s due date and schedule the birth. Now, they have to fill out a detailed form, with some requests needing special approval.\u003c/li>\n\u003cli>\u003cstrong>Improved patient education:\u003c/strong> The hospital encourages women to wait for labor to come naturally. If patients want an elective C-section, they have to sign a consent form in the doctor’s office that details the risks.\u003c/li>\n\u003cli>\u003cstrong>Engaged nurses in the effort:\u003c/strong> Nurses use various techniques to help laboring women avoid C-sections and receive end-of-year bonuses if they help the hospital reach certain goals on reducing surgical births.\u003c/li>\n\u003cli>\u003cstrong>Expanded its use of \"laborists\":\u003c/strong> A new obstetrics emergency room is staffed around the clock with doctors specifically assigned to monitor women in labor, deliver babies and respond to emergencies.\u003c/li>\n\u003c/ul>\n\u003cp>Dr. Alex Deyan, who delivered more than 500 babies at the hospital last year, used to turn away patients who wanted vaginal births after cesarean sections. With a busy private practice, Deyan said he couldn’t always be immediately available if labor didn’t go as expected and a woman needed a C-section. That changed with the laborist program.\u003c/p>\n\u003cp>“Having in-house doctors 24/7 is a huge benefit,” Deyan said. “I can be a little more patient.”\u003c/p>\n\u003cp>\u003cstrong>Good for Patients Too\u003c/strong>\u003c/p>\n\u003cp>Holly Grim appreciated Hoag’s approach. She knew she didn’t want a C-section with her second baby. Her first labor at another hospital in December 2013 was long and painful and ended with a cesarean section that kept her in the hospital for days. Her son was healthy, but she said, “this wasn’t exactly how I had it planned – not even close.”\u003c/p>\n\u003cp>This time, she needed to get back on her feet quickly so she could chase after her 16-month-old. She decided to switch to a doctor at Hoag. And in early April, she got her wish -- giving birth naturally to an 8-pound girl, Agnes.\u003c/p>\n\u003cp>The day after Agnes was born, the family was packing up to go home. She didn’t have any restrictions on lifting or driving, and she wasn’t in severe pain. This, she said, is how childbirth is supposed to be.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I’m feeling really good,” she said as she nursed Agnes, wrapped in a blanket decorated with pastel footprints. “I’m relieved I’ll be able to run around after my son.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>NEWPORT BEACH, Calif.— Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly.\u003c/p>\n\u003cp>A big insurer had warned that its maternity costs were too high and it might be cut from the plan’s network. The reason? Too many cesarean sections.\u003c/p>\n\u003cp>“We were under intense scrutiny,” said Dr. Allyson Brooks, executive medical director of Hoag’s women’s health institute.\u003c/p>\n\u003cp>The C-section rate at the time, in early 2012, was about 38 percent. That was higher than the state average of 33 percent and above most others in the area, according to the California Maternal Quality Care Collaborative, which seeks to use data to improve birth outcomes.\u003c/p>\n\u003cp>Within three years, Hoag had lowered its cesarean section rates for all women to just over a third of all births. For low-risk births (first-time moms with single, normal pregnancies), the rate dropped to about a quarter of births. Hoag also increased the percentage of women who had vaginal births after delivering previous children by C-section.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In medicine, this qualifies as a quick turnaround. And the story of how Hoag changed sheds light on what it takes to rapidly improve a hospital’s performance of crucial services, to the benefit of patients, insurers and taxpayers.\u003c/p>\n\u003cfigure id=\"attachment_25740\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-4.jpg\">\u003cimg class=\"size-thumbnail wp-image-25740\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-4-400x267.jpg\" alt=\"According to the Pacific Business Group on Health, surgical births cost about $7,000 more than vaginal births.\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-960x641.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">According to the Pacific Business Group on Health, surgical births cost about $7,000 more than vaginal births. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Decreasing C-sections results in “better health to mothers and better health to babies and lower costs,” said Stephanie Teleki, senior program officer at the California HealthCare Foundation, which helped fund the data collection and analysis by the California Maternal Quality Care Collaborative. “That’s like a nirvana moment in health care.”\u003c/p>\n\u003cp>Experts have long been troubled by the wide variation of C-sections among hospitals nationally. (In California, the rates range from 18 percent to 56 percent.) Certainly there are instances in which C-sections are typically recommended – such as a baby in breech position. But the disparities suggest that decisions are being driven by factors other than medical necessity – such as doctors’ time constraints and malpractice concerns.\u003c/p>\n\u003cp>Over the past few years, there has been a coordinated push to cut C-section rates in other states and in \u003ca title=\"http://kaiserhealthnews.org/news/early-elective-deliveries-leapfrog-group/\" href=\"http://kaiserhealthnews.org/news/early-elective-deliveries-leapfrog-group/\" target=\"_blank\">births covered by Medicaid\u003c/a>, the health coverage program for low-income Americans.\u003c/p>\n\u003cp>Across California, \u003ca title=\"http://www.chcf.org/publications/2014/11/tale-two-births http://www.pbgh.org/storage/documents/PBGH_C-Section_NTSV_Variation_Report.pdf\" href=\"http://www.chcf.org/publications/2014/11/tale-two-births%20http://www.pbgh.org/storage/documents/PBGH_C-Section_NTSV_Variation_Report.pdf\" target=\"_blank\">data publicly released\u003c/a> by the California HealthCare Foundation, the Pacific Business Group on Health and others in the past few years have underscored the differences in how hospitals handle maternity care.\u003c/p>\n\u003cp>Despite the increased transparency, however, many hospitals don’t act until dollars are at stake, said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative. That’s what happened with Hoag, which Main said is now becoming a model for others.\u003c/p>\n\u003cp>“In quality improvement, we call it ‘the burning bridge,’” he said. “You can’t just stay still. You’ve got to move.”\u003c/p>\n\u003cp>\u003cstrong>Focus on Physicians\u003c/strong>\u003c/p>\n\u003cp>At Hoag, where more than 6,000 babies are born each year, Brooks and other administrators knew that they had to focus on changing the mindset and behavior of physicians. “Hospitals don’t do C-sections, doctors do,” she said.\u003c/p>\n\u003cfigure id=\"attachment_25742\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-2-e1431122104603.jpg\">\u003cimg class=\"size-thumbnail wp-image-25742\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-2-400x267.jpg\" alt=\"Hoag Memorial Hospital in Newport Beach. In 2012, its c-section date was about 38 percent -- 5 percent higher than the state average.\" width=\"400\" height=\"267\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hoag Memorial Hospital in Newport Beach. In 2012, its c-section date was about 38 percent -- 5 percent higher than the state average. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So they took some aggressive steps. First, they shared the data with all the physicians in the department without names -- then decided to reveal the names. Suddenly, everyone knew who had exceeded or come in under the average.\u003c/p>\n\u003cp>“There was a lot of upheaval,” Dr. Jeffrey Illeck, a community OB-GYN and the hospital’s obstetrics department chair. “None of us want to look bad in front of our peers. … And some looked horrible.”\u003c/p>\n\u003cp>Some physicians reacted with surprise and frustration. Initially, many attributed the high rates to the patients, saying they were older, had more complicated pregnancies or demanded scheduled C-sections.\u003c/p>\n\u003cp>Dr. Amy VanBlaricom, an OB-GYN who delivers about 25 to 30 babies a month, said she wasn’t opposed to sharing the data. But she said doctors were worried that the rates would be used to penalize them rather than to drive improvement.\u003c/p>\n\u003cp>“It’s very heated,” she said. “We should use this data as an opportunity rather than a polarizing topic.”\u003c/p>\n\u003cp>VanBlaricom already tracked her own rates, which she said fell in the middle of the pack, and has only seen a small drop since. But she said being aware that Hoag is monitoring the C-sections has changed how she thinks about her practice and has encouraged her to let women remain in labor longer.\u003c/p>\n\u003cp>That’s what Hoag administrators were aiming for – a realization among doctors that C-sections should not be undertaken lightly. They carry surgical risks, including serious infection and blood clots, and require longer hospital stays.\u003c/p>\n\u003cp>“Doctors and patients look at cesareans as an easy way to time the birth,” said Dr. Marlin Mills, chief of perinatology at the hospital. “But a C-section is not benign. It’s a big surgery.”\u003c/p>\n\u003cp>The costs are also well-documented. Surgical births cost nearly $19,000, compared to about $11,500 for vaginal births, according to the Pacific Business Group on Health, (PBGH) an organization of employers that is also working to bring down C-section rates around the state.\u003c/p>\n\u003cp>PBGH worked with the hospital on the financial side. It enlisted the help of some of the biggest local employers, including Disney, and another insurer, Blue Shield, to adjust payments so the hospital didn’t earn more from elective C-sections than vaginal births.\u003c/p>\n\u003cp>Hoag took other steps, too:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>New scheduling rules:\u003c/strong> In the past, doctors could simply call in with the woman’s due date and schedule the birth. Now, they have to fill out a detailed form, with some requests needing special approval.\u003c/li>\n\u003cli>\u003cstrong>Improved patient education:\u003c/strong> The hospital encourages women to wait for labor to come naturally. If patients want an elective C-section, they have to sign a consent form in the doctor’s office that details the risks.\u003c/li>\n\u003cli>\u003cstrong>Engaged nurses in the effort:\u003c/strong> Nurses use various techniques to help laboring women avoid C-sections and receive end-of-year bonuses if they help the hospital reach certain goals on reducing surgical births.\u003c/li>\n\u003cli>\u003cstrong>Expanded its use of \"laborists\":\u003c/strong> A new obstetrics emergency room is staffed around the clock with doctors specifically assigned to monitor women in labor, deliver babies and respond to emergencies.\u003c/li>\n\u003c/ul>\n\u003cp>Dr. Alex Deyan, who delivered more than 500 babies at the hospital last year, used to turn away patients who wanted vaginal births after cesarean sections. With a busy private practice, Deyan said he couldn’t always be immediately available if labor didn’t go as expected and a woman needed a C-section. That changed with the laborist program.\u003c/p>\n\u003cp>“Having in-house doctors 24/7 is a huge benefit,” Deyan said. “I can be a little more patient.”\u003c/p>\n\u003cp>\u003cstrong>Good for Patients Too\u003c/strong>\u003c/p>\n\u003cp>Holly Grim appreciated Hoag’s approach. She knew she didn’t want a C-section with her second baby. Her first labor at another hospital in December 2013 was long and painful and ended with a cesarean section that kept her in the hospital for days. Her son was healthy, but she said, “this wasn’t exactly how I had it planned – not even close.”\u003c/p>\n\u003cp>This time, she needed to get back on her feet quickly so she could chase after her 16-month-old. She decided to switch to a doctor at Hoag. And in early April, she got her wish -- giving birth naturally to an 8-pound girl, Agnes.\u003c/p>\n\u003cp>The day after Agnes was born, the family was packing up to go home. She didn’t have any restrictions on lifting or driving, and she wasn’t in severe pain. This, she said, is how childbirth is supposed to be.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I’m feeling really good,” she said as she nursed Agnes, wrapped in a blanket decorated with pastel footprints. “I’m relieved I’ll be able to run around after my son.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Therapists Target Mental Health Stigma With 'Sidewalk Talks'",
"title": "Therapists Target Mental Health Stigma With 'Sidewalk Talks'",
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"content": "\u003cp>\u003cspan class=\"Apple-style-span\">Along Market Street in San Francisco Thursday, down the block from the people handing out brochures about Jesus and a man protesting the local bank, a bunch of therapists set some chairs on the sidewalk.\u003c/span>\u003c/p>\n\u003cp>“Free listening!” therapist Traci Ruble called out to passersby. “Do you wanna be listened to?”\u003c/p>\n\u003cp>Most people rushed by, either saying a quick “No thank you,” flashing a bemused smile, or ignoring the offer altogether.\u003c/p>\n\u003cp>“I feel like a canvasser,” Ruble said, admitting she felt a bit rejected.\u003c/p>\n\u003cp>It was a tough and unusual sell: asking people to take 15 minutes out of their lunch break to sit on the street and talk with a therapist. But Ruble and her collaborator, therapist Lily Sloane, say they have a noble objective.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The goal is really about de-stigmatizing mental health,” Ruble says, adding that they also want to combat the technology culture that has people walking down the street with their eyes glued to their cellphones. She says she misses random urban interactions.\u003c/p>\n\u003cp>“I love seeing someone dancing in the street, or when an old lady calls me sweetheart,” she says. “I want everyone to feel like we belong. I feel like that has a huge impact on mental health itself.”\u003c/p>\n\u003cp>She organized more than two dozen therapists -- and a couple nuns from the \u003ca title=\"http://www.thesisters.org\" href=\"http://www.thesisters.org\" target=\"_blank\" rel=\"noopener noreferrer\">Sisters of Perpetual Indulgence\u003c/a> -- to station themselves at spots throughout San Francisco for a day of “\u003ca title=\"http://www.sidewalktalksf.com/about.html\" href=\"http://www.sidewalktalksf.com/about.html\" target=\"_blank\" rel=\"noopener noreferrer\">Sidewalk Talks\u003c/a>.”\u003c/p>\n\u003cp>Before long, Ruble’s calls outside the Embarcadero BART station -- and bright yellow “Free Listening” fliers taped on the sidewalk --managed to snag the first customer of the day, Tony.\u003c/p>\n\u003cp>“I recently came out of the closet with my bi-polar disorder,” he said.\u003c/p>\n\u003cp>He tells Ruble that when he was younger, he was taught to be ashamed of his condition, and to hide his medication. Sometimes he'd stop taking it altogether.\u003c/p>\n\u003cp>“Every time I wound up in the hospital,” he said.\u003c/p>\n\u003cp>“Which isn’t great for you,” Ruble responded.\u003c/p>\n\u003cp>“Which is not good for me at all,” said Tony, who did not want his last name to be included in this story.\u003c/p>\n\u003cp>“It’s like a person with really high blood pressure not taking their blood pressure medicine,” Ruble said. “You could die.”\u003c/p>\n\u003cp>“Yeah, exactly,” he said. “So this idea of me accepting my condition has always been difficult and challenging, because of my own self-stigma, because of stigma I feel from others around me.”\u003c/p>\n\u003cp>He says the attitude around mental illness today is similar to the gay rights movement in the 1980s. He says more people need to go public with their depression or anxiety so it becomes more broadly accepted throughout the culture.\u003c/p>\n\u003cp>“We have to have the courage to look people eye to eye,” he said.\u003c/p>\n\u003cp>Ruble says she’s gotten calls from several other cities in the country that want to replicate the idea of Sidewalk Talks. In San Francisco, they plan to repeat the event at least once a year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/204574311\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The goal is really about de-stigmatizing mental health,” Ruble says, adding that they also want to combat the technology culture that has people walking down the street with their eyes glued to their cellphones. She says she misses random urban interactions.\u003c/p>\n\u003cp>“I love seeing someone dancing in the street, or when an old lady calls me sweetheart,” she says. “I want everyone to feel like we belong. I feel like that has a huge impact on mental health itself.”\u003c/p>\n\u003cp>She organized more than two dozen therapists -- and a couple nuns from the \u003ca title=\"http://www.thesisters.org\" href=\"http://www.thesisters.org\" target=\"_blank\" rel=\"noopener noreferrer\">Sisters of Perpetual Indulgence\u003c/a> -- to station themselves at spots throughout San Francisco for a day of “\u003ca title=\"http://www.sidewalktalksf.com/about.html\" href=\"http://www.sidewalktalksf.com/about.html\" target=\"_blank\" rel=\"noopener noreferrer\">Sidewalk Talks\u003c/a>.”\u003c/p>\n\u003cp>Before long, Ruble’s calls outside the Embarcadero BART station -- and bright yellow “Free Listening” fliers taped on the sidewalk --managed to snag the first customer of the day, Tony.\u003c/p>\n\u003cp>“I recently came out of the closet with my bi-polar disorder,” he said.\u003c/p>\n\u003cp>He tells Ruble that when he was younger, he was taught to be ashamed of his condition, and to hide his medication. Sometimes he'd stop taking it altogether.\u003c/p>\n\u003cp>“Every time I wound up in the hospital,” he said.\u003c/p>\n\u003cp>“Which isn’t great for you,” Ruble responded.\u003c/p>\n\u003cp>“Which is not good for me at all,” said Tony, who did not want his last name to be included in this story.\u003c/p>\n\u003cp>“It’s like a person with really high blood pressure not taking their blood pressure medicine,” Ruble said. “You could die.”\u003c/p>\n\u003cp>“Yeah, exactly,” he said. “So this idea of me accepting my condition has always been difficult and challenging, because of my own self-stigma, because of stigma I feel from others around me.”\u003c/p>\n\u003cp>He says the attitude around mental illness today is similar to the gay rights movement in the 1980s. He says more people need to go public with their depression or anxiety so it becomes more broadly accepted throughout the culture.\u003c/p>\n\u003cp>“We have to have the courage to look people eye to eye,” he said.\u003c/p>\n\u003cp>Ruble says she’s gotten calls from several other cities in the country that want to replicate the idea of Sidewalk Talks. In San Francisco, they plan to repeat the event at least once a year.\u003c/p>\n\u003cp>\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/204574311&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/204574311'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Know Someone with Cancer? Here Are the Cards You Should Really Send",
"title": "Know Someone with Cancer? Here Are the Cards You Should Really Send",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/267_ILlnessJourney.jpg\">\u003cimg class=\"aligncenter size-full wp-image-25421\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/267_ILlnessJourney.jpg\" alt=\"267_ILlnessJourney\" width=\"1800\" height=\"2400\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney.jpg 1800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney-1440x1920.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney-960x1280.jpg 960w\" sizes=\"(max-width: 1800px) 100vw, 1800px\">\u003c/a>When a friend or loved one gets sick — really, seriously sick — it's hard to know what to say. So some of us say nothing. Which seems better than saying the wrong thing, though people do that too.\u003c/p>\n\u003cp>Los Angeles graphic designer \u003ca title=\"http://emilymcdowell.com/pages/emily-mcdowellthe-person\" href=\"http://emilymcdowell.com/pages/emily-mcdowellthe-person\" target=\"_blank\">Emily McDowell's \u003c/a>solution to this dilemma are what she calls \u003ca title=\"http://emilymcdowell.com/search?type=product&q=Empathy+cards\" href=\"http://emilymcdowell.com/search?type=product&q=Empathy+cards\" target=\"_blank\">Empathy Cards\u003c/a>. When someone is seriously ill, she says, the usual \"Get Well Soon\" won't do. Because you might not, she says. At least not soon.\u003c/p>\n\u003cp>McDowell knows this from experience. She's a 15-year survivor of \u003ca title=\"http://www.cancer.gov/cancertopics/types/lymphoma\" href=\"http://www.cancer.gov/cancertopics/types/lymphoma\" target=\"_blank\">Hodgkin lymphoma\u003c/a>. She was just 24 when she was diagnosed.\u003cbr>\n\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/263_HappensForReason.jpg\">\u003cimg class=\"alignright wp-image-25427 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/263_HappensForReason-400x533.jpg\" alt=\"263_HappensForReason\" width=\"400\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/263_HappensForReason-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/263_HappensForReason-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/263_HappensForReason-1440x1920.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/263_HappensForReason-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/263_HappensForReason-960x1280.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cbr>\n\"The most difficult thing about my illness was the fact that it was so lonely,\" she says. One of the reasons was \"friends and family either disappearing because they didn't know what to say or well-intentioned people saying the wrong thing. So one of the most difficult things about being sick was feeling really alienated from everyone that I knew.\"\u003c/p>\n\u003cp>McDowell says she often got well-meaning advice on Internet \"cures.\" \"The thing that I felt when it was happening to me was: 'I also have the Internet. And I really appreciate you trying to help, but believe me, I've spent way too many hours Googling my own condition and any possible treatments. And I've made the decisions to do the things that I'm doing because I felt like they were the best choices for me.' \"\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/265_CureInternet.jpg\">\u003cimg class=\"alignleft wp-image-25429 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/265_CureInternet-400x533.jpg\" alt=\"265_CureInternet\" width=\"400\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/265_CureInternet-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/265_CureInternet-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/265_CureInternet-1440x1920.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/265_CureInternet-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/265_CureInternet-960x1280.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>And then there's \"Everything happens for a reason.\" With time and distance, some people do come to that conclusion on their own, McDowell says. But \"hearing that immediately after some shocking or terrible thing happens in your life is generally not what people want to hear.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>What is it with people who respond to the news of your dire prognosis with more bad news? That was the impetus for \"When life gives you lemons, I won't tell you a story about my cousin's friend who died of lemons.\"\u003c/p>\n\u003cp>\"This is a weird thing that people do. When they found out ... that I had cancer, it was 'Oh yeah, so and so I know had cancer and they died.' ... It's like sort of knee-jerk 'Oh, I can relate to this' and then they don't really think about the ending. ... But it's really surprising how many people this happens to and how common that is as a reaction.\"\u003c/p>\n\u003cp>And wouldn't it be great if no one ever referred to your illness as a \"journey\"? \"With time and distance some people do come to that conclusion on their own that this ... feels like a journey,\" McDowell says. \"But a lot of people really feel like 'If this is a journey I'd like my ticket refunded,' or 'This is a journey to hell and back.' \"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/264_ChemoDown.jpg\">\u003cimg class=\"aligncenter wp-image-25428 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/264_ChemoDown-400x533.jpg\" alt=\"264_ChemoDown\" width=\"400\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/264_ChemoDown-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/264_ChemoDown-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/264_ChemoDown-1440x1920.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/264_ChemoDown-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/264_ChemoDown-960x1280.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003c/p>\n\n",
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"excerpt": "Graphic designer -- also a cancer survivor -- designed the \"empathy cards\" she wishes she had received. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/267_ILlnessJourney.jpg\">\u003cimg class=\"aligncenter size-full wp-image-25421\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/267_ILlnessJourney.jpg\" alt=\"267_ILlnessJourney\" width=\"1800\" height=\"2400\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney.jpg 1800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney-1440x1920.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/267_ILlnessJourney-960x1280.jpg 960w\" sizes=\"(max-width: 1800px) 100vw, 1800px\">\u003c/a>When a friend or loved one gets sick — really, seriously sick — it's hard to know what to say. So some of us say nothing. Which seems better than saying the wrong thing, though people do that too.\u003c/p>\n\u003cp>Los Angeles graphic designer \u003ca title=\"http://emilymcdowell.com/pages/emily-mcdowellthe-person\" href=\"http://emilymcdowell.com/pages/emily-mcdowellthe-person\" target=\"_blank\">Emily McDowell's \u003c/a>solution to this dilemma are what she calls \u003ca title=\"http://emilymcdowell.com/search?type=product&q=Empathy+cards\" href=\"http://emilymcdowell.com/search?type=product&q=Empathy+cards\" target=\"_blank\">Empathy Cards\u003c/a>. When someone is seriously ill, she says, the usual \"Get Well Soon\" won't do. Because you might not, she says. At least not soon.\u003c/p>\n\u003cp>McDowell knows this from experience. She's a 15-year survivor of \u003ca title=\"http://www.cancer.gov/cancertopics/types/lymphoma\" href=\"http://www.cancer.gov/cancertopics/types/lymphoma\" target=\"_blank\">Hodgkin lymphoma\u003c/a>. She was just 24 when she was diagnosed.\u003cbr>\n\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/263_HappensForReason.jpg\">\u003cimg class=\"alignright wp-image-25427 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/263_HappensForReason-400x533.jpg\" alt=\"263_HappensForReason\" width=\"400\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/263_HappensForReason-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/263_HappensForReason-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/263_HappensForReason-1440x1920.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/263_HappensForReason-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/263_HappensForReason-960x1280.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cbr>\n\"The most difficult thing about my illness was the fact that it was so lonely,\" she says. One of the reasons was \"friends and family either disappearing because they didn't know what to say or well-intentioned people saying the wrong thing. So one of the most difficult things about being sick was feeling really alienated from everyone that I knew.\"\u003c/p>\n\u003cp>McDowell says she often got well-meaning advice on Internet \"cures.\" \"The thing that I felt when it was happening to me was: 'I also have the Internet. And I really appreciate you trying to help, but believe me, I've spent way too many hours Googling my own condition and any possible treatments. And I've made the decisions to do the things that I'm doing because I felt like they were the best choices for me.' \"\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/265_CureInternet.jpg\">\u003cimg class=\"alignleft wp-image-25429 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/265_CureInternet-400x533.jpg\" alt=\"265_CureInternet\" width=\"400\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/265_CureInternet-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/265_CureInternet-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/265_CureInternet-1440x1920.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/265_CureInternet-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/265_CureInternet-960x1280.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>And then there's \"Everything happens for a reason.\" With time and distance, some people do come to that conclusion on their own, McDowell says. But \"hearing that immediately after some shocking or terrible thing happens in your life is generally not what people want to hear.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>What is it with people who respond to the news of your dire prognosis with more bad news? That was the impetus for \"When life gives you lemons, I won't tell you a story about my cousin's friend who died of lemons.\"\u003c/p>\n\u003cp>\"This is a weird thing that people do. When they found out ... that I had cancer, it was 'Oh yeah, so and so I know had cancer and they died.' ... It's like sort of knee-jerk 'Oh, I can relate to this' and then they don't really think about the ending. ... But it's really surprising how many people this happens to and how common that is as a reaction.\"\u003c/p>\n\u003cp>And wouldn't it be great if no one ever referred to your illness as a \"journey\"? \"With time and distance some people do come to that conclusion on their own that this ... feels like a journey,\" McDowell says. \"But a lot of people really feel like 'If this is a journey I'd like my ticket refunded,' or 'This is a journey to hell and back.' \"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/264_ChemoDown.jpg\">\u003cimg class=\"aligncenter wp-image-25428 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/264_ChemoDown-400x533.jpg\" alt=\"264_ChemoDown\" width=\"400\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/264_ChemoDown-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/264_ChemoDown-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/264_ChemoDown-1440x1920.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/264_ChemoDown-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/264_ChemoDown-960x1280.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "State Expands Dental Coverage for Poor — But Getting Treatment Is Another Matter",
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"content": "\u003cp>Inside the cavernous main building at the Sacramento County Fairgrounds was a beehive of activity. But this was no county fair or concert.\u003c/p>\n\u003cp>Instead, hundreds of long, reclining dental chairs fill the floor, and 2,000 people wait for a turn. The sound of drilling buzzed the air, and the acrid smell of anesthetic permeated it.\u003c/p>\n\u003cp>It was free dental day – a special program run by the California Dental Association Foundation. “CDA Cares” took over the entire fairgrounds for this event in March, and 300 dentists were busy pumping in Novocain and making lame jokes to captive patients.\u003c/p>\n\u003cp>Across the broad hall, there was one station for filling cavities, one for root canals, another for extractions, yet another for dentures.\u003c/p>\n\u003cp>It looked like a sort of Dental Disneyland.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rhonda Morse of Sacramento was among the patients. She camped out at the fairgrounds the night before the event.\u003c/p>\n\u003cp>“Got here at 7 o’clock last night,” she said. “We slept outside. It gets crowded real fast.”\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/204359777″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>That’s because the need is so profound. Denti-Cal, the state’s program of dental care for low-income Californians, including 5 million children, is in disarray. At a time when millions more have been added into coverage, it’s becoming harder to find dental care. The CDA Foundation \u003ca title=\"http://www.cdafoundation.org/cda-cares\" href=\"http://www.cdafoundation.org/cda-cares\" target=\"_blank\" rel=\"noopener\">estimates that 10 million Californians\u003c/a> face barriers to dental care.\u003c/p>\n\u003cp>Morse knows this first-hand.\u003c/p>\n\u003cp>“It takes months to get in, then you get an appointment, and it takes months to get in again,” she explained.\u003c/p>\n\u003cp>She said it would have taken her years of appointments to get the dental care she received in a single day at the fair.\u003c/p>\n\u003cp>“Coverage and access are two different things,” said James Stephens, a Palo Alto dentist and former chair of the California Dental Association who volunteered for the Sacramento event.\u003c/p>\n\u003cp>The reason there’s no access, he said, is because so few dentists take Denti-Cal patients — because they lose money on every one of them.\u003c/p>\n\u003cp>“Fees have been cut in the program so much, they’re not enough to create a viable provider network,” Stephens said.\u003c/p>\n\u003cfigure id=\"attachment_25339\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/IMG_1429-2-e1430955574138.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-25339\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/IMG_1429-2-800x1067.jpg\" alt=\"George Maranon, an oral surgeon from Encino, is extracting a tooth from a young boy who already has diseased gums. \" width=\"800\" height=\"1067\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">George Maranon, an oral surgeon from Encino, is extracting a tooth from a young boy who already has diseased gums. \u003ccite>(David Gorn/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That network of providers is even thinner now, he said. So there are fewere dentists to serve even more people who have signed up since the state expanded eligibility rules.\u003c/p>\n\u003cp>George Maranon, an oral surgeon from Encino, was working on a tooth extraction at one of the fair stations for a 9-year-old boy with diseased gums. He said he’d rather volunteer his time than take Denti-Cal payments.\u003c/p>\n\u003cp>“There are Denti-Cal patients who I actually see in my practice for free,” Maranon said. “Sometimes dealing with the state in terms of reimbursement can be more expensive than just doing it for free.”\u003c/p>\n\u003cp>Just to get to the national average for provider rates, California would have to spend three times as much as it does now, at least another $100 million a year, according to Elizabeth Mertz, a dental sciences professor at UC San Francisco.\u003c/p>\n\u003cp>Beyond inadequate provider rates, there’s another huge challenge in the Denti-Cal system, Mertz said. Half of the state’s kids are in Denti-Cal, and those kids desperately need preventive care.\u003c/p>\n\u003cp>“So you’re talking about taking care of a large portion of the state’s children,” she said. “If those children grow up with dental disease, they’re going to be adults with dental disease.”\u003c/p>\n\u003cp>She said lawmakers could pass a dental health parity law, and that would put preventive dental health services on the same plane as other essential medical care.\u003c/p>\n\u003cp>“Because nobody’s made it a priority from the top on down,” Mertz said. “When you say something’s essential but you make it optional, that’s not sending the message that it’s a priority.”\u003c/p>\n\u003cp>The new director of the Department of Health Care Services, Jennifer Kent, has acknowledged the deficiencies of Denti-Cal and says fixing it is one of her top two priorities. The department is working on a plan now to restructure the program, but state officials haven’t said whether or not that would include a boost in reimbursement rates.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the meantime, \u003ca title=\"Fresno Dental Fair\" href=\"http://www.cdafoundation.org/cda-cares/fresno\" target=\"_blank\" rel=\"noopener\">the next free California Dental Association dental fair \u003c/a>will be held in Fresno, in October.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Inside the cavernous main building at the Sacramento County Fairgrounds was a beehive of activity. But this was no county fair or concert.\u003c/p>\n\u003cp>Instead, hundreds of long, reclining dental chairs fill the floor, and 2,000 people wait for a turn. The sound of drilling buzzed the air, and the acrid smell of anesthetic permeated it.\u003c/p>\n\u003cp>It was free dental day – a special program run by the California Dental Association Foundation. “CDA Cares” took over the entire fairgrounds for this event in March, and 300 dentists were busy pumping in Novocain and making lame jokes to captive patients.\u003c/p>\n\u003cp>Across the broad hall, there was one station for filling cavities, one for root canals, another for extractions, yet another for dentures.\u003c/p>\n\u003cp>It looked like a sort of Dental Disneyland.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rhonda Morse of Sacramento was among the patients. She camped out at the fairgrounds the night before the event.\u003c/p>\n\u003cp>“Got here at 7 o’clock last night,” she said. “We slept outside. It gets crowded real fast.”\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/204359777″&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/204359777″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That’s because the need is so profound. Denti-Cal, the state’s program of dental care for low-income Californians, including 5 million children, is in disarray. At a time when millions more have been added into coverage, it’s becoming harder to find dental care. The CDA Foundation \u003ca title=\"http://www.cdafoundation.org/cda-cares\" href=\"http://www.cdafoundation.org/cda-cares\" target=\"_blank\" rel=\"noopener\">estimates that 10 million Californians\u003c/a> face barriers to dental care.\u003c/p>\n\u003cp>Morse knows this first-hand.\u003c/p>\n\u003cp>“It takes months to get in, then you get an appointment, and it takes months to get in again,” she explained.\u003c/p>\n\u003cp>She said it would have taken her years of appointments to get the dental care she received in a single day at the fair.\u003c/p>\n\u003cp>“Coverage and access are two different things,” said James Stephens, a Palo Alto dentist and former chair of the California Dental Association who volunteered for the Sacramento event.\u003c/p>\n\u003cp>The reason there’s no access, he said, is because so few dentists take Denti-Cal patients — because they lose money on every one of them.\u003c/p>\n\u003cp>“Fees have been cut in the program so much, they’re not enough to create a viable provider network,” Stephens said.\u003c/p>\n\u003cfigure id=\"attachment_25339\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/IMG_1429-2-e1430955574138.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-25339\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/IMG_1429-2-800x1067.jpg\" alt=\"George Maranon, an oral surgeon from Encino, is extracting a tooth from a young boy who already has diseased gums. \" width=\"800\" height=\"1067\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">George Maranon, an oral surgeon from Encino, is extracting a tooth from a young boy who already has diseased gums. \u003ccite>(David Gorn/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That network of providers is even thinner now, he said. So there are fewere dentists to serve even more people who have signed up since the state expanded eligibility rules.\u003c/p>\n\u003cp>George Maranon, an oral surgeon from Encino, was working on a tooth extraction at one of the fair stations for a 9-year-old boy with diseased gums. He said he’d rather volunteer his time than take Denti-Cal payments.\u003c/p>\n\u003cp>“There are Denti-Cal patients who I actually see in my practice for free,” Maranon said. “Sometimes dealing with the state in terms of reimbursement can be more expensive than just doing it for free.”\u003c/p>\n\u003cp>Just to get to the national average for provider rates, California would have to spend three times as much as it does now, at least another $100 million a year, according to Elizabeth Mertz, a dental sciences professor at UC San Francisco.\u003c/p>\n\u003cp>Beyond inadequate provider rates, there’s another huge challenge in the Denti-Cal system, Mertz said. Half of the state’s kids are in Denti-Cal, and those kids desperately need preventive care.\u003c/p>\n\u003cp>“So you’re talking about taking care of a large portion of the state’s children,” she said. “If those children grow up with dental disease, they’re going to be adults with dental disease.”\u003c/p>\n\u003cp>She said lawmakers could pass a dental health parity law, and that would put preventive dental health services on the same plane as other essential medical care.\u003c/p>\n\u003cp>“Because nobody’s made it a priority from the top on down,” Mertz said. “When you say something’s essential but you make it optional, that’s not sending the message that it’s a priority.”\u003c/p>\n\u003cp>The new director of the Department of Health Care Services, Jennifer Kent, has acknowledged the deficiencies of Denti-Cal and says fixing it is one of her top two priorities. The department is working on a plan now to restructure the program, but state officials haven’t said whether or not that would include a boost in reimbursement rates.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the meantime, \u003ca title=\"Fresno Dental Fair\" href=\"http://www.cdafoundation.org/cda-cares/fresno\" target=\"_blank\" rel=\"noopener\">the next free California Dental Association dental fair \u003c/a>will be held in Fresno, in October.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Whooping Cough Vaccine Effectiveness Fades -- and Fast",
"title": "Whooping Cough Vaccine Effectiveness Fades -- and Fast",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Lately, Californians have been focused on a \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">significant measles outbreak\u003c/a> that just ended. But in the last five years, state health officials have declared an epidemic of whooping cough (also known as pertussis) twice -- in 2010 and in 2014, when \u003ca title=\"http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis%20report%204-20-2015.pdf\" href=\"http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis%20report%204-20-2015.pdf\" target=\"_blank\">11,000 people were sickened\u003c/a> and three infants died.\u003c/p>\n\u003cp>Now an analysis from a recent whooping cough epidemic in Washington state shows that the effectiveness of the Tdap vaccine used to fight whooping cough waned significantly. For adolescents who received all their shots, effectiveness within one year of the final booster was 73 percent. That rate plummeted to 34 percent within two to four years.\u003c/p>\n\u003cp>\"(T)his waning is likely contributing to the increase in pertussis among adolescents,\" the authors wrote.\u003c/p>\n\u003cp>Tdap protects against three diseases: tetanus, diphtheria and pertussis. The pertussis protection is from the acellular pertussis vaccine. It was introduced in 1997 to replace the whole-cell vaccine, which caused more side effects. Monday's report\u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/08/03/todays-whooping-cough-vaccine-may-be-safer-but-less-effective-than-the-old-one/\" href=\"http://ww2.kqed.org/stateofhealth/2012/08/03/todays-whooping-cough-vaccine-may-be-safer-but-less-effective-than-the-old-one/\" target=\"_blank\"> confirms an earlier analysis\u003c/a> that the acellular pertussis may be safer, but less effective, than the old one.\u003c/p>\n\u003cp>\u003ca title=\"http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2014-3358d.abstract\" href=\"http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2014-3358d.abstract\" target=\"_blank\">The study\u003c/a> was published Monday in the journal Pediatrics.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The take-home message is that the waning is there,\" said Dr. Art Reingold, a UC Berkeley professor of public health. \"You're protected initially but it wanes over time.\"\u003c/p>\n\u003cp>It doesn't mean anyone should skip the vaccine. Someone who is vaccinated, but becomes sick with whooping cough, should have a less severe course of illness.\u003c/p>\n\u003cp>The authors said that new vaccines are \"likely needed to reduce the burden of pertussis disease.\" But Reingold, who leads the CDC's Advisory Committee on Immunization Practices (ACIP) group on pertussis, said he doesn't know of any pertussis vaccine development in the pipeline.\u003c/p>\n\u003cp>He also said that adding another dose of the vaccine at a later age would not help much, based on research that was presented to the ACIP group. \"(An additional dose) would have very little impact on pertussis,\" he said, \"in terms of cases prevented.\"\u003c/p>\n\u003cp>The most severe cases are in very young infants, Reingold said. Babies cannot be vaccinated \u003ca title=\"http://www.cdc.gov/pertussis/pregnant/mom/vaccinate-baby.html\" href=\"http://www.cdc.gov/pertussis/pregnant/mom/vaccinate-baby.html\" target=\"_blank\">until they are 2 months old\u003c/a>. To protect newborns before they can be vaccinated, the CDC recommends that women be vaccinated \u003ca title=\"http://www.cdc.gov/pertussis/pregnant/mom/get-vaccinated.html\" href=\"http://www.cdc.gov/pertussis/pregnant/mom/get-vaccinated.html\" target=\"_blank\">during the last trimester of every pregnancy\u003c/a> -- even if they received a vaccine before they became pregnant.\u003c/p>\n\u003cp>\"Babies will be born with circulating antibodies,\" Reingold said, \"and there's pretty good evidence that that will reduce the risk of hospitalization and death in babies.\"\u003c/p>\n\u003cp>In an \u003ca title=\"http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2014-4118.full.pdf+html\" href=\"http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2014-4118.full.pdf+html\" target=\"_blank\">accompanying commentary\u003c/a>, Dr. James Cherry at UCLA said the findings about Tdap effectiveness were \"disappointing,\" but he also pointed to other drivers of recent pertussis outbreaks, including increased awareness and better, more sensitive, testing.\u003c/p>\n\u003cp>Previous reports have shown that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" href=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" target=\"_blank\">vaccine refusal\u003c/a> played a role in the 2010 whooping cough epidemic in California.\u003c/p>\n\u003cp>Reingold also drew an interesting distinction between measles and pertussis having to do with herd immunity. If a great enough percentage of the population is immunized against measles, both individuals and the broader community are protected against outbreak. That's because the measles vaccine protects people against the virus that actually causes the measles illness.\u003c/p>\n\u003cp>But in pertussis, the disease is caused by toxins that are released by bacteria. The pertussis vaccine protects people against those toxins, but may not prevent you from spreading the bacteria to others -- and causing illness in them.\u003c/p>\n\u003cp>The outbreak of measles earlier this year was likely caused by someone who brought the disease back from abroad. Measles was eliminated in the United States in 2000.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Pertussis is not going to go away with the current vaccine,\" Reingold said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lately, Californians have been focused on a \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">significant measles outbreak\u003c/a> that just ended. But in the last five years, state health officials have declared an epidemic of whooping cough (also known as pertussis) twice -- in 2010 and in 2014, when \u003ca title=\"http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis%20report%204-20-2015.pdf\" href=\"http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis%20report%204-20-2015.pdf\" target=\"_blank\">11,000 people were sickened\u003c/a> and three infants died.\u003c/p>\n\u003cp>Now an analysis from a recent whooping cough epidemic in Washington state shows that the effectiveness of the Tdap vaccine used to fight whooping cough waned significantly. For adolescents who received all their shots, effectiveness within one year of the final booster was 73 percent. That rate plummeted to 34 percent within two to four years.\u003c/p>\n\u003cp>\"(T)his waning is likely contributing to the increase in pertussis among adolescents,\" the authors wrote.\u003c/p>\n\u003cp>Tdap protects against three diseases: tetanus, diphtheria and pertussis. The pertussis protection is from the acellular pertussis vaccine. It was introduced in 1997 to replace the whole-cell vaccine, which caused more side effects. Monday's report\u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/08/03/todays-whooping-cough-vaccine-may-be-safer-but-less-effective-than-the-old-one/\" href=\"http://ww2.kqed.org/stateofhealth/2012/08/03/todays-whooping-cough-vaccine-may-be-safer-but-less-effective-than-the-old-one/\" target=\"_blank\"> confirms an earlier analysis\u003c/a> that the acellular pertussis may be safer, but less effective, than the old one.\u003c/p>\n\u003cp>\u003ca title=\"http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2014-3358d.abstract\" href=\"http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2014-3358d.abstract\" target=\"_blank\">The study\u003c/a> was published Monday in the journal Pediatrics.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The take-home message is that the waning is there,\" said Dr. Art Reingold, a UC Berkeley professor of public health. \"You're protected initially but it wanes over time.\"\u003c/p>\n\u003cp>It doesn't mean anyone should skip the vaccine. Someone who is vaccinated, but becomes sick with whooping cough, should have a less severe course of illness.\u003c/p>\n\u003cp>The authors said that new vaccines are \"likely needed to reduce the burden of pertussis disease.\" But Reingold, who leads the CDC's Advisory Committee on Immunization Practices (ACIP) group on pertussis, said he doesn't know of any pertussis vaccine development in the pipeline.\u003c/p>\n\u003cp>He also said that adding another dose of the vaccine at a later age would not help much, based on research that was presented to the ACIP group. \"(An additional dose) would have very little impact on pertussis,\" he said, \"in terms of cases prevented.\"\u003c/p>\n\u003cp>The most severe cases are in very young infants, Reingold said. Babies cannot be vaccinated \u003ca title=\"http://www.cdc.gov/pertussis/pregnant/mom/vaccinate-baby.html\" href=\"http://www.cdc.gov/pertussis/pregnant/mom/vaccinate-baby.html\" target=\"_blank\">until they are 2 months old\u003c/a>. To protect newborns before they can be vaccinated, the CDC recommends that women be vaccinated \u003ca title=\"http://www.cdc.gov/pertussis/pregnant/mom/get-vaccinated.html\" href=\"http://www.cdc.gov/pertussis/pregnant/mom/get-vaccinated.html\" target=\"_blank\">during the last trimester of every pregnancy\u003c/a> -- even if they received a vaccine before they became pregnant.\u003c/p>\n\u003cp>\"Babies will be born with circulating antibodies,\" Reingold said, \"and there's pretty good evidence that that will reduce the risk of hospitalization and death in babies.\"\u003c/p>\n\u003cp>In an \u003ca title=\"http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2014-4118.full.pdf+html\" href=\"http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2014-4118.full.pdf+html\" target=\"_blank\">accompanying commentary\u003c/a>, Dr. James Cherry at UCLA said the findings about Tdap effectiveness were \"disappointing,\" but he also pointed to other drivers of recent pertussis outbreaks, including increased awareness and better, more sensitive, testing.\u003c/p>\n\u003cp>Previous reports have shown that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" href=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" target=\"_blank\">vaccine refusal\u003c/a> played a role in the 2010 whooping cough epidemic in California.\u003c/p>\n\u003cp>Reingold also drew an interesting distinction between measles and pertussis having to do with herd immunity. If a great enough percentage of the population is immunized against measles, both individuals and the broader community are protected against outbreak. That's because the measles vaccine protects people against the virus that actually causes the measles illness.\u003c/p>\n\u003cp>But in pertussis, the disease is caused by toxins that are released by bacteria. The pertussis vaccine protects people against those toxins, but may not prevent you from spreading the bacteria to others -- and causing illness in them.\u003c/p>\n\u003cp>The outbreak of measles earlier this year was likely caused by someone who brought the disease back from abroad. Measles was eliminated in the United States in 2000.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Pertussis is not going to go away with the current vaccine,\" Reingold said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Breast-Feeding May Reduce Risk of Breast Cancer Recurrence, Death",
"title": "Breast-Feeding May Reduce Risk of Breast Cancer Recurrence, Death",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_25163\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/2127061197_7321f7ac3c_o-e1430254712327.jpg\">\u003cimg class=\"size-large wp-image-25163\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/2127061197_7321f7ac3c_o-640x426.jpg\" alt=\"(Ozgur Poyrazoglu via Flickr) \" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Ozgur Poyrazoglu via Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>In a small study, women who had been diagnosed with breast cancer were 30 percent less likely to see a return of the disease if they had a history of breast-feeding. While previous research has found a \u003ca title=\"http://www.cancer.org/cancer/news/expertvoices/post/2013/05/07/can-breastfeeding-lower-breast-cancer-risk.aspx\" href=\"http://www.cancer.org/cancer/news/expertvoices/post/2013/05/07/can-breastfeeding-lower-breast-cancer-risk.aspx\" target=\"_blank\">small protective effect \u003c/a>of breast-feeding and breast cancer risk, researchers from Kaiser Permanente's Division of Research believe this is the first study to explore an association between nursing and a recurrence of cancer.\u003c/p>\n\u003cp>In the study, researchers asked 1,636 women who had breast cancer, mostly Kaiser patients, to fill out a questionnaire that included their history of breast-feeding. \"We followed them for over nine years, and we identified the women who had a recurrence and also those who died of breast cancer,\" said lead author Marilyn Kwan, Ph.D., with Kaiser. \"And we (found) this dramatic reduction in risk of recurrence.\"\u003c/p>\n\u003cp>In addition to the reduced risk of recurrence, the researchers found a 28 percent reduced risk of dying from the disease among women who breast-fed.\u003c!--more-->\u003c/p>\n\u003cp>They study also looked at specific types of tumors. They found that women who had breast-fed were more likely to develop a more common -- and more easily treatable -- kind of tumor, known as luminal A subtype, which includes estrogen-receptor positive tumors.\u003c/p>\n\u003cp>\"These tumors are less likely to spread, to metastasize, and they're treatable with hormonal therapy such as tamoxifen,\" Kwan said. \"Because of this, they have better prognosis. Women who have luminal A tumors are more likely to survive.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The study was published in the \u003ca title=\"http://jnci.oxfordjournals.org/content/107/7/djv087.abstract?sid=d7434ffc-ae03-423d-b438-80acfd8f2a12\" href=\"http://jnci.oxfordjournals.org/content/107/7/djv087.abstract?sid=d7434ffc-ae03-423d-b438-80acfd8f2a12\" target=\"_blank\">Journal of the National Cancer Institute\u003c/a> and was funded by the National Institutes of Health.\u003c/p>\n\u003cp>Kwan said that breast-feeding \"can increase the maturation of the cells in the breast.\" She theorized that it may set up a \"molecular environment that makes a tumor more responsive to therapy, so women, in the end, are less likely to have a recurrence or die from their disease.\"\u003c/p>\n\u003cp>Experts not affiliated with the study called it interesting, but noted that it was conducted among a fairly small sample of women. Of the 1,600 women in the study, 383 had a recurrence of cancer during the nine-year study period, and 290 women died of the disease. More than 200,000 women in the U.S. are \u003ca title=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics\" href=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics\" target=\"_blank\">projected to be diagnosed with breast cancer\u003c/a> in 2015.\u003c/p>\n\u003cp>\"It's a hypothesis that supports doing more research,\" said Dr. Otis Brawley, chief medical officer with the American Cancer Society. \"We can't take this study and tell women, 'Breast-feed, and you are more likely to get the easier-to-treat breast cancer.' \"\u003c/p>\n\u003cp>\u003cstrong>Intriguing Questions for African-American Women\u003c/strong>\u003c/p>\n\u003cp>Brawley also theorized that this study could have implications for African-American women who have higher rates of diagnosis of basal-type tumors, also called \"triple negative,\" which are more aggressive. Women with these types of tumors face a poorer prognosis.\u003c/p>\n\u003cp>Thirty percent of African-American women are diagnosed with these basal-type tumors, but only 20 percent of Caucasian women are. African-American women have a higher mortality rate from breast cancer overall. And, Brawley noted, African-American women have lower rates of breast-feeding.\u003c/p>\n\u003cp>\"Maybe breast-feeding, or lack thereof, is part of the reason for that difference,\" Brawley said of the breast cancer disparity. \"I can only say maybe.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Karuna Jaggar, executive director of Breast Cancer Action, a San Francisco-based advocacy group, said that overall the study adds to our understanding of breast cancer. \"(This research) underscores that breast cancer is a life course disease,\" she said. \"Exposures and activities that happen earlier in life impact breast cancer risk and mortality,\" both positively and negatively.\u003c/p>\n\n",
"disqusIdentifier": "25160 http://blogs.kqed.org/stateofhealth/?p=25160",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_25163\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/2127061197_7321f7ac3c_o-e1430254712327.jpg\">\u003cimg class=\"size-large wp-image-25163\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/2127061197_7321f7ac3c_o-640x426.jpg\" alt=\"(Ozgur Poyrazoglu via Flickr) \" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Ozgur Poyrazoglu via Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>In a small study, women who had been diagnosed with breast cancer were 30 percent less likely to see a return of the disease if they had a history of breast-feeding. While previous research has found a \u003ca title=\"http://www.cancer.org/cancer/news/expertvoices/post/2013/05/07/can-breastfeeding-lower-breast-cancer-risk.aspx\" href=\"http://www.cancer.org/cancer/news/expertvoices/post/2013/05/07/can-breastfeeding-lower-breast-cancer-risk.aspx\" target=\"_blank\">small protective effect \u003c/a>of breast-feeding and breast cancer risk, researchers from Kaiser Permanente's Division of Research believe this is the first study to explore an association between nursing and a recurrence of cancer.\u003c/p>\n\u003cp>In the study, researchers asked 1,636 women who had breast cancer, mostly Kaiser patients, to fill out a questionnaire that included their history of breast-feeding. \"We followed them for over nine years, and we identified the women who had a recurrence and also those who died of breast cancer,\" said lead author Marilyn Kwan, Ph.D., with Kaiser. \"And we (found) this dramatic reduction in risk of recurrence.\"\u003c/p>\n\u003cp>In addition to the reduced risk of recurrence, the researchers found a 28 percent reduced risk of dying from the disease among women who breast-fed.\u003c!--more-->\u003c/p>\n\u003cp>They study also looked at specific types of tumors. They found that women who had breast-fed were more likely to develop a more common -- and more easily treatable -- kind of tumor, known as luminal A subtype, which includes estrogen-receptor positive tumors.\u003c/p>\n\u003cp>\"These tumors are less likely to spread, to metastasize, and they're treatable with hormonal therapy such as tamoxifen,\" Kwan said. \"Because of this, they have better prognosis. Women who have luminal A tumors are more likely to survive.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The study was published in the \u003ca title=\"http://jnci.oxfordjournals.org/content/107/7/djv087.abstract?sid=d7434ffc-ae03-423d-b438-80acfd8f2a12\" href=\"http://jnci.oxfordjournals.org/content/107/7/djv087.abstract?sid=d7434ffc-ae03-423d-b438-80acfd8f2a12\" target=\"_blank\">Journal of the National Cancer Institute\u003c/a> and was funded by the National Institutes of Health.\u003c/p>\n\u003cp>Kwan said that breast-feeding \"can increase the maturation of the cells in the breast.\" She theorized that it may set up a \"molecular environment that makes a tumor more responsive to therapy, so women, in the end, are less likely to have a recurrence or die from their disease.\"\u003c/p>\n\u003cp>Experts not affiliated with the study called it interesting, but noted that it was conducted among a fairly small sample of women. Of the 1,600 women in the study, 383 had a recurrence of cancer during the nine-year study period, and 290 women died of the disease. More than 200,000 women in the U.S. are \u003ca title=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics\" href=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics\" target=\"_blank\">projected to be diagnosed with breast cancer\u003c/a> in 2015.\u003c/p>\n\u003cp>\"It's a hypothesis that supports doing more research,\" said Dr. Otis Brawley, chief medical officer with the American Cancer Society. \"We can't take this study and tell women, 'Breast-feed, and you are more likely to get the easier-to-treat breast cancer.' \"\u003c/p>\n\u003cp>\u003cstrong>Intriguing Questions for African-American Women\u003c/strong>\u003c/p>\n\u003cp>Brawley also theorized that this study could have implications for African-American women who have higher rates of diagnosis of basal-type tumors, also called \"triple negative,\" which are more aggressive. Women with these types of tumors face a poorer prognosis.\u003c/p>\n\u003cp>Thirty percent of African-American women are diagnosed with these basal-type tumors, but only 20 percent of Caucasian women are. African-American women have a higher mortality rate from breast cancer overall. And, Brawley noted, African-American women have lower rates of breast-feeding.\u003c/p>\n\u003cp>\"Maybe breast-feeding, or lack thereof, is part of the reason for that difference,\" Brawley said of the breast cancer disparity. \"I can only say maybe.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Karuna Jaggar, executive director of Breast Cancer Action, a San Francisco-based advocacy group, said that overall the study adds to our understanding of breast cancer. \"(This research) underscores that breast cancer is a life course disease,\" she said. \"Exposures and activities that happen earlier in life impact breast cancer risk and mortality,\" both positively and negatively.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why You Should Rethink That Daily Dose of Aspirin",
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"content": "\u003cfigure id=\"attachment_25127\" class=\"wp-caption aligncenter\" style=\"max-width: 641px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg\">\u003cimg class=\"wp-image-25127\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg\" alt=\"(Getty Images)\" width=\"641\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-320x213.jpg 320w\" sizes=\"(max-width: 641px) 100vw, 641px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Maanvi Singh,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/04/27/402039544/maybe-you-should-rethink-that-daily-aspirin\" href=\"http://www.npr.org/blogs/health/2015/04/27/402039544/maybe-you-should-rethink-that-daily-aspirin\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>We've all heard that an aspirin a day can keep heart disease at bay. But lots of Americans seem to be taking it as a preventive measure, when many probably shouldn't.\u003c/p>\n\u003caside class=\"pullquote alignleft\"> The chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects \u003c/aside>\n\u003cp>In a recent national survey, more than half the adults who were middle age or older reported taking an aspirin regularly to prevent a heart attack or stroke. The Food and Drug Administration only recommends the drug for people who've already experienced such an event, or who are at extremely high risk.\u003c/p>\n\u003cp>The survey, published in the American Journal of Preventive Medicine, found that 52 percent of people age 45 to 75 are taking aspirin daily or every other day. And 47 percent are taking it even though they have never had a heart attack or stroke.\u003c!--more-->\u003c/p>\n\u003cp>\"That's very controversial in the medical community,\" says Craig Williams, a pharmacologist at Oregon State University, who led the study.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Aspirin thins the blood and can help prevent blood clots that can clog blood vessels and cause strokes and heart attacks. But long-term use of the drug also increases the risk of ulcers, gastrointestinal bleeding and bleeding in the brain.\u003c/p>\n\u003cp>\"Everyone agrees that for people who have already had a cardiac event, the benefits outweigh the risk,\" Williams says.\u003c/p>\n\u003cp>But for most other people, the chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects, research suggests.\u003c/p>\n\u003cp>The American Heart Association says aspirin should be used only for prevention when someone's risk for heart disease is especially high.\u003c/p>\n\u003cp>And Williams says that the U.S. Preventive Services Task Force is in the process of revising its recommendation, which currently holds that older men and women should generally take aspirin if their risk for heart attack outweighs the risk of bleeding due to the medication.\u003c/p>\n\u003cp>In the survey by Williams' team, about 43 percent of people said they were taking the drug for prevention without having consulted a physician. That's a bad idea, says Steve Nissen, a cardiologist at the Cleveland Clinic who wasn't involved in the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The vast majority of people in America who take aspirin for prevention are what I like to call the 'worried well,' \" Nissen says. \"They are perfectly healthy. They may not even have a lot of risk factors. But, they're very health conscious. And somebody told them that aspirin was good for preventing heart attacks, so they just started taking it.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_25127\" class=\"wp-caption aligncenter\" style=\"max-width: 641px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg\">\u003cimg class=\"wp-image-25127\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg\" alt=\"(Getty Images)\" width=\"641\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-320x213.jpg 320w\" sizes=\"(max-width: 641px) 100vw, 641px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Maanvi Singh,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/04/27/402039544/maybe-you-should-rethink-that-daily-aspirin\" href=\"http://www.npr.org/blogs/health/2015/04/27/402039544/maybe-you-should-rethink-that-daily-aspirin\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>We've all heard that an aspirin a day can keep heart disease at bay. But lots of Americans seem to be taking it as a preventive measure, when many probably shouldn't.\u003c/p>\n\u003caside class=\"pullquote alignleft\"> The chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects \u003c/aside>\n\u003cp>In a recent national survey, more than half the adults who were middle age or older reported taking an aspirin regularly to prevent a heart attack or stroke. The Food and Drug Administration only recommends the drug for people who've already experienced such an event, or who are at extremely high risk.\u003c/p>\n\u003cp>The survey, published in the American Journal of Preventive Medicine, found that 52 percent of people age 45 to 75 are taking aspirin daily or every other day. And 47 percent are taking it even though they have never had a heart attack or stroke.\u003c!--more-->\u003c/p>\n\u003cp>\"That's very controversial in the medical community,\" says Craig Williams, a pharmacologist at Oregon State University, who led the study.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Aspirin thins the blood and can help prevent blood clots that can clog blood vessels and cause strokes and heart attacks. But long-term use of the drug also increases the risk of ulcers, gastrointestinal bleeding and bleeding in the brain.\u003c/p>\n\u003cp>\"Everyone agrees that for people who have already had a cardiac event, the benefits outweigh the risk,\" Williams says.\u003c/p>\n\u003cp>But for most other people, the chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects, research suggests.\u003c/p>\n\u003cp>The American Heart Association says aspirin should be used only for prevention when someone's risk for heart disease is especially high.\u003c/p>\n\u003cp>And Williams says that the U.S. Preventive Services Task Force is in the process of revising its recommendation, which currently holds that older men and women should generally take aspirin if their risk for heart attack outweighs the risk of bleeding due to the medication.\u003c/p>\n\u003cp>In the survey by Williams' team, about 43 percent of people said they were taking the drug for prevention without having consulted a physician. That's a bad idea, says Steve Nissen, a cardiologist at the Cleveland Clinic who wasn't involved in the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The vast majority of people in America who take aspirin for prevention are what I like to call the 'worried well,' \" Nissen says. \"They are perfectly healthy. They may not even have a lot of risk factors. But, they're very health conscious. And somebody told them that aspirin was good for preventing heart attacks, so they just started taking it.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
"airtime": "SUN 9pm-10pm",
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"meta": {
"site": "radio",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.commonwealthclub.org/podcasts",
"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"id": "here-and-now",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/hiddenbrain.jpg",
"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
"site": "news",
"source": "NPR"
},
"link": "/radio/program/hidden-brain",
"subscribe": {
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"tuneIn": "https://tunein.com/podcasts/Science-Podcasts/Hidden-Brain-p787503/",
"rss": "https://feeds.npr.org/510308/podcast.xml"
}
},
"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"rss": "https://feeds.npr.org/510313/podcast.xml"
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"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. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
"imageAlt": "KQED Hyphenación",
"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
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"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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"amazon": "https://music.amazon.com/podcasts/6c3dd23c-93fb-4aab-97ba-1725fa6315f1/hyphenaci%C3%B3n",
"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"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. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Political Mind of Jerry Brown",
"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/xtTd",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"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.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"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>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"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.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"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?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"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",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
"site": "news",
"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
"meta": {
"site": "news",
"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
"imageAlt": "KQED Perspectives",
"officialWebsiteLink": "/perspectives/",
"meta": {
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"source": "kqed",
"order": 14
},
"link": "/perspectives",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/id73801135",
"npr": "https://www.npr.org/podcasts/432309616/perspectives",
"rss": "https://ww2.kqed.org/perspectives/category/perspectives/feed/",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"
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},
"planet-money": {
"id": "planet-money",
"title": "Planet Money",
"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.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
"officialWebsiteLink": "https://www.npr.org/sections/money/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/planet-money",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/M4f5",
"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
"tuneIn": "https://tunein.com/podcasts/Business--Economics-Podcasts/Planet-Money-p164680/",
"rss": "https://feeds.npr.org/510289/podcast.xml"
}
},
"politicalbreakdown": {
"id": "politicalbreakdown",
"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",
"imageAlt": "KQED Political Breakdown",
"officialWebsiteLink": "/podcasts/politicalbreakdown",
"meta": {
"site": "radio",
"source": "kqed",
"order": 5
},
"link": "/podcasts/politicalbreakdown",
"subscribe": {
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"amazon": "https://music.amazon.com/podcasts/e0c2d153-ad36-4c8d-901d-f1da6a724824/political-breakdown",
"npr": "https://www.npr.org/podcasts/572155894/political-breakdown",
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