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"disqusTitle": "California Has High Aspirations for Lowering HIV Infections",
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"content": "\u003cp>Zero.\u003c/p>\n\u003cp>That’s the number of new HIV infections California officials are aiming for under a \u003ca href=\"https://www.cdph.ca.gov/programs/aids/Documents/IP_2016_Final.pdf\" target=\"_blank\">comprehensive initiative\u003c/a> released this fall.\u003c/p>\n\u003cp>The “Getting to Zero” plan, intended to guide the state’s AIDS policy from 2017 to 2021, is designed to boost surveillance, increase access to care and eliminate disparities in treatment.\u003c/p>\n\u003cp>“Thanks to better treatment and prevention options, new testing technology and better access to health care, California has reached a point where we can envision the possibility of zero new HIV infections,” said Dr. Karen Smith, director of the California Department of Public Health.\u003c/p>\n\u003cp>In the near term, however, the plan seeks to cut the number of new diagnoses in half, to fewer than 2,500 per year. It’s an ambitious goal in itself, but state health officials claim it is attainable.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We know how to do it from a clinical and from a public health perspective,” said Dr. Gilberto Chavez, deputy director for infectious disease programs at the public health department. “We have the tools to make it happen.”\u003c/p>\n\u003cp>Expanded testing is the cornerstone of California’s HIV response, Chavez said. “For folks with HIV infection, the sooner that they know about it the better, from both an individual and community perspective.”\u003c/p>\n\u003cp>\u003cstrong>Goals Versus Reality\u003c/strong>\u003c/p>\n\u003cp>Some say the goals in the plan may be easier stated than done.\u003c/p>\n\u003cp>“Getting to zero is aspirational,” said Dr. Hyman Scott, a researcher and clinician with Bridge HIV at the San Francisco Department of Public Health. “If we don’t address racial, ethnic and age disparities in HIV treatment we won’t get there.”\u003c/p>\n\u003cp>Dr. Paul Volberding, who codirects the AIDS Research Institute at the University of California San Francisco and has been involved in fighting the epidemic from its earliest days, also sees challenges ahead.\u003c/p>\n\u003cp>“We can’t just coast along and in five years get to zero,” he said. “Stigma is the biggest issue, because that’s what keeps people out of the system.”\u003c/p>\n\u003cp>Although enormous inroads have been made against HIV, and prominent researchers such as Volberding are talking about a cure as a possibility, the public health department’s Office of AIDS estimates that 139,000 people in the state were living with the virus in 2014, the latest year for which statistics were available. And nearly 10 percent of them were undiagnosed.\u003c/p>\n\u003cp>African-Americans, Latinos and immigrants have seen a disproportionate rise in infections and have the lowest rates for testing, according to Scott.\u003c/p>\n\u003cp>“We want people to be aware of their HIV status so they can access care and treatments that are really life-saving,” he said. The state’s plan encourages targeted testing in these communities, not only to link patients with treatment, but also to prevent new infections.\u003c/p>\n\u003cp>“If somebody is engaged in treatment and has a suppressed viral load, then the risk of onward transmission is negligible,” Scott said.\u003c/p>\n\u003cp>\u003cimg class=\"alignleft wp-image-218028 size-khn-article-small\" src=\"https://californiahealthline.files.wordpress.com/2016/11/hiv-negative_770.jpg?w=370&h=247&crop=1\" alt=\"Blood sample with HIV negative\" width=\"370\" height=\"247\">\u003c/p>\n\u003cp>The state’s goal is to ensure that at least 95 percent of people with HIV get diagnosed. To get there, the blueprint encourages hospital emergency departments, primary care physicians and jail and prison health systems to offer routine testing. Such tests are free to Medi-Cal patients and Californians insured under the Affordable Care Act. Regardless of their coverage, patients are able to refuse testing.\u003c/p>\n\u003cp>The “Getting to Zero” plan seeks to have new patients begin antiretroviral treatment on the same day as diagnosis and to have them connected with a medical provider within 72 hours.\u003c/p>\n\u003cp>“In our plan, it’s not just about providing medication, but also providing a medical home and making sure that folks are getting evaluated regularly,” said Chavez.\u003c/p>\n\u003cp>The plan will be paid for through a mix of federal, state and local dollars. The state Department of Public Health says that it “utilizes existing state resources,” suggesting that it adds no new costs.\u003c/p>\n\u003cp>But California’s plan was constructed before the presidential election, which has injected uncertainty and “great fear” into the AIDS treatment community, said UCSF’s Volberding. We rely on a good deal of federal support, and if that is dramatically reversed I think we are in for some serious trouble.”\u003c/p>\n\u003cp>\u003cstrong>‘A Game Changer’\u003c/strong>\u003c/p>\n\u003cp>The best way to cure any epidemic, of course, is to prevent infections in the first place.\u003c/p>\n\u003cp>The state’s plan urges greatly expanded use of preexposure prophylaxis, known as PrEP.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-prevention.html\" target=\"_blank\">Centers for Disease Control and Prevention estimates \u003c/a>the prevention therapy could reduce infections by 70 percent by 2020. It involves taking a daily dose of Truvada, an antiviral pill that contains two AIDS medications (emtricitabine and tenofovir).\u003c/p>\n\u003cp>When people who take PrEP are exposed regularly to HIV through sex or injection drug use, the medication can reduce their risk of infection by more than 90 percent, according to the CDC. (Still, health officials emphasize it is still important to wear condoms to protect against other STDs, pregnancy and highly-resistant strains of HIV.)\u003c/p>\n\u003cp>PrEP costs about $1,400 per month, but the public health department’s Chavez said it is covered by Medi-Cal and most health insurers.\u003c/p>\n\u003cp>“PrEP is a game-changer that can really transform our HIV prevention strategies in California and across the nation,” said Scott, who has led efforts to increase PrEP use in San Francisco. The program, established last year, has approximately 300 people on PrEP across 18 primary care clinics.\u003c/p>\n\u003cp>Nineteen-year-old James has been taking PrEP for nearly a year. The freshman at California State University, Chico requested that his last name not be used to protect his privacy. He has, like many of his gay peers, grown up in fear of HIV infection.\u003c/p>\n\u003cp>James doesn’t have a steady boyfriend and says he uses condoms “most of the time.” The student, who is majoring in animation, learned about PrEP when he was being tested for sexually transmitted diseases.\u003c/p>\n\u003cp>“I used to always be really worried about STDs and especially HIV, and now it’s, like, okay, that’s one great big scary thing that I don’t have to worry so much about,” he said.\u003c/p>\n\u003cp>James, who is insured by Kaiser Permanente, has a prescription for Truvada with no copayment. To be effective, the medication must be taken every day.\u003c/p>\n\u003cp>James said he takes his pill “every morning after I brush my teeth,” and has experienced no side effects. He goes to the student health center at school for regular HIV testing, which is what health officials recommend.\u003c/p>\n\u003cp>James is among about 9,000 Californians now taking PrEP medication, according to the \u003ca href=\"https://www.cdph.ca.gov/programs/aids/Documents/California%20Needs%20Assessment%20-%202016%20-%20FINAL%2030Sept.pdf\">California Needs Assessment for HIV\u003c/a>. Still, officials say the treatment is indicated for up to 240,000 people in the state.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We are just now at the beginning of our PrEP program,” Chavez said, “so there’s a long way to go.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Zero.\u003c/p>\n\u003cp>That’s the number of new HIV infections California officials are aiming for under a \u003ca href=\"https://www.cdph.ca.gov/programs/aids/Documents/IP_2016_Final.pdf\" target=\"_blank\">comprehensive initiative\u003c/a> released this fall.\u003c/p>\n\u003cp>The “Getting to Zero” plan, intended to guide the state’s AIDS policy from 2017 to 2021, is designed to boost surveillance, increase access to care and eliminate disparities in treatment.\u003c/p>\n\u003cp>“Thanks to better treatment and prevention options, new testing technology and better access to health care, California has reached a point where we can envision the possibility of zero new HIV infections,” said Dr. Karen Smith, director of the California Department of Public Health.\u003c/p>\n\u003cp>In the near term, however, the plan seeks to cut the number of new diagnoses in half, to fewer than 2,500 per year. It’s an ambitious goal in itself, but state health officials claim it is attainable.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We know how to do it from a clinical and from a public health perspective,” said Dr. Gilberto Chavez, deputy director for infectious disease programs at the public health department. “We have the tools to make it happen.”\u003c/p>\n\u003cp>Expanded testing is the cornerstone of California’s HIV response, Chavez said. “For folks with HIV infection, the sooner that they know about it the better, from both an individual and community perspective.”\u003c/p>\n\u003cp>\u003cstrong>Goals Versus Reality\u003c/strong>\u003c/p>\n\u003cp>Some say the goals in the plan may be easier stated than done.\u003c/p>\n\u003cp>“Getting to zero is aspirational,” said Dr. Hyman Scott, a researcher and clinician with Bridge HIV at the San Francisco Department of Public Health. “If we don’t address racial, ethnic and age disparities in HIV treatment we won’t get there.”\u003c/p>\n\u003cp>Dr. Paul Volberding, who codirects the AIDS Research Institute at the University of California San Francisco and has been involved in fighting the epidemic from its earliest days, also sees challenges ahead.\u003c/p>\n\u003cp>“We can’t just coast along and in five years get to zero,” he said. “Stigma is the biggest issue, because that’s what keeps people out of the system.”\u003c/p>\n\u003cp>Although enormous inroads have been made against HIV, and prominent researchers such as Volberding are talking about a cure as a possibility, the public health department’s Office of AIDS estimates that 139,000 people in the state were living with the virus in 2014, the latest year for which statistics were available. And nearly 10 percent of them were undiagnosed.\u003c/p>\n\u003cp>African-Americans, Latinos and immigrants have seen a disproportionate rise in infections and have the lowest rates for testing, according to Scott.\u003c/p>\n\u003cp>“We want people to be aware of their HIV status so they can access care and treatments that are really life-saving,” he said. The state’s plan encourages targeted testing in these communities, not only to link patients with treatment, but also to prevent new infections.\u003c/p>\n\u003cp>“If somebody is engaged in treatment and has a suppressed viral load, then the risk of onward transmission is negligible,” Scott said.\u003c/p>\n\u003cp>\u003cimg class=\"alignleft wp-image-218028 size-khn-article-small\" src=\"https://californiahealthline.files.wordpress.com/2016/11/hiv-negative_770.jpg?w=370&h=247&crop=1\" alt=\"Blood sample with HIV negative\" width=\"370\" height=\"247\">\u003c/p>\n\u003cp>The state’s goal is to ensure that at least 95 percent of people with HIV get diagnosed. To get there, the blueprint encourages hospital emergency departments, primary care physicians and jail and prison health systems to offer routine testing. Such tests are free to Medi-Cal patients and Californians insured under the Affordable Care Act. Regardless of their coverage, patients are able to refuse testing.\u003c/p>\n\u003cp>The “Getting to Zero” plan seeks to have new patients begin antiretroviral treatment on the same day as diagnosis and to have them connected with a medical provider within 72 hours.\u003c/p>\n\u003cp>“In our plan, it’s not just about providing medication, but also providing a medical home and making sure that folks are getting evaluated regularly,” said Chavez.\u003c/p>\n\u003cp>The plan will be paid for through a mix of federal, state and local dollars. The state Department of Public Health says that it “utilizes existing state resources,” suggesting that it adds no new costs.\u003c/p>\n\u003cp>But California’s plan was constructed before the presidential election, which has injected uncertainty and “great fear” into the AIDS treatment community, said UCSF’s Volberding. We rely on a good deal of federal support, and if that is dramatically reversed I think we are in for some serious trouble.”\u003c/p>\n\u003cp>\u003cstrong>‘A Game Changer’\u003c/strong>\u003c/p>\n\u003cp>The best way to cure any epidemic, of course, is to prevent infections in the first place.\u003c/p>\n\u003cp>The state’s plan urges greatly expanded use of preexposure prophylaxis, known as PrEP.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-prevention.html\" target=\"_blank\">Centers for Disease Control and Prevention estimates \u003c/a>the prevention therapy could reduce infections by 70 percent by 2020. It involves taking a daily dose of Truvada, an antiviral pill that contains two AIDS medications (emtricitabine and tenofovir).\u003c/p>\n\u003cp>When people who take PrEP are exposed regularly to HIV through sex or injection drug use, the medication can reduce their risk of infection by more than 90 percent, according to the CDC. (Still, health officials emphasize it is still important to wear condoms to protect against other STDs, pregnancy and highly-resistant strains of HIV.)\u003c/p>\n\u003cp>PrEP costs about $1,400 per month, but the public health department’s Chavez said it is covered by Medi-Cal and most health insurers.\u003c/p>\n\u003cp>“PrEP is a game-changer that can really transform our HIV prevention strategies in California and across the nation,” said Scott, who has led efforts to increase PrEP use in San Francisco. The program, established last year, has approximately 300 people on PrEP across 18 primary care clinics.\u003c/p>\n\u003cp>Nineteen-year-old James has been taking PrEP for nearly a year. The freshman at California State University, Chico requested that his last name not be used to protect his privacy. He has, like many of his gay peers, grown up in fear of HIV infection.\u003c/p>\n\u003cp>James doesn’t have a steady boyfriend and says he uses condoms “most of the time.” The student, who is majoring in animation, learned about PrEP when he was being tested for sexually transmitted diseases.\u003c/p>\n\u003cp>“I used to always be really worried about STDs and especially HIV, and now it’s, like, okay, that’s one great big scary thing that I don’t have to worry so much about,” he said.\u003c/p>\n\u003cp>James, who is insured by Kaiser Permanente, has a prescription for Truvada with no copayment. To be effective, the medication must be taken every day.\u003c/p>\n\u003cp>James said he takes his pill “every morning after I brush my teeth,” and has experienced no side effects. He goes to the student health center at school for regular HIV testing, which is what health officials recommend.\u003c/p>\n\u003cp>James is among about 9,000 Californians now taking PrEP medication, according to the \u003ca href=\"https://www.cdph.ca.gov/programs/aids/Documents/California%20Needs%20Assessment%20-%202016%20-%20FINAL%2030Sept.pdf\">California Needs Assessment for HIV\u003c/a>. Still, officials say the treatment is indicated for up to 240,000 people in the state.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The number of seniors in California is expected to more than double by 2060, from roughly 5 million to 12 million. A new report from the \u003ca href=\"http://www.lao.ca.gov/\" target=\"_blank\">Legislative Analyst's Office \u003c/a>says this future senior population will be more racially diverse than seniors in the U.S. as a whole: the state's elderly population is projected to become majority nonwhite as soon as 2030.\u003c/p>\n\u003cp>The proportion of these future seniors who are disabled will also increase. That's because nonwhite populations have higher disability rates. Seniors are also expected to live longer, and seniors over age 85 experience higher disability rates as well.\u003c/p>\n\u003cp>Eventually, this will present new and difficult challenges for California in providing long-term care for these seniors, the report concludes.\u003c/p>\n\u003cp>The report explains that:\u003c/p>\n\u003cul>\n\u003cli>Seniors are now about 13 percent of the state population. By 2060, they will be 24 percent.\u003c/li>\n\u003cli>California's Medicaid program, \u003ca href=\"http://www.coveredca.com/medi-cal/\" target=\"_blank\">Medi-Cal\u003c/a>, already spends $14 billion a year on disability services (for all ages). The federal government picks up about half of this cost.\u003c/li>\n\u003cli>Education matters: More educated seniors experience less disability as they age, and educational levels among California seniors are projected to increase over time, which will somewhat offset the impact of other disabling factors.\u003c/li>\n\u003cli>Unpaid caregivers will be crucial: There will be fewer working-age adults per senior in California in the future, so non-disabled seniors may be tapped to do more to care for their disabled counterparts.\u003c/li>\n\u003c/ul>\n\u003cp>The report merely lays out the problem -- there's no conjecture on what the financial impact will be for Medi-Cal or the state. \"Such projections are not available at this time,\" the report's author, \u003ca href=\"http://www.lao.ca.gov/staff/AssignmentDetail/11\" target=\"_blank\">Mac Taylor\u003c/a>, concludes, although he might look into it someday, \"subject to available data.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[scribd id=332689844 key=key-6N5mtis3iWAZmjsZ12Le mode=scroll]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The number of seniors in California is expected to more than double by 2060, from roughly 5 million to 12 million. A new report from the \u003ca href=\"http://www.lao.ca.gov/\" target=\"_blank\">Legislative Analyst's Office \u003c/a>says this future senior population will be more racially diverse than seniors in the U.S. as a whole: the state's elderly population is projected to become majority nonwhite as soon as 2030.\u003c/p>\n\u003cp>The proportion of these future seniors who are disabled will also increase. That's because nonwhite populations have higher disability rates. Seniors are also expected to live longer, and seniors over age 85 experience higher disability rates as well.\u003c/p>\n\u003cp>Eventually, this will present new and difficult challenges for California in providing long-term care for these seniors, the report concludes.\u003c/p>\n\u003cp>The report explains that:\u003c/p>\n\u003cul>\n\u003cli>Seniors are now about 13 percent of the state population. By 2060, they will be 24 percent.\u003c/li>\n\u003cli>California's Medicaid program, \u003ca href=\"http://www.coveredca.com/medi-cal/\" target=\"_blank\">Medi-Cal\u003c/a>, already spends $14 billion a year on disability services (for all ages). The federal government picks up about half of this cost.\u003c/li>\n\u003cli>Education matters: More educated seniors experience less disability as they age, and educational levels among California seniors are projected to increase over time, which will somewhat offset the impact of other disabling factors.\u003c/li>\n\u003cli>Unpaid caregivers will be crucial: There will be fewer working-age adults per senior in California in the future, so non-disabled seniors may be tapped to do more to care for their disabled counterparts.\u003c/li>\n\u003c/ul>\n\u003cp>The report merely lays out the problem -- there's no conjecture on what the financial impact will be for Medi-Cal or the state. \"Such projections are not available at this time,\" the report's author, \u003ca href=\"http://www.lao.ca.gov/staff/AssignmentDetail/11\" target=\"_blank\">Mac Taylor\u003c/a>, concludes, although he might look into it someday, \"subject to available data.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Worries About Health Insurance Cross Political Boundaries",
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"content": "\u003cp>This month's election results could have big implications for those who now have insurance because of the Affordable Care Act — either through the exchanges or Medicaid expansion. President-elect Trump and Republicans in Congress have made it clear they want to scrap the law, but it's unclear what may replace it. That gap between repeal and replacement has left many unsure of what will happen with their medical care. We have these reports from around the country from people who could be affected by changes.\u003c/p>\n\u003cp>\u003cstrong>Little Lula's Preexisting Condition Is Cancer\u003c/strong>\u003c/p>\n\u003cp>If you stop by Julep, a Kansas City, Missouri, bar and restaurant, you might catch a glimpse of Lula — the blond, blue-eyed toddler daughter of the owners, Keely Edgington and Beau Williams. They let her inspect the customers a bit before the place gets too busy.\u003c/p>\n\u003cp>\"She likes to go out there and essentially just stare everybody down and smile at them,\" Edgington says.\u003c/p>\n\u003cp>She's so smiley you'd never guess how much she's been through in her short life. \"She happens to have \u003ca href=\"http://www.cancer.org/cancer/neuroblastoma/detailedguide/neuroblastoma-staging\">4S non-amplified neuroblastoma\u003c/a>,\" Edgington says. It's a cancer in her adrenal gland that doctors discovered when Lula was 9 months old. She needed emergency surgery because of the size and location of the tumor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The cost was enormous. Edgington says she stopped looking at bills after they topped $350,000, and that was before the surgery. The vast majority of the cost was paid for through the insurance the family gets through HealthCare.gov, the federal health insurance marketplace created under the Affordable Care Act. They say, as small business owners, the exchange and subsidies they received because of the law were their only way they could get covered.\u003c/p>\n\u003cp>Even with coverage, the family was still on the hook for $10,000.\u003c/p>\n\u003cp>Lula has responded well to the treatment. She's been in remission for a few months, but the family still faces high medical costs. At a minimum, Lula will need intensive, expensive screenings and scans for a few years, then she'll have to be monitored for health conditions that might come up as a result of chemotherapy.\u003c/p>\n\u003cp>Since the election, the family says they've been on eggshells waiting to see what will happen with their insurance. They fear possibly losing subsidies. And, before the Affordable Care Act insurance companies could deny coverage to people with preexisting medical conditions like Lula's, and the companies could set lifetime limits on the amount they'd pay for someone's care. Insurers could also take into account an individual's health history, so that someone with a chronic disease might pay many times more than a healthier person.\u003c/p>\n\u003cp>The family has been thinking about how they might cope with huge medical or insurance costs that might come if Obamacare is repealed. They've pondered a second mortgage, selling their business or even more desperate measures.\u003c/p>\n\u003cp>\"Do we have to move to Canada and hope we get coverage there? That's really extreme, but what wouldn't you do for your child's life?\" says Edgington.\u003c/p>\n\u003cp>Trump has said he'd make sure insurance companies couldn't deny coverage to a person with a preexisting condition, but he has provided no formal plan, and much of what happens next is in Congress's hands. Insurance and legal analysts are also unclear about what will happen, although most think the biggest changes probably wouldn't go into effect until at least 2018. — \u003cem>Alex Smith, KCUR, Kansas City, Missouri\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Obamacare Choices Are Dwindling For Some \u003cbr>\u003c/strong>\u003c/p>\n\u003cp>Michael Cluck and his wife Nancy live in Edwardsville, Illinois, just outside St. Louis. Cluck, 62, and his wife, Nancy, 58, bought insurance through HealthCare.gov in 2015, and it, \"actually saved us $300 a month, and we were really happy with it,\" he says.\u003c/p>\n\u003cp>But two providers, including his own insurer, Coventry, dropped out of the health insurance exchange in his county and two adjacent ones for 2017. There's now just one choice there: Blue Cross Blue Shield of Illinois.\u003c/p>\n\u003cp>\"Premiums were not that bad. Deductibles were not that bad,\" Cluck says of Blue Cross. \"But the problem was, they would not cover any doctors or hospital stays on the Missouri side of the river.\"\u003c/p>\n\u003cp>Cluck had prostate cancer. He is now free of cancer, but he still needs regular checkups and he fears the cancer may return. It takes him about 30 minutes to drive to oncology appointments now, but the \u003ca href=\"http://www.npr.org/sections/health-shots/2014/07/16/331419293/patients-with-low-cost-insurance-struggle-to-find-specialists\">in-network providers\u003c/a> Blue Cross Blue Shield of Illinois shows in its directory are farther away.\u003c/p>\n\u003cp>\"That's where the problem came in. Because all of my cancer doctors, and Siteman Cancer Center, are in St. Louis, Missouri,\" Cluck says.\u003c/p>\n\u003cp>To Cluck, it's a frustrating display of flaws in the Affordable Care Act.\u003c/p>\n\u003cp>\"This was not supposed to happen,\" he says. \"When they put the Affordable Care Act in place, we were promised we could keep our doctors. We were promised it would cost $2,500 less than what we were currently paying. And nothing's come true.\"\u003c/p>\n\u003cp>On Nov. 8, when faced with a choice between Democratic presidential nominee Hillary Clinton and Donald Trump, he voted for the Republican.\u003c/p>\n\u003cp>\"For a lot of reasons, not just Obamacare,\" he says. But while he hopes that there's a good replacement plan ready for any changes to Obamacare, he's is frustrated by the insurance companies' narrow networks.\u003c/p>\n\u003cp>\"I don't understand why, when the health care companies are recording record profits that they're not staying in the Affordable Care Act. That's the one thing that just boggles my mind.\"\u003c/p>\n\u003cp>So, he hopes Trump follows through on his promise to repeal and replace.\u003c/p>\n\u003cp>\"There's a lot of things they need to fix, because there's a lot of people who are reliant upon medical care and health care. I think this should really be fixing, dismantling--however you want to call it--the Affordable Care Act, I think that needs to really be a priority for the new administration.\" — \u003cem>Durrie Bouscaren, St. Louis Public Radio.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Fears About Losing Insurance Limited Job Options\u003cbr>\u003c/strong>\u003c/p>\n\u003cp>Leigh Kvetko, 46, of Dallas, has to take 10 medications twice a day because she's had two organ transplants to replace her pancreas and kidney in 2003. Several of the pills she takes cost nearly $1,000 each per month. For years, Kvetko stuck with a job she hated in large part because it offered health insurance. When the Affordable Care Act passed, insurers could no longer discriminate against people like Kvetko, who have diagnosed health problems, and she and her husband finally felt free.\u003c/p>\n\u003cp>\"It gave me hope and [my husband and I] decided to sell our house, to downsize, and to start our own businesses and start a new chapter of our lives.\"\u003c/p>\n\u003cp>In this new chapter, Kvetko is retail manager at a busy Dallas coffee shop. She struts through the store in cowboy boots, her long red hair framing green-speckled eyes. She looks happy — and healthy. But her pancreas is failing, and she's terrified about President-elect Trump's promise to dismantle the Affordable Care Act. She fears it will put health care out of reach for her, and another \u003ca href=\"http://keranews.org/post/about-12-million-texans-signed-through-health-exchange\">1.2 million Texans\u003c/a> who rely on subsidized plans. — \u003cem>Lauren Silverman, KERA, Dallas.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>These reports come to us as part of a partnership with NPR, local member stations and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\">Kaiser Health News\u003c/a>. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Worries+About+Health+Insurance+Cross+Political+Boundaries&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Many people who are grateful for Obamacare are also frustrated by it. Three voters in three states weigh in about their hopes and fears for the Affordable Care Act under a Trump administration.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>This month's election results could have big implications for those who now have insurance because of the Affordable Care Act — either through the exchanges or Medicaid expansion. President-elect Trump and Republicans in Congress have made it clear they want to scrap the law, but it's unclear what may replace it. That gap between repeal and replacement has left many unsure of what will happen with their medical care. We have these reports from around the country from people who could be affected by changes.\u003c/p>\n\u003cp>\u003cstrong>Little Lula's Preexisting Condition Is Cancer\u003c/strong>\u003c/p>\n\u003cp>If you stop by Julep, a Kansas City, Missouri, bar and restaurant, you might catch a glimpse of Lula — the blond, blue-eyed toddler daughter of the owners, Keely Edgington and Beau Williams. They let her inspect the customers a bit before the place gets too busy.\u003c/p>\n\u003cp>\"She likes to go out there and essentially just stare everybody down and smile at them,\" Edgington says.\u003c/p>\n\u003cp>She's so smiley you'd never guess how much she's been through in her short life. \"She happens to have \u003ca href=\"http://www.cancer.org/cancer/neuroblastoma/detailedguide/neuroblastoma-staging\">4S non-amplified neuroblastoma\u003c/a>,\" Edgington says. It's a cancer in her adrenal gland that doctors discovered when Lula was 9 months old. She needed emergency surgery because of the size and location of the tumor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The cost was enormous. Edgington says she stopped looking at bills after they topped $350,000, and that was before the surgery. The vast majority of the cost was paid for through the insurance the family gets through HealthCare.gov, the federal health insurance marketplace created under the Affordable Care Act. They say, as small business owners, the exchange and subsidies they received because of the law were their only way they could get covered.\u003c/p>\n\u003cp>Even with coverage, the family was still on the hook for $10,000.\u003c/p>\n\u003cp>Lula has responded well to the treatment. She's been in remission for a few months, but the family still faces high medical costs. At a minimum, Lula will need intensive, expensive screenings and scans for a few years, then she'll have to be monitored for health conditions that might come up as a result of chemotherapy.\u003c/p>\n\u003cp>Since the election, the family says they've been on eggshells waiting to see what will happen with their insurance. They fear possibly losing subsidies. And, before the Affordable Care Act insurance companies could deny coverage to people with preexisting medical conditions like Lula's, and the companies could set lifetime limits on the amount they'd pay for someone's care. Insurers could also take into account an individual's health history, so that someone with a chronic disease might pay many times more than a healthier person.\u003c/p>\n\u003cp>The family has been thinking about how they might cope with huge medical or insurance costs that might come if Obamacare is repealed. They've pondered a second mortgage, selling their business or even more desperate measures.\u003c/p>\n\u003cp>\"Do we have to move to Canada and hope we get coverage there? That's really extreme, but what wouldn't you do for your child's life?\" says Edgington.\u003c/p>\n\u003cp>Trump has said he'd make sure insurance companies couldn't deny coverage to a person with a preexisting condition, but he has provided no formal plan, and much of what happens next is in Congress's hands. Insurance and legal analysts are also unclear about what will happen, although most think the biggest changes probably wouldn't go into effect until at least 2018. — \u003cem>Alex Smith, KCUR, Kansas City, Missouri\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Obamacare Choices Are Dwindling For Some \u003cbr>\u003c/strong>\u003c/p>\n\u003cp>Michael Cluck and his wife Nancy live in Edwardsville, Illinois, just outside St. Louis. Cluck, 62, and his wife, Nancy, 58, bought insurance through HealthCare.gov in 2015, and it, \"actually saved us $300 a month, and we were really happy with it,\" he says.\u003c/p>\n\u003cp>But two providers, including his own insurer, Coventry, dropped out of the health insurance exchange in his county and two adjacent ones for 2017. There's now just one choice there: Blue Cross Blue Shield of Illinois.\u003c/p>\n\u003cp>\"Premiums were not that bad. Deductibles were not that bad,\" Cluck says of Blue Cross. \"But the problem was, they would not cover any doctors or hospital stays on the Missouri side of the river.\"\u003c/p>\n\u003cp>Cluck had prostate cancer. He is now free of cancer, but he still needs regular checkups and he fears the cancer may return. It takes him about 30 minutes to drive to oncology appointments now, but the \u003ca href=\"http://www.npr.org/sections/health-shots/2014/07/16/331419293/patients-with-low-cost-insurance-struggle-to-find-specialists\">in-network providers\u003c/a> Blue Cross Blue Shield of Illinois shows in its directory are farther away.\u003c/p>\n\u003cp>\"That's where the problem came in. Because all of my cancer doctors, and Siteman Cancer Center, are in St. Louis, Missouri,\" Cluck says.\u003c/p>\n\u003cp>To Cluck, it's a frustrating display of flaws in the Affordable Care Act.\u003c/p>\n\u003cp>\"This was not supposed to happen,\" he says. \"When they put the Affordable Care Act in place, we were promised we could keep our doctors. We were promised it would cost $2,500 less than what we were currently paying. And nothing's come true.\"\u003c/p>\n\u003cp>On Nov. 8, when faced with a choice between Democratic presidential nominee Hillary Clinton and Donald Trump, he voted for the Republican.\u003c/p>\n\u003cp>\"For a lot of reasons, not just Obamacare,\" he says. But while he hopes that there's a good replacement plan ready for any changes to Obamacare, he's is frustrated by the insurance companies' narrow networks.\u003c/p>\n\u003cp>\"I don't understand why, when the health care companies are recording record profits that they're not staying in the Affordable Care Act. That's the one thing that just boggles my mind.\"\u003c/p>\n\u003cp>So, he hopes Trump follows through on his promise to repeal and replace.\u003c/p>\n\u003cp>\"There's a lot of things they need to fix, because there's a lot of people who are reliant upon medical care and health care. I think this should really be fixing, dismantling--however you want to call it--the Affordable Care Act, I think that needs to really be a priority for the new administration.\" — \u003cem>Durrie Bouscaren, St. Louis Public Radio.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Fears About Losing Insurance Limited Job Options\u003cbr>\u003c/strong>\u003c/p>\n\u003cp>Leigh Kvetko, 46, of Dallas, has to take 10 medications twice a day because she's had two organ transplants to replace her pancreas and kidney in 2003. Several of the pills she takes cost nearly $1,000 each per month. For years, Kvetko stuck with a job she hated in large part because it offered health insurance. When the Affordable Care Act passed, insurers could no longer discriminate against people like Kvetko, who have diagnosed health problems, and she and her husband finally felt free.\u003c/p>\n\u003cp>\"It gave me hope and [my husband and I] decided to sell our house, to downsize, and to start our own businesses and start a new chapter of our lives.\"\u003c/p>\n\u003cp>In this new chapter, Kvetko is retail manager at a busy Dallas coffee shop. She struts through the store in cowboy boots, her long red hair framing green-speckled eyes. She looks happy — and healthy. But her pancreas is failing, and she's terrified about President-elect Trump's promise to dismantle the Affordable Care Act. She fears it will put health care out of reach for her, and another \u003ca href=\"http://keranews.org/post/about-12-million-texans-signed-through-health-exchange\">1.2 million Texans\u003c/a> who rely on subsidized plans. — \u003cem>Lauren Silverman, KERA, Dallas.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>These reports come to us as part of a partnership with NPR, local member stations and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\">Kaiser Health News\u003c/a>. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Worries+About+Health+Insurance+Cross+Political+Boundaries&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Loneliness can be a problem for older people, especially when they're in the hospital. Their children may have moved away. Spouses and friends may themselves be too frail to visit. So a California hospital is providing volunteer companions in the geriatric unit.\u003c/p>\n\u003cp>One of the volunteers at the UCLA Medical Center in Santa Monica is 24-year-old Julia Torrano. She hopes to go to medical school. Meanwhile, her twice-weekly volunteer shifts give her a lot of practice working with patients.\u003c/p>\n\u003cp>One of them is Estelle Day. She's 79 years old, a slender woman with a wild mane of hair that is still mostly red. Torrano peppers her with questions.\u003c/p>\n\u003cp>\"Where were you originally from?\" asks Torrano. Day replies that she grew up on Long Island in New York. Torrano also wants to know how Day met her husband, where she learned to play the harp, where her travels have taken her.\u003c/p>\n\u003cp>Day is happy to answer everything. She says she likes people and describes herself as \"windbaggy.\" That's especially true if she's talking about playing music. She is a lifelong musician and retired music teacher. She plays harp and guitar, but her favorite instrument is the pipe organ. \"To be able to rock a building under your hands and your feet is exciting,\" she says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This was Day's fifth day as a patient in the geriatric unit. She says multiple chronic conditions brought her here, but she didn't want to name them. Visible were a bulky back brace she wears for her osteoporosis, an IV drip and a heart monitor.\u003c/p>\n\u003cp>When that heart monitor suddenly began beeping, Torrano was out of the room like a shot. She returned seconds later with a nurse who solved the problem with the push of a button.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/500222611/502841593\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Torrano and the other volunteer companions aren't just candy stripers, bringing snacks and magazines. She knew what to do when the heart monitor started beeping because, like all of the volunteers in this program, she's been trained. As \u003ca href=\"http://www.geronet.ucla.edu/research/researchers/476\">Dr. David Reuben\u003c/a>, chief of geriatrics at the Geffen School of Medicine at UCLA explains: \"Just because you're willing to do something doesn't mean you know how to do it.\"\u003c/p>\n\u003cp>Volunteers learn about medical confidentiality, what to do in an emergency, and how to interact with patients, including patients with dementia. Reuben says they go through a \"vigorous training process and vetting process before we allow them to be with patients.\" There are nearly three dozen volunteers so far. The program started just a few months ago, and the hospital plans to expand it.\u003c/p>\n\u003cp>Loneliness is a legitimate medical issue. There are a number of studies linking loneliness and social isolation in old people to poorer health and earlier death, including one published earlier this month in \u003ca href=\"http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2575729\">JAMA Psychiatry\u003c/a> associating loneliness, social isolation and brain changes typical in Alzheimer's. Reuben cautions that those studies weren't done in a hospital setting. Nevertheless, he says, \"you might suspect that being more engaged, more energized ... might promote a speedier recovery.\"\u003c/p>\n\u003cp>So now the hospital is designing studies to find out if the volunteer companionship improves medical outcomes, or at least improves the patient's experience in the hospital.\u003c/p>\n\u003cp>Torrano says she'll sometimes spend her entire four-hour shift with a single patient. Like Estelle Day, many are happy to share their life stories. She remembers one man in particular who had been a political prisoner in Iran. He'd run an underground newspaper. \"He was in jail so much,\" she recalls, yet he told her he also misses Iran. \"Even though it was very traumatic, he still wishes he was there,\" Torrano says.\u003c/p>\n\u003cp>Estelle Day says she's not especially lonely, but she has been alone much of the time since she was admitted to the geriatric unit. So it helps to have a companion who will not only listen to her life story, but can also troubleshoot the little problems that can make life in a hospital such a challenge. \"Somebody who is sensitive and tuned-in and is very helpful,\" explains Day, the way Torrano was when Day's heart monitor started acting up.\u003c/p>\n\u003cp>And companionship can take many forms. On the day of Torrano's visit, one of Day's most pressing issues was fixing her hair. It had been shoved up in a rubber band since she was admitted.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So with Day's encouragement, Torrano picks up a comb and gently begins detangling. Whatever it takes to make the patient look good and feel better.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\">NPR.org\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hospital+Companions+Can+Ease+Isolation+For+Older+People&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Loneliness can be a problem for older people, especially when they're in the hospital. Their children may have moved away. Spouses and friends may themselves be too frail to visit. So a California hospital is providing volunteer companions in the geriatric unit.\u003c/p>\n\u003cp>One of the volunteers at the UCLA Medical Center in Santa Monica is 24-year-old Julia Torrano. She hopes to go to medical school. Meanwhile, her twice-weekly volunteer shifts give her a lot of practice working with patients.\u003c/p>\n\u003cp>One of them is Estelle Day. She's 79 years old, a slender woman with a wild mane of hair that is still mostly red. Torrano peppers her with questions.\u003c/p>\n\u003cp>\"Where were you originally from?\" asks Torrano. Day replies that she grew up on Long Island in New York. Torrano also wants to know how Day met her husband, where she learned to play the harp, where her travels have taken her.\u003c/p>\n\u003cp>Day is happy to answer everything. She says she likes people and describes herself as \"windbaggy.\" That's especially true if she's talking about playing music. She is a lifelong musician and retired music teacher. She plays harp and guitar, but her favorite instrument is the pipe organ. \"To be able to rock a building under your hands and your feet is exciting,\" she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This was Day's fifth day as a patient in the geriatric unit. She says multiple chronic conditions brought her here, but she didn't want to name them. Visible were a bulky back brace she wears for her osteoporosis, an IV drip and a heart monitor.\u003c/p>\n\u003cp>When that heart monitor suddenly began beeping, Torrano was out of the room like a shot. She returned seconds later with a nurse who solved the problem with the push of a button.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/500222611/502841593\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Torrano and the other volunteer companions aren't just candy stripers, bringing snacks and magazines. She knew what to do when the heart monitor started beeping because, like all of the volunteers in this program, she's been trained. As \u003ca href=\"http://www.geronet.ucla.edu/research/researchers/476\">Dr. David Reuben\u003c/a>, chief of geriatrics at the Geffen School of Medicine at UCLA explains: \"Just because you're willing to do something doesn't mean you know how to do it.\"\u003c/p>\n\u003cp>Volunteers learn about medical confidentiality, what to do in an emergency, and how to interact with patients, including patients with dementia. Reuben says they go through a \"vigorous training process and vetting process before we allow them to be with patients.\" There are nearly three dozen volunteers so far. The program started just a few months ago, and the hospital plans to expand it.\u003c/p>\n\u003cp>Loneliness is a legitimate medical issue. There are a number of studies linking loneliness and social isolation in old people to poorer health and earlier death, including one published earlier this month in \u003ca href=\"http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2575729\">JAMA Psychiatry\u003c/a> associating loneliness, social isolation and brain changes typical in Alzheimer's. Reuben cautions that those studies weren't done in a hospital setting. Nevertheless, he says, \"you might suspect that being more engaged, more energized ... might promote a speedier recovery.\"\u003c/p>\n\u003cp>So now the hospital is designing studies to find out if the volunteer companionship improves medical outcomes, or at least improves the patient's experience in the hospital.\u003c/p>\n\u003cp>Torrano says she'll sometimes spend her entire four-hour shift with a single patient. Like Estelle Day, many are happy to share their life stories. She remembers one man in particular who had been a political prisoner in Iran. He'd run an underground newspaper. \"He was in jail so much,\" she recalls, yet he told her he also misses Iran. \"Even though it was very traumatic, he still wishes he was there,\" Torrano says.\u003c/p>\n\u003cp>Estelle Day says she's not especially lonely, but she has been alone much of the time since she was admitted to the geriatric unit. So it helps to have a companion who will not only listen to her life story, but can also troubleshoot the little problems that can make life in a hospital such a challenge. \"Somebody who is sensitive and tuned-in and is very helpful,\" explains Day, the way Torrano was when Day's heart monitor started acting up.\u003c/p>\n\u003cp>And companionship can take many forms. On the day of Torrano's visit, one of Day's most pressing issues was fixing her hair. It had been shoved up in a rubber band since she was admitted.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So with Day's encouragement, Torrano picks up a comb and gently begins detangling. Whatever it takes to make the patient look good and feel better.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\">NPR.org\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hospital+Companions+Can+Ease+Isolation+For+Older+People&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Will Legal Marijuana Lead to More People Smoking Tobacco?",
"title": "Will Legal Marijuana Lead to More People Smoking Tobacco?",
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"content": "\u003cp>California's decision to legalize marijuana was touted as a victory for those who had argued that the state needed a system to decriminalize, regulate and tax it.\u003c/p>\n\u003cp>But the new law, approved by voters on Nov. 8, also could be a boon to the tobacco industry at a time when cigarette smoking is down and cigarette companies are looking for ways to expand their market, according to researchers in Los Angeles County and around the state.\u003c/p>\n\u003cp>They warn that unless the state proceeds carefully, the legalization of marijuana for recreational use could roll back some of the gains California has made in reducing the use of tobacco.\u003c/p>\n\u003cp>\"There is a concern that there could be a potential renormalization of smoking,\" says Michael Ong, an associate professor at UCLA's David Geffen School of Medicine.\u003c/p>\n\u003cp>Ong says it will depend on how the initiative is implemented, whether officials follow through on the regulation, and how involved public health officials are with it. \"It will be important to make sure that we don't have a setback in terms of what we have done for clean air in California ... and what we have done to reduce tobacco's harms,\" he says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Ethan Nadelmann, executive director of the Drug Policy Alliance, which supports marijuana legalization, defended the measure, saying there is no evidence that legalization leads to increased cannabis consumption — or tobacco smoking.\u003c/p>\n\u003cp>California's adult smoking rate is the second-lowest in the country, at 11.6 percent, according to the \u003ca href=\"https://www.cdph.ca.gov/programs/tobacco/Documents/CDPH%20CTCP%20Refresh/Research%20and%20Evaluation/Facts%20and%20Figures/FactsFigures2016PrePrintEditionV2.pdf?ncid=txtlnkusaolp00000618\" target=\"_blank\">California Department of Public Health\u003c/a>. The smoking rate dropped by more than 50 percent between 1988 and 2014, cutting health care costs and reducing tobacco-related diseases, according to the department.\u003c/p>\n\u003cp>The headway against smoking over the past few decades is due to a combination of factors, including tobacco taxes, laws restricting where people can smoke, and broad-based media campaigns and programs to help people quit. Despite the decline in smoking, the use of e-cigarettes has increased dramatically over the past few years, with nearly 10 percent of adults ages 18 through 24 now using them, according to the department.\u003c/p>\n\u003cp>Another ballot initiative passed by voters last week could push the smoking rate even lower. Prop. 56 will add $2 per pack to the tax on cigarettes and increases taxes on electronic cigarettes that contain nicotine and other tobacco products. The money will help pay for health care and increase funding for tobacco control and prevention.\u003c/p>\n\u003cp>The marijuana initiative, Prop. 64, allows adults ages 21 and over to grow, buy and possess small amounts of marijuana for personal use. It also regulates recreational marijuana businesses and imposes taxes that will help pay for drug education and prevention programs.\u003c/p>\n\u003cp>Bonnie Halpern-Felsher, a pediatrics professor at the Stanford University School of Medicine, says she is concerned that there may not be enough education and prevention written into the proposition, especially targeted at youth.\u003c/p>\n\u003cp>Marijuana is already the most widely used illegal drug among adolescents. Many young people consider marijuana and blunts, which are marijuana rolled with a tobacco leaf wrapper, to be more socially acceptable and less risky than cigarettes, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27746339\" target=\"_blank\">recent study\u003c/a> co-authored by Halpern-Felsher. The study also found that youths who saw messages about the benefits of marijuana were more likely to use it.\u003c/p>\n\u003cp>Blunts are particularly worrisome because they contain nicotine as well as marijuana, Halpern-Felsher says. Many young people may not understand the risk of blunts or marijuana, she notes, and once they start thinking that smoking one product is acceptable, they may believe it's OK to smoke other things as well. \"That's my concern,\" she says. \"I do think people are going to generalize.\"\u003c/p>\n\u003cp>From the tobacco industry's point of view, marijuana could serve as a \"smoke inhalation trainer,\" and thus become a gateway to tobacco use, says Robert K. Jackler, a professor at the Stanford School of Medicine who researches tobacco advertising. He says tobacco and marijuana are marketed in similar ways — as products to help people relax and ease their stress. \"There is tremendous overlap potential,\" he says.\u003c/p>\n\u003cp>Tobacco companies could easily try to exploit that similarity to enter the marijuana market, Jackler says. They already have enormous influence on state laws and regulations, and could try to set up small dispensaries and make marijuana another one of their products.\u003c/p>\n\u003cp>\"The tobacco industry is always looking for replacement products because, at least in America, smoking is down,\" he says. \"This will give them a new entry into the market. They are best equipped to exploit this market opportunity.\"\u003c/p>\n\u003cp>In fact, the tobacco industry considered getting into the marijuana market in the 1960s and 70s and could easily do so, says Stanton Glantz, a professor at University of California, San Francisco School of Medicine. Glantz believes that even as the newly approved tobacco tax reduces California's smoking rate further, legalized marijuana will help sustain the tobacco market. He says he expected to see mass marketing and branding of marijuana over time.\u003c/p>\n\u003cp>Along with some therapeutic benefits of marijuana, there are also health risks, Glantz says. \"The likely costs that are going to be incurred by all the marijuana-induced diseases don't come close to being covered by the taxes that are written into Prop. 64,\" he warns.\u003c/p>\n\u003cp>The initiative should have included higher taxes, graphic warning labels, provisions to keep demand low and a broad-based education campaign like there is on tobacco, Glantz argues. \"The ideal situation is where it's legal so nobody is thrown in jail, but nobody wants to buy it.\"\u003c/p>\n\u003cp>Legalization supporters said they don't believe the tobacco industry will get involved in the marijuana market until and unless federal prohibition ends. Marijuana is still illegal under federal law.\u003c/p>\n\u003cp>Nadelmann, of the pro-marijuana Drug Policy Alliance, says it is misguided to conflate the two products. Young people can distinguish between the effects of cigarettes and marijuana, he says.\u003c/p>\n\u003cp>\"Teenagers are actually smarter than most of the adult propaganda,\" Nadelmann says. \"They know smoking cigarettes is really stupid and that smoking marijuana is not such a major issue.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by\u003c/em> \u003ca href=\"http://khn.org/\" target=\"_blank\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, which publishes\u003c/em> \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\">\u003cem>California Healthline\u003c/em>\u003c/a>\u003cem>, an editorially independent service of the\u003c/em> \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">\u003cem>California Health Care Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Will+Legal+Marijuana+Lead+To+More+People+Smoking+Tobacco%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California's decision to legalize marijuana was touted as a victory for those who had argued that the state needed a system to decriminalize, regulate and tax it.\u003c/p>\n\u003cp>But the new law, approved by voters on Nov. 8, also could be a boon to the tobacco industry at a time when cigarette smoking is down and cigarette companies are looking for ways to expand their market, according to researchers in Los Angeles County and around the state.\u003c/p>\n\u003cp>They warn that unless the state proceeds carefully, the legalization of marijuana for recreational use could roll back some of the gains California has made in reducing the use of tobacco.\u003c/p>\n\u003cp>\"There is a concern that there could be a potential renormalization of smoking,\" says Michael Ong, an associate professor at UCLA's David Geffen School of Medicine.\u003c/p>\n\u003cp>Ong says it will depend on how the initiative is implemented, whether officials follow through on the regulation, and how involved public health officials are with it. \"It will be important to make sure that we don't have a setback in terms of what we have done for clean air in California ... and what we have done to reduce tobacco's harms,\" he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Ethan Nadelmann, executive director of the Drug Policy Alliance, which supports marijuana legalization, defended the measure, saying there is no evidence that legalization leads to increased cannabis consumption — or tobacco smoking.\u003c/p>\n\u003cp>California's adult smoking rate is the second-lowest in the country, at 11.6 percent, according to the \u003ca href=\"https://www.cdph.ca.gov/programs/tobacco/Documents/CDPH%20CTCP%20Refresh/Research%20and%20Evaluation/Facts%20and%20Figures/FactsFigures2016PrePrintEditionV2.pdf?ncid=txtlnkusaolp00000618\" target=\"_blank\">California Department of Public Health\u003c/a>. The smoking rate dropped by more than 50 percent between 1988 and 2014, cutting health care costs and reducing tobacco-related diseases, according to the department.\u003c/p>\n\u003cp>The headway against smoking over the past few decades is due to a combination of factors, including tobacco taxes, laws restricting where people can smoke, and broad-based media campaigns and programs to help people quit. Despite the decline in smoking, the use of e-cigarettes has increased dramatically over the past few years, with nearly 10 percent of adults ages 18 through 24 now using them, according to the department.\u003c/p>\n\u003cp>Another ballot initiative passed by voters last week could push the smoking rate even lower. Prop. 56 will add $2 per pack to the tax on cigarettes and increases taxes on electronic cigarettes that contain nicotine and other tobacco products. The money will help pay for health care and increase funding for tobacco control and prevention.\u003c/p>\n\u003cp>The marijuana initiative, Prop. 64, allows adults ages 21 and over to grow, buy and possess small amounts of marijuana for personal use. It also regulates recreational marijuana businesses and imposes taxes that will help pay for drug education and prevention programs.\u003c/p>\n\u003cp>Bonnie Halpern-Felsher, a pediatrics professor at the Stanford University School of Medicine, says she is concerned that there may not be enough education and prevention written into the proposition, especially targeted at youth.\u003c/p>\n\u003cp>Marijuana is already the most widely used illegal drug among adolescents. Many young people consider marijuana and blunts, which are marijuana rolled with a tobacco leaf wrapper, to be more socially acceptable and less risky than cigarettes, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27746339\" target=\"_blank\">recent study\u003c/a> co-authored by Halpern-Felsher. The study also found that youths who saw messages about the benefits of marijuana were more likely to use it.\u003c/p>\n\u003cp>Blunts are particularly worrisome because they contain nicotine as well as marijuana, Halpern-Felsher says. Many young people may not understand the risk of blunts or marijuana, she notes, and once they start thinking that smoking one product is acceptable, they may believe it's OK to smoke other things as well. \"That's my concern,\" she says. \"I do think people are going to generalize.\"\u003c/p>\n\u003cp>From the tobacco industry's point of view, marijuana could serve as a \"smoke inhalation trainer,\" and thus become a gateway to tobacco use, says Robert K. Jackler, a professor at the Stanford School of Medicine who researches tobacco advertising. He says tobacco and marijuana are marketed in similar ways — as products to help people relax and ease their stress. \"There is tremendous overlap potential,\" he says.\u003c/p>\n\u003cp>Tobacco companies could easily try to exploit that similarity to enter the marijuana market, Jackler says. They already have enormous influence on state laws and regulations, and could try to set up small dispensaries and make marijuana another one of their products.\u003c/p>\n\u003cp>\"The tobacco industry is always looking for replacement products because, at least in America, smoking is down,\" he says. \"This will give them a new entry into the market. They are best equipped to exploit this market opportunity.\"\u003c/p>\n\u003cp>In fact, the tobacco industry considered getting into the marijuana market in the 1960s and 70s and could easily do so, says Stanton Glantz, a professor at University of California, San Francisco School of Medicine. Glantz believes that even as the newly approved tobacco tax reduces California's smoking rate further, legalized marijuana will help sustain the tobacco market. He says he expected to see mass marketing and branding of marijuana over time.\u003c/p>\n\u003cp>Along with some therapeutic benefits of marijuana, there are also health risks, Glantz says. \"The likely costs that are going to be incurred by all the marijuana-induced diseases don't come close to being covered by the taxes that are written into Prop. 64,\" he warns.\u003c/p>\n\u003cp>The initiative should have included higher taxes, graphic warning labels, provisions to keep demand low and a broad-based education campaign like there is on tobacco, Glantz argues. \"The ideal situation is where it's legal so nobody is thrown in jail, but nobody wants to buy it.\"\u003c/p>\n\u003cp>Legalization supporters said they don't believe the tobacco industry will get involved in the marijuana market until and unless federal prohibition ends. Marijuana is still illegal under federal law.\u003c/p>\n\u003cp>Nadelmann, of the pro-marijuana Drug Policy Alliance, says it is misguided to conflate the two products. Young people can distinguish between the effects of cigarettes and marijuana, he says.\u003c/p>\n\u003cp>\"Teenagers are actually smarter than most of the adult propaganda,\" Nadelmann says. \"They know smoking cigarettes is really stupid and that smoking marijuana is not such a major issue.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by\u003c/em> \u003ca href=\"http://khn.org/\" target=\"_blank\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, which publishes\u003c/em> \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\">\u003cem>California Healthline\u003c/em>\u003c/a>\u003cem>, an editorially independent service of the\u003c/em> \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">\u003cem>California Health Care Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Will+Legal+Marijuana+Lead+To+More+People+Smoking+Tobacco%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Do Parents Invade Children's Privacy When They Post Photos Online?",
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"content": "\u003cp>When Katlyn Burbidge's son was 6 years old, he was performing some silly antic typical of a first-grader. But after she snapped a photo and started using her phone, he asked her a serious question: \"Are you going to post that to Facebook?\"\u003c/p>\n\u003cp>She laughed and answered, \"Yes, I think I will.\" What he said next stopped her.\u003c/p>\n\u003cp>\"Can you not?\"\u003c/p>\n\u003cp>That's when it dawned on her: She had been posting photos of him online without asking his permission.\u003c/p>\n\u003cp>\"We're big proponents of bodily autonomy and not forcing him to hug or kiss people unless he wants to, but it never occurred to me that I should ask his permission to post photos of him online,\" says Burbridge, a mom of two in Wakefield, Mass. \"Now when I post photos of him on Facebook, I show him the photo and get his okay. I get to approve tags and photos of myself I want posted — why not my child?\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When her 8-month-old is 3 or 4 years old, she plans to start asking him in an age-appropriate way, \"Do you want other people to see this?\"\u003c/p>\n\u003cp>That's precisely the approach that two researchers advocated before a room of pediatricians last week at the American Academy of Pediatrics meeting, when they discussed the 21st century challenge of \"sharenting,\" a new term for parents' online sharing about their children.\u003c/p>\n\u003cp>\"As children's-rights advocates, we believe that children should have a voice about what information is shared about them if possible,\" says Stacey Steinberg, a legal skills professor at the University of Florida Levin College of Law in Gainesville.\u003c/p>\n\u003cp>Whether it's ensuring your child isn't bullied over something you post, that their identity isn't \u003ca href=\"http://www.cosmopolitan.com/lifestyle/a44264/digital-kidnapping/\">digitally\u003c/a> \"\u003ca href=\"https://www.fastcompany.com/3036073/the-creepiest-new-corner-of-instagram-role-playing-with-stolen-baby-photos\">kidnapped\u003c/a>\" or that their photos don't end up on a half dozen child pornography sites, as \u003ca href=\"http://www.kidspot.com.au/parenting/real-life/reader-stories/mums-warning-i-found-my-childrens-photos-on-porn-sites\">one Australian mom discovered\u003c/a>, parents and pediatricians are increasingly aware of the importance of protecting children's digital presence.\u003c/p>\n\u003cp>Steinberg and \u003ca href=\"https://ufhealth.org/bahareh-keith\">Bahareh Keith\u003c/a>, an assistant professor of pediatrics at the University of Florida College of Medicine, say most children will likely never experience problems related to what their parents share, but a tension still exists between parents' rights to share their experiences and their children's rights to privacy.\u003c/p>\n\u003cp>\"We're in no way trying to silence parents' voices,\" Steinberg says. \"At the same time, we recognize that children might have an interest in entering adulthood free to create their own digital footprint.\"\u003c/p>\n\u003cp>They cited a \u003ca href=\"http://yardi.people.si.umich.edu/pubs/Schoenebeck_FamilyTechRules16.pdf\">study presented earlier this year\u003c/a> of 249 pairs of parents and their children in which more than twice as many children than parents wanted rules on what parents could share.\u003c/p>\n\u003cp>\"The parents said, 'We don't need rules — we're fine,' and the children said, 'Our parents need rules,' \" Keith says. \"The children wanted autonomy about this issue and were worried about their parents sharing information about them.\"\u003c/p>\n\u003cp>She pointed out that the American Academy of Pediatrics offers \u003ca href=\"http://pediatrics.aappublications.org/content/early/2016/10/19/peds.2016-2591\">guidelines\u003c/a> to parents on monitoring their children's social media use, but not the other way around, something \u003ca href=\"http://doctordavidhill.com/about-dr-hill/\">David Hill\u003c/a>, chair of the AAP Council on Communications and Media, expects will become an important part of AAP's messaging.\u003c/p>\n\u003cp>Although its current media guidelines do recommend that parents model appropriate social media use for their children, it does not explicitly discuss oversharing by parents.\u003c/p>\n\u003cp>\"I think this is a very legitimate concern, and I appreciate their drawing our attention to it,\" Hill, a father of five, says. He sees a role for pediatricians to talk with parents about this, but believes the messaging must extend far beyond pediatricians' offices. \"I look forward to seeing researchers expand our understanding of the issue so we can translate it into effective education and policy,\" he says.\u003c/p>\n\u003cp>There's been little research on the topic, Steinbert wrote in a \u003ca href=\"https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2711442\">law article\u003c/a> about this issue. While states could pass laws related to sharing information about children online, Steinberg feels parents themselves are generally best suited to make these decisions for their families.\u003c/p>\n\u003cp>\"While we didn't want to create any unnecessary panic, we did find some concerns that were troublesome, and we thought that parents or at least physicians should be aware of those potential risks,\" Steinberg says. They include photos repurposed for inappropriate or illegal means, identity theft, embarrassment, bullying by peers or \u003ca href=\"https://www.yahoo.com/news/mom-my-son-was-digitally-kidnapped-what-112545291567.html\">digital kidnapping\u003c/a>.\u003c/p>\n\u003cp>Parents aren't oblivious to these possibilities. A March 2015 \u003ca href=\"http://mottnpch.org/sites/default/files/documents/031615_sharenting_0.pdf\">survey of 569 parents\u003c/a> of children ages 4 and younger, conducted by C.S. Mott Children's Hospital at the University of Michigan, found that 68 percent worried about their child's privacy and 67 percent worried their children's photos might be reshared — a concern grounded in reality.\u003c/p>\n\u003cp>For example, an unscientific survey of an online child pornography site by an Australian government official found a \u003ca href=\"http://www.smh.com.au/national/millions-of-social-media-photos-found-on-child-exploitation-sharing-sites-20150929-gjxe55.html\">significant chunk of the photos\u003c/a> had initially been shared by parents on sites such as Facebook and Instagram. The photos themselves were mostly innocent, everyday scenes of kids playing, but they were accompanied by explicit, inappropriate comments. The Australian official estimated that \"about half\" of the 45 million images \"appeared to be sourced directly from social media.\"\u003c/p>\n\u003cp>But that's the sordid side, with risks that must be balanced against the benefits of sharing. Steinberg pointed out that parental sharing on social media helps build communities, connect spread-out families, provide support and raise awareness around important social issues for which parents might be their child's only voice.\u003c/p>\n\u003cp>The same C.S. Mott survey found among the 56 percent of mothers and 34 percent of fathers who discussed parenting on social media, 72 percent of them said sharing made them feel less alone and nearly as many said sharing helped them worry less and gave them advice from other parents. The most common topics they discussed included kids' sleep, nutrition, discipline, behavior problems and day care and preschool.\u003c/p>\n\u003cp>\"There's this peer-to-peer nature of health care these days with a profound opportunity for parents to learn helpful tips, safety and prevention efforts, pro-vaccine messages and all kinds of other messages from other parents in their social communities,\" says Wendy Sue Swanson, a pediatrician and executive director of digital health at Seattle Children's Hospital, where \u003ca href=\"http://seattlemamadoc.seattlechildrens.org/\">she blogs\u003c/a> about her own parenting journey to help other parents. \"They're getting nurtured by people they've already preselected that they trust,\" she says.\u003c/p>\n\u003cp>\"How do we weigh the risks, how do we think about the benefits, and how do we mitigate the risks?\" she says. \"Those are the questions we need to ask ourselves, and everyone can have a different answer.\"\u003c/p>\n\u003cp>For mom Karen Koy, of Platte City, Mo., avoiding nudity or posts about bodily fluids is a given, but for things she's uncertain about, she asks herself a series of questions.\u003c/p>\n\u003cp>\"Who does this serve? If it's anyone other than the kid, no go,\" she explained via Facebook Messenger. \"Is this something people would enjoy hearing or seeing? If the answer is no, no go. Is this something I would love to see pop up as a Facebook memory on a bad day? If not, no go.\"\u003c/p>\n\u003cp>The last question is the reason she did not share photos when her daughter was hospitalized.\u003c/p>\n\u003cp>\"She looked adorable in the oversized hospital gown, which she was wearing because she was vulnerable, and I feel like posting that takes advantage of that vulnerability to gain attention for us, her parents,\" Koy says. \"Her being in the hospital shouldn't be about us, it should be about her and what she needs in that moment.\"\u003c/p>\n\u003cp>Some parents find the best route for them is not to share at all. Bridget O'Hanlon and her husband, who live in Cleveland, decided before their daughter was born that they would not post her photos online. When a few family members did post pictures, O'Hanlon and her husband made their wishes clear.\u003c/p>\n\u003cp>\"It's been hard not to share pics of her because people always want to know how babies and toddlers are doing and to see pictures, but we made the decision to have social media, she did not,\" O'Hanlon told NPR via Facebook Messenger.\u003c/p>\n\u003cp>Similarly, Alison Jamison of Fairport, N.Y., decided with her husband that their child had a right to their own online identity. They did use an invitation-only photo sharing platform so that friends and family, including those far away, could see the photos, but they stood firm when they received pushback about not using other social media platforms, she told NPR via Facebook Messenger.\u003c/p>\n\u003cp>\"For most families, it's a journey. Sometimes it goes wrong, but most of the time it doesn't,\" says Swanson, who recommends starting to ask children permission to post narratives or photos around ages 6 to 8. \"We'll learn more and more what our tolerance is. We can ask our kids to help us learn as a society what's okay and what's not.\"\u003c/p>\n\u003cp>Indeed, that learning process goes both ways. Bria Dunham, a mother in Somerville, Mass., was so excited to watch a moment of brotherly bonding while her first-grader and baby took a bath together that she snapped a few photos. But when she considered posting them on Facebook, she took the perspective of her son: How would he feel if his classmates' parents saw photos of him chest-up in the bathtub?\u003c/p>\n\u003cp>\"It made me think about how I am teaching him to have ownership of his own body and how what is shared today endures into the future,\" Dunham says. \"So I kept the pictures to myself and accepted this as one more step in supporting his increasing autonomy.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Tara Haelle is the co-author of \u003c/em>\u003ca href=\"http://www.npr.org/books/titles/473075468/the-informed-parent-a-science-based-resource-for-your-childs-first-four-years\">The Informed Parent: A Science-Based Resource for Your Child's First Four Years\u003c/a>\u003cem>. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/tarahaelle\">@tarahaelle\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Do+Parents+Invade+Children%27s+Privacy+When+They+Post+Photos+Online%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Katlyn Burbidge's son was 6 years old, he was performing some silly antic typical of a first-grader. But after she snapped a photo and started using her phone, he asked her a serious question: \"Are you going to post that to Facebook?\"\u003c/p>\n\u003cp>She laughed and answered, \"Yes, I think I will.\" What he said next stopped her.\u003c/p>\n\u003cp>\"Can you not?\"\u003c/p>\n\u003cp>That's when it dawned on her: She had been posting photos of him online without asking his permission.\u003c/p>\n\u003cp>\"We're big proponents of bodily autonomy and not forcing him to hug or kiss people unless he wants to, but it never occurred to me that I should ask his permission to post photos of him online,\" says Burbridge, a mom of two in Wakefield, Mass. \"Now when I post photos of him on Facebook, I show him the photo and get his okay. I get to approve tags and photos of myself I want posted — why not my child?\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When her 8-month-old is 3 or 4 years old, she plans to start asking him in an age-appropriate way, \"Do you want other people to see this?\"\u003c/p>\n\u003cp>That's precisely the approach that two researchers advocated before a room of pediatricians last week at the American Academy of Pediatrics meeting, when they discussed the 21st century challenge of \"sharenting,\" a new term for parents' online sharing about their children.\u003c/p>\n\u003cp>\"As children's-rights advocates, we believe that children should have a voice about what information is shared about them if possible,\" says Stacey Steinberg, a legal skills professor at the University of Florida Levin College of Law in Gainesville.\u003c/p>\n\u003cp>Whether it's ensuring your child isn't bullied over something you post, that their identity isn't \u003ca href=\"http://www.cosmopolitan.com/lifestyle/a44264/digital-kidnapping/\">digitally\u003c/a> \"\u003ca href=\"https://www.fastcompany.com/3036073/the-creepiest-new-corner-of-instagram-role-playing-with-stolen-baby-photos\">kidnapped\u003c/a>\" or that their photos don't end up on a half dozen child pornography sites, as \u003ca href=\"http://www.kidspot.com.au/parenting/real-life/reader-stories/mums-warning-i-found-my-childrens-photos-on-porn-sites\">one Australian mom discovered\u003c/a>, parents and pediatricians are increasingly aware of the importance of protecting children's digital presence.\u003c/p>\n\u003cp>Steinberg and \u003ca href=\"https://ufhealth.org/bahareh-keith\">Bahareh Keith\u003c/a>, an assistant professor of pediatrics at the University of Florida College of Medicine, say most children will likely never experience problems related to what their parents share, but a tension still exists between parents' rights to share their experiences and their children's rights to privacy.\u003c/p>\n\u003cp>\"We're in no way trying to silence parents' voices,\" Steinberg says. \"At the same time, we recognize that children might have an interest in entering adulthood free to create their own digital footprint.\"\u003c/p>\n\u003cp>They cited a \u003ca href=\"http://yardi.people.si.umich.edu/pubs/Schoenebeck_FamilyTechRules16.pdf\">study presented earlier this year\u003c/a> of 249 pairs of parents and their children in which more than twice as many children than parents wanted rules on what parents could share.\u003c/p>\n\u003cp>\"The parents said, 'We don't need rules — we're fine,' and the children said, 'Our parents need rules,' \" Keith says. \"The children wanted autonomy about this issue and were worried about their parents sharing information about them.\"\u003c/p>\n\u003cp>She pointed out that the American Academy of Pediatrics offers \u003ca href=\"http://pediatrics.aappublications.org/content/early/2016/10/19/peds.2016-2591\">guidelines\u003c/a> to parents on monitoring their children's social media use, but not the other way around, something \u003ca href=\"http://doctordavidhill.com/about-dr-hill/\">David Hill\u003c/a>, chair of the AAP Council on Communications and Media, expects will become an important part of AAP's messaging.\u003c/p>\n\u003cp>Although its current media guidelines do recommend that parents model appropriate social media use for their children, it does not explicitly discuss oversharing by parents.\u003c/p>\n\u003cp>\"I think this is a very legitimate concern, and I appreciate their drawing our attention to it,\" Hill, a father of five, says. He sees a role for pediatricians to talk with parents about this, but believes the messaging must extend far beyond pediatricians' offices. \"I look forward to seeing researchers expand our understanding of the issue so we can translate it into effective education and policy,\" he says.\u003c/p>\n\u003cp>There's been little research on the topic, Steinbert wrote in a \u003ca href=\"https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2711442\">law article\u003c/a> about this issue. While states could pass laws related to sharing information about children online, Steinberg feels parents themselves are generally best suited to make these decisions for their families.\u003c/p>\n\u003cp>\"While we didn't want to create any unnecessary panic, we did find some concerns that were troublesome, and we thought that parents or at least physicians should be aware of those potential risks,\" Steinberg says. They include photos repurposed for inappropriate or illegal means, identity theft, embarrassment, bullying by peers or \u003ca href=\"https://www.yahoo.com/news/mom-my-son-was-digitally-kidnapped-what-112545291567.html\">digital kidnapping\u003c/a>.\u003c/p>\n\u003cp>Parents aren't oblivious to these possibilities. A March 2015 \u003ca href=\"http://mottnpch.org/sites/default/files/documents/031615_sharenting_0.pdf\">survey of 569 parents\u003c/a> of children ages 4 and younger, conducted by C.S. Mott Children's Hospital at the University of Michigan, found that 68 percent worried about their child's privacy and 67 percent worried their children's photos might be reshared — a concern grounded in reality.\u003c/p>\n\u003cp>For example, an unscientific survey of an online child pornography site by an Australian government official found a \u003ca href=\"http://www.smh.com.au/national/millions-of-social-media-photos-found-on-child-exploitation-sharing-sites-20150929-gjxe55.html\">significant chunk of the photos\u003c/a> had initially been shared by parents on sites such as Facebook and Instagram. The photos themselves were mostly innocent, everyday scenes of kids playing, but they were accompanied by explicit, inappropriate comments. The Australian official estimated that \"about half\" of the 45 million images \"appeared to be sourced directly from social media.\"\u003c/p>\n\u003cp>But that's the sordid side, with risks that must be balanced against the benefits of sharing. Steinberg pointed out that parental sharing on social media helps build communities, connect spread-out families, provide support and raise awareness around important social issues for which parents might be their child's only voice.\u003c/p>\n\u003cp>The same C.S. Mott survey found among the 56 percent of mothers and 34 percent of fathers who discussed parenting on social media, 72 percent of them said sharing made them feel less alone and nearly as many said sharing helped them worry less and gave them advice from other parents. The most common topics they discussed included kids' sleep, nutrition, discipline, behavior problems and day care and preschool.\u003c/p>\n\u003cp>\"There's this peer-to-peer nature of health care these days with a profound opportunity for parents to learn helpful tips, safety and prevention efforts, pro-vaccine messages and all kinds of other messages from other parents in their social communities,\" says Wendy Sue Swanson, a pediatrician and executive director of digital health at Seattle Children's Hospital, where \u003ca href=\"http://seattlemamadoc.seattlechildrens.org/\">she blogs\u003c/a> about her own parenting journey to help other parents. \"They're getting nurtured by people they've already preselected that they trust,\" she says.\u003c/p>\n\u003cp>\"How do we weigh the risks, how do we think about the benefits, and how do we mitigate the risks?\" she says. \"Those are the questions we need to ask ourselves, and everyone can have a different answer.\"\u003c/p>\n\u003cp>For mom Karen Koy, of Platte City, Mo., avoiding nudity or posts about bodily fluids is a given, but for things she's uncertain about, she asks herself a series of questions.\u003c/p>\n\u003cp>\"Who does this serve? If it's anyone other than the kid, no go,\" she explained via Facebook Messenger. \"Is this something people would enjoy hearing or seeing? If the answer is no, no go. Is this something I would love to see pop up as a Facebook memory on a bad day? If not, no go.\"\u003c/p>\n\u003cp>The last question is the reason she did not share photos when her daughter was hospitalized.\u003c/p>\n\u003cp>\"She looked adorable in the oversized hospital gown, which she was wearing because she was vulnerable, and I feel like posting that takes advantage of that vulnerability to gain attention for us, her parents,\" Koy says. \"Her being in the hospital shouldn't be about us, it should be about her and what she needs in that moment.\"\u003c/p>\n\u003cp>Some parents find the best route for them is not to share at all. Bridget O'Hanlon and her husband, who live in Cleveland, decided before their daughter was born that they would not post her photos online. When a few family members did post pictures, O'Hanlon and her husband made their wishes clear.\u003c/p>\n\u003cp>\"It's been hard not to share pics of her because people always want to know how babies and toddlers are doing and to see pictures, but we made the decision to have social media, she did not,\" O'Hanlon told NPR via Facebook Messenger.\u003c/p>\n\u003cp>Similarly, Alison Jamison of Fairport, N.Y., decided with her husband that their child had a right to their own online identity. They did use an invitation-only photo sharing platform so that friends and family, including those far away, could see the photos, but they stood firm when they received pushback about not using other social media platforms, she told NPR via Facebook Messenger.\u003c/p>\n\u003cp>\"For most families, it's a journey. Sometimes it goes wrong, but most of the time it doesn't,\" says Swanson, who recommends starting to ask children permission to post narratives or photos around ages 6 to 8. \"We'll learn more and more what our tolerance is. We can ask our kids to help us learn as a society what's okay and what's not.\"\u003c/p>\n\u003cp>Indeed, that learning process goes both ways. Bria Dunham, a mother in Somerville, Mass., was so excited to watch a moment of brotherly bonding while her first-grader and baby took a bath together that she snapped a few photos. But when she considered posting them on Facebook, she took the perspective of her son: How would he feel if his classmates' parents saw photos of him chest-up in the bathtub?\u003c/p>\n\u003cp>\"It made me think about how I am teaching him to have ownership of his own body and how what is shared today endures into the future,\" Dunham says. \"So I kept the pictures to myself and accepted this as one more step in supporting his increasing autonomy.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Tara Haelle is the co-author of \u003c/em>\u003ca href=\"http://www.npr.org/books/titles/473075468/the-informed-parent-a-science-based-resource-for-your-childs-first-four-years\">The Informed Parent: A Science-Based Resource for Your Child's First Four Years\u003c/a>\u003cem>. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/tarahaelle\">@tarahaelle\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Do+Parents+Invade+Children%27s+Privacy+When+They+Post+Photos+Online%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Workers in California's hospitals and doctors' offices may be less likely to get hit, kicked, bitten or grabbed under workplace standards adopted by a state workplace safety board.\u003c/p>\n\u003cp>Regulators within the California Division of Occupational Safety and Health approved \u003ca href=\"http://www.dir.ca.gov/oshsb/documents/Workplace-Violence-Prevention-in-Health-Care-txtbdconsider.pdf\">a rule\u003c/a> last Thursday that would require hospitals and other employers of health professionals to develop violence prevention protocols and involve workers in the process. The standard now will be reviewed by the Office of Administrative Law, which proponents expect will approve the new rules. The earliest they could take effect would be January 2017.\u003c/p>\n\u003cp>\"This is a landmark day for the entire country,\" said Bonnie Castillo, a registered nurse who is director of health and safety for the California Nurses Association/National Nurses United, which represents 185,000 registered nurses across the U.S.\u003c/p>\n\u003cp>But some states, including California, New York, Illinois and New Jersey require public employers to take preventive measures, according to the \u003ca href=\"http://nursingworld.org/workplaceviolence\" target=\"_blank\">American Nurses Association\u003c/a>.\u003c/p>\n\u003cp>The Cal/OSHA rules apply to private health care facilities in the state and are more robust than existing workplace protection rules, union officials say. Site-specific assessments will be done to identify violence risks, and the resulting plans to prevent injuries will address concerns identified by workers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"California has now set the bar with the strongest workplace violence regulation in the nation,\" wrote Castillo in a statement.\u003c/p>\n\u003cp>Two unions, the California Nurses Association and the Service Employees International Union, have been pushing for more comprehensive protections because of what they see as an alarming rate of health care workplace assaults, such as the \u003ca href=\"http://www.npr.org/sections/health-shots/2015/10/20/449200736/5-years-after-a-murder-calif-hospital-still-struggles-with-violence\">2010 strangling death of a nurse\u003c/a> at a state-run psychiatric hospital in Napa.\u003c/p>\n\u003cp>\"Unfortunately, [violence] is sort of a daily occurrence,\" said Kathy Hughes, a registered nurse and spokesperson for the SEIU Nurse Alliance of California. She said her union formed a campaign and talked to hundreds of health care professionals, many of whom had accepted the idea that assaults happen at work. But \"violence shouldn't be part of the job,\" said Hughes.\u003c/p>\n\u003cp>The California Nurses Association sponsored the 2014 bill that required the board to adopt the violence prevention rules this year.\u003c/p>\n\u003cp>National \u003ca href=\"http://www.gao.gov/assets/680/675858.pdf\" target=\"_blank\">research\u003c/a> shows that health care workers are at a \"substantially higher\" risk of workplace violence than the average worker. In 2013, for example, private-sector hospital workers were five times more likely to take time off from work because of an injury caused by violence than a typical private sector worker.\u003c/p>\n\u003cp>Workplace safety standards already exist in California, but the Cal/OSHA rules are specifically designed to prevent violence.\u003c/p>\n\u003cp>\"It can't be a cookie-cutter approach,\" said Hughes, adding that emergency departments and pediatric care units pose different dangers to workers, so safety protocols can't simply be a canned plan found on the Internet.\u003c/p>\n\u003cp>Both the California Nurses Association and SEIU say they hope the new California standards will become a national model.\u003c/p>\n\u003cp>Testimony at hearings leading up to the approval of the rules to prevent violence suggest that worker assaults vary in severity.\u003c/p>\n\u003cp>As a student nurse at a San Francisco hospital, Amy Erb \u003ca href=\"http://www.dir.ca.gov/dosh/DoshReg/Workplace-Violence-in-Healthcare/Meeting-minutes.2015-04-01.pdf\" target=\"_blank\">remembered\u003c/a> being kicked in the head by an agitated, confused patient with a traumatic brain injury.\u003c/p>\n\u003cp>Other health care workers told stories about patients throwing lamps, lifting caregivers up by their necks or stuffing dirt into the mouths of their colleagues.\u003c/p>\n\u003cp>Under the new rules, California employers wouldn't be liable for every act of violence against a worker, such as a mass shooting, but they could be cited by Cal/OSHA for not following protocols, Hughes said. The standard applies to hospital-affiliated facilities and clinics, including home health care settings and drug treatment programs.\u003c/p>\n\u003cp>Hospitals and physicians were at the table when regulators hammered out the workplace rules. The California Hospital Association didn't provide comment for this story, but it had been opposed to creating new standards when lawmakers looked at the issue in 2014. Hospitals also wanted \"workplace violence\" to be \u003ca href=\"http://www.dir.ca.gov/dosh/doshreg/Workplace-Violence-in-Healthcare/Comments/Cal-OSHA-Workplace-Violence-Letter-Nov14.pdf\" target=\"_blank\">better defined\u003c/a>.\u003c/p>\n\u003cp>The hospital trade association said several recent trends may contribute to violence at health care facilities. Cuts to mental health care services lead to more psychiatric patients in hospitals. The aging patient population may include more Alzheimer's patients, some with aggressive tendencies. And hospitals caring for current or recently released prisoners face a higher risk of violence.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>,\u003cem> which publishes \u003c/em>\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>,\u003cem> an editorially independent service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=California+Rules+About+Violence+Against+Health+Workers+Could+Become+A+Model&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Workers in California's hospitals and doctors' offices may be less likely to get hit, kicked, bitten or grabbed under workplace standards adopted by a state workplace safety board.\u003c/p>\n\u003cp>Regulators within the California Division of Occupational Safety and Health approved \u003ca href=\"http://www.dir.ca.gov/oshsb/documents/Workplace-Violence-Prevention-in-Health-Care-txtbdconsider.pdf\">a rule\u003c/a> last Thursday that would require hospitals and other employers of health professionals to develop violence prevention protocols and involve workers in the process. The standard now will be reviewed by the Office of Administrative Law, which proponents expect will approve the new rules. The earliest they could take effect would be January 2017.\u003c/p>\n\u003cp>\"This is a landmark day for the entire country,\" said Bonnie Castillo, a registered nurse who is director of health and safety for the California Nurses Association/National Nurses United, which represents 185,000 registered nurses across the U.S.\u003c/p>\n\u003cp>But some states, including California, New York, Illinois and New Jersey require public employers to take preventive measures, according to the \u003ca href=\"http://nursingworld.org/workplaceviolence\" target=\"_blank\">American Nurses Association\u003c/a>.\u003c/p>\n\u003cp>The Cal/OSHA rules apply to private health care facilities in the state and are more robust than existing workplace protection rules, union officials say. Site-specific assessments will be done to identify violence risks, and the resulting plans to prevent injuries will address concerns identified by workers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"California has now set the bar with the strongest workplace violence regulation in the nation,\" wrote Castillo in a statement.\u003c/p>\n\u003cp>Two unions, the California Nurses Association and the Service Employees International Union, have been pushing for more comprehensive protections because of what they see as an alarming rate of health care workplace assaults, such as the \u003ca href=\"http://www.npr.org/sections/health-shots/2015/10/20/449200736/5-years-after-a-murder-calif-hospital-still-struggles-with-violence\">2010 strangling death of a nurse\u003c/a> at a state-run psychiatric hospital in Napa.\u003c/p>\n\u003cp>\"Unfortunately, [violence] is sort of a daily occurrence,\" said Kathy Hughes, a registered nurse and spokesperson for the SEIU Nurse Alliance of California. She said her union formed a campaign and talked to hundreds of health care professionals, many of whom had accepted the idea that assaults happen at work. But \"violence shouldn't be part of the job,\" said Hughes.\u003c/p>\n\u003cp>The California Nurses Association sponsored the 2014 bill that required the board to adopt the violence prevention rules this year.\u003c/p>\n\u003cp>National \u003ca href=\"http://www.gao.gov/assets/680/675858.pdf\" target=\"_blank\">research\u003c/a> shows that health care workers are at a \"substantially higher\" risk of workplace violence than the average worker. In 2013, for example, private-sector hospital workers were five times more likely to take time off from work because of an injury caused by violence than a typical private sector worker.\u003c/p>\n\u003cp>Workplace safety standards already exist in California, but the Cal/OSHA rules are specifically designed to prevent violence.\u003c/p>\n\u003cp>\"It can't be a cookie-cutter approach,\" said Hughes, adding that emergency departments and pediatric care units pose different dangers to workers, so safety protocols can't simply be a canned plan found on the Internet.\u003c/p>\n\u003cp>Both the California Nurses Association and SEIU say they hope the new California standards will become a national model.\u003c/p>\n\u003cp>Testimony at hearings leading up to the approval of the rules to prevent violence suggest that worker assaults vary in severity.\u003c/p>\n\u003cp>As a student nurse at a San Francisco hospital, Amy Erb \u003ca href=\"http://www.dir.ca.gov/dosh/DoshReg/Workplace-Violence-in-Healthcare/Meeting-minutes.2015-04-01.pdf\" target=\"_blank\">remembered\u003c/a> being kicked in the head by an agitated, confused patient with a traumatic brain injury.\u003c/p>\n\u003cp>Other health care workers told stories about patients throwing lamps, lifting caregivers up by their necks or stuffing dirt into the mouths of their colleagues.\u003c/p>\n\u003cp>Under the new rules, California employers wouldn't be liable for every act of violence against a worker, such as a mass shooting, but they could be cited by Cal/OSHA for not following protocols, Hughes said. The standard applies to hospital-affiliated facilities and clinics, including home health care settings and drug treatment programs.\u003c/p>\n\u003cp>Hospitals and physicians were at the table when regulators hammered out the workplace rules. The California Hospital Association didn't provide comment for this story, but it had been opposed to creating new standards when lawmakers looked at the issue in 2014. Hospitals also wanted \"workplace violence\" to be \u003ca href=\"http://www.dir.ca.gov/dosh/doshreg/Workplace-Violence-in-Healthcare/Comments/Cal-OSHA-Workplace-Violence-Letter-Nov14.pdf\" target=\"_blank\">better defined\u003c/a>.\u003c/p>\n\u003cp>The hospital trade association said several recent trends may contribute to violence at health care facilities. Cuts to mental health care services lead to more psychiatric patients in hospitals. The aging patient population may include more Alzheimer's patients, some with aggressive tendencies. And hospitals caring for current or recently released prisoners face a higher risk of violence.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>,\u003cem> which publishes \u003c/em>\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>,\u003cem> an editorially independent service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=California+Rules+About+Violence+Against+Health+Workers+Could+Become+A+Model&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "STD Infections Rise to New Highs After States Close Health Clinics",
"title": "STD Infections Rise to New Highs After States Close Health Clinics",
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"content": "\u003cp>The number of people infected with three major sexually transmitted diseases is at an all-time high, according to a CDC report released Wednesday. And the increase in reported cases of chlamydia, gonorrhea and syphilis is hitting teenagers and young adults hardest.\u003c/p>\n\u003cp>Over half of gonorrhea and chlamydia cases are in people under the age of 25, says Dr. \u003ca href=\"http://www.cdc.gov/about/leadership/new-leaders/nchhstp.html\">Jonathan Mermin\u003c/a>, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention for the CDC.\u003c/p>\n\u003cp>These STDs can have serious long term health consequences, including chronic pain and fertility problems. Pregnant women can pass syphilis on to their children, leading to \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/12/455768422/more-babies-are-dying-because-of-congenital-syphilis\">stillbirth or birth defects\u003c/a>.\u003c/p>\n\u003cp>State and local budget cuts to STD care and prevention programs are major drivers in the surge in STDs, Mermin says.\u003c/p>\n\u003cp>\"Our ability to prevent STDs is only as strong as the public health infrastructure to support it,\" he says. \"More than half of state and local STD programs have experienced budget cuts. In 2012, 20 health departments reported having to close their STD clinics.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Syphilis infections have been increasing at a particularly troubling rate, \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/2016/2015-std-surveillance-report.html\">according to the report\u003c/a>. In 2015, 23,872 cases were reported, a 19 percent increase since 2014. \u003ca href=\"http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm\">Syphilis\u003c/a> cases have been going up over the past decade, while the spike in cases of chlamydia and gonorrhea is more recent.\u003c/p>\n\u003cp>There were 395,216 cases of \u003ca href=\"http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm\">gonorrhea\u003c/a> and 1.5 million cases of \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm\">chlamydia \u003c/a>reported in the same year, showing a rise of 6 and 13 percent over the past year. All three infections can be treated with antibiotics, though gonorrhea is becoming \u003ca href=\"http://www.npr.org/sections/thetwo-way/2016/08/30/491969011/u-n-health-officials-warn-gonorrhea-is-becoming-untreatable\">increasingly resistant to antibiotics\u003c/a>.\u003c/p>\n\u003cp>\"This basically tells us we have to do a better job of reach out to some of these communities that are disproportionately affected by these infections,\" says \u003ca href=\"https://internalmedicine.osu.edu/infectiousdisease/directory/faculty/josebazan/\">Dr. Jose Bazan\u003c/a>, a medical director for an STD clinic at Columbus Public Health and an assistant professor of internal medicine at Ohio State University who was not involved with the report.\u003c/p>\n\u003cp>Men who have sex with men face a greater risk of being infected with syphilis. Over 80 percent of male syphilis cases were reported among gay and bisexual males, and over 90 percent of all syphilis cases were in men. People in racial and sexual minority groups can have more than the usual trouble finding care for preventing and treating STDs.\u003c/p>\n\u003cp>According to a congressional briefing last April by Dr. Gail Bolan, the director for the CDC Division of STD Prevention, over 40 percent of health departments reduced clinic hours, screening, or tracing people who may have been infected.\u003c/p>\n\u003cp>\"If that infrastructure gets STDeroded, people are more likely to have their STDs for a longer period of time, and that can lead to increased transmission,\" Mermin says.\u003c/p>\n\u003cp>The federal government also helps fund state and local STD programs through the CDC, but federal funds have not helped make up for some of the budget cuts on the local level, according to \u003ca href=\"http://www.ncsddc.org/who-we-are/board\">David Harvey\u003c/a>, the executive director for the National Coalition of STD Directors.\u003c/p>\n\u003cp>\"We believe there's a direct relationship between budget cuts and increases in STDs in the United States. There has been no federal increases for STD programs in this country since 2003,\" he says.\u003c/p>\n\u003cp>If the trend is to be reversed, Mermin says there needs to be a real investment in STD prevention so that clinics can monitor these diseases and quickly diagnose and treat people who are infected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We've seen success in the past where investments have paid off,\" he says. \"We know what we need to do. We just need to do it more effectively than we've been able to do with this eroding infrastructure.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=STD+Infections+Rise+To+New+Highs+After+States+Close+Health+Clinics&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The number of people infected with three major sexually transmitted diseases is at an all-time high, according to a CDC report released Wednesday. And the increase in reported cases of chlamydia, gonorrhea and syphilis is hitting teenagers and young adults hardest.\u003c/p>\n\u003cp>Over half of gonorrhea and chlamydia cases are in people under the age of 25, says Dr. \u003ca href=\"http://www.cdc.gov/about/leadership/new-leaders/nchhstp.html\">Jonathan Mermin\u003c/a>, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention for the CDC.\u003c/p>\n\u003cp>These STDs can have serious long term health consequences, including chronic pain and fertility problems. Pregnant women can pass syphilis on to their children, leading to \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/12/455768422/more-babies-are-dying-because-of-congenital-syphilis\">stillbirth or birth defects\u003c/a>.\u003c/p>\n\u003cp>State and local budget cuts to STD care and prevention programs are major drivers in the surge in STDs, Mermin says.\u003c/p>\n\u003cp>\"Our ability to prevent STDs is only as strong as the public health infrastructure to support it,\" he says. \"More than half of state and local STD programs have experienced budget cuts. In 2012, 20 health departments reported having to close their STD clinics.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Syphilis infections have been increasing at a particularly troubling rate, \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/2016/2015-std-surveillance-report.html\">according to the report\u003c/a>. In 2015, 23,872 cases were reported, a 19 percent increase since 2014. \u003ca href=\"http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm\">Syphilis\u003c/a> cases have been going up over the past decade, while the spike in cases of chlamydia and gonorrhea is more recent.\u003c/p>\n\u003cp>There were 395,216 cases of \u003ca href=\"http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm\">gonorrhea\u003c/a> and 1.5 million cases of \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm\">chlamydia \u003c/a>reported in the same year, showing a rise of 6 and 13 percent over the past year. All three infections can be treated with antibiotics, though gonorrhea is becoming \u003ca href=\"http://www.npr.org/sections/thetwo-way/2016/08/30/491969011/u-n-health-officials-warn-gonorrhea-is-becoming-untreatable\">increasingly resistant to antibiotics\u003c/a>.\u003c/p>\n\u003cp>\"This basically tells us we have to do a better job of reach out to some of these communities that are disproportionately affected by these infections,\" says \u003ca href=\"https://internalmedicine.osu.edu/infectiousdisease/directory/faculty/josebazan/\">Dr. Jose Bazan\u003c/a>, a medical director for an STD clinic at Columbus Public Health and an assistant professor of internal medicine at Ohio State University who was not involved with the report.\u003c/p>\n\u003cp>Men who have sex with men face a greater risk of being infected with syphilis. Over 80 percent of male syphilis cases were reported among gay and bisexual males, and over 90 percent of all syphilis cases were in men. People in racial and sexual minority groups can have more than the usual trouble finding care for preventing and treating STDs.\u003c/p>\n\u003cp>According to a congressional briefing last April by Dr. Gail Bolan, the director for the CDC Division of STD Prevention, over 40 percent of health departments reduced clinic hours, screening, or tracing people who may have been infected.\u003c/p>\n\u003cp>\"If that infrastructure gets STDeroded, people are more likely to have their STDs for a longer period of time, and that can lead to increased transmission,\" Mermin says.\u003c/p>\n\u003cp>The federal government also helps fund state and local STD programs through the CDC, but federal funds have not helped make up for some of the budget cuts on the local level, according to \u003ca href=\"http://www.ncsddc.org/who-we-are/board\">David Harvey\u003c/a>, the executive director for the National Coalition of STD Directors.\u003c/p>\n\u003cp>\"We believe there's a direct relationship between budget cuts and increases in STDs in the United States. There has been no federal increases for STD programs in this country since 2003,\" he says.\u003c/p>\n\u003cp>If the trend is to be reversed, Mermin says there needs to be a real investment in STD prevention so that clinics can monitor these diseases and quickly diagnose and treat people who are infected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We've seen success in the past where investments have paid off,\" he says. \"We know what we need to do. We just need to do it more effectively than we've been able to do with this eroding infrastructure.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=STD+Infections+Rise+To+New+Highs+After+States+Close+Health+Clinics&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Women are less likely to die of breast cancer than they were a decade ago, but not all women are benefiting from that trend.\u003c/p>\n\u003cp>White women saw more of a drop in death rates than black women — 1.9 percent a year from 2010 to 2014, compared to a 1.5 percent decrease for black women, according to a \u003ca href=\"http://www.cdc.gov/mmwr/volumes/65/wr/mm6540a1.htm?s_cid=mm6540a1_w\">report\u003c/a> published Thursday by the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>And while the death rates for women under 50 declined regardless of race, older black women are more likely to die of breast cancer than are white women.\u003c/p>\n\u003cp>That's especially troubling because 40 years ago, black women were less likely to get breast cancer. That's changed. Black women's breast cancer risk is \u003ca href=\"http://www.npr.org/sections/health-shots/2015/10/29/452650557/black-womens-breast-cancer-risk-rises-to-equal-white-womens\">now the same\u003c/a> as that of white women's, and black women are 41 percent more likely to die of the disease.\u003c/p>\n\u003cp>There can be some good reasons for the rise in the number of black women being diagnosed with breast cancer, like more women getting screening mammograms. But there are bad reasons, too.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The CDC report cites calorie-dense foods, lack of exercise and increasing rates of obesity as potential reasons.\u003c/p>\n\u003cp>And while this report found similar reductions in deaths among younger black and white women, older white women saw their death rates drop by 2 percent a year, compared to 1 percent in black women.\u003c/p>\n\u003cp>Access to care is one big reason why, according to \u003ca href=\"http://www.cancer.org/research/acsresearchers/otis-brawley-md-facp\">Otis Brawley\u003c/a>, chief medical and scientific officer for the American Cancer Society.\u003c/p>\n\u003cp>\"Forty to 50 percent of black women get less than optimal care for breast cancer, whether it's mammography or treatment,\" Brawley says.\u003c/p>\n\u003cp>They're not alone in that; poor white women are also much less likely to get adequate care, and more likely to die as a result.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We need to focus on getting good care, high-quality care to everybody,\" Brawley adds. \"We need to realize that in the United States of America in 2016 a substantial proportion of Americans with cancer get absolutely atrocious care.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Breast+Cancer+Death+Rates+Are+Down%2C+But+Racial+Disparities+Persist&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Women are less likely to die of breast cancer than they were a decade ago, but not all women are benefiting from that trend.\u003c/p>\n\u003cp>White women saw more of a drop in death rates than black women — 1.9 percent a year from 2010 to 2014, compared to a 1.5 percent decrease for black women, according to a \u003ca href=\"http://www.cdc.gov/mmwr/volumes/65/wr/mm6540a1.htm?s_cid=mm6540a1_w\">report\u003c/a> published Thursday by the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>And while the death rates for women under 50 declined regardless of race, older black women are more likely to die of breast cancer than are white women.\u003c/p>\n\u003cp>That's especially troubling because 40 years ago, black women were less likely to get breast cancer. That's changed. Black women's breast cancer risk is \u003ca href=\"http://www.npr.org/sections/health-shots/2015/10/29/452650557/black-womens-breast-cancer-risk-rises-to-equal-white-womens\">now the same\u003c/a> as that of white women's, and black women are 41 percent more likely to die of the disease.\u003c/p>\n\u003cp>There can be some good reasons for the rise in the number of black women being diagnosed with breast cancer, like more women getting screening mammograms. But there are bad reasons, too.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The CDC report cites calorie-dense foods, lack of exercise and increasing rates of obesity as potential reasons.\u003c/p>\n\u003cp>And while this report found similar reductions in deaths among younger black and white women, older white women saw their death rates drop by 2 percent a year, compared to 1 percent in black women.\u003c/p>\n\u003cp>Access to care is one big reason why, according to \u003ca href=\"http://www.cancer.org/research/acsresearchers/otis-brawley-md-facp\">Otis Brawley\u003c/a>, chief medical and scientific officer for the American Cancer Society.\u003c/p>\n\u003cp>\"Forty to 50 percent of black women get less than optimal care for breast cancer, whether it's mammography or treatment,\" Brawley says.\u003c/p>\n\u003cp>They're not alone in that; poor white women are also much less likely to get adequate care, and more likely to die as a result.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We need to focus on getting good care, high-quality care to everybody,\" Brawley adds. \"We need to realize that in the United States of America in 2016 a substantial proportion of Americans with cancer get absolutely atrocious care.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Breast+Cancer+Death+Rates+Are+Down%2C+But+Racial+Disparities+Persist&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When doctors want to help untangle confusing and sometimes contradictory findings in the scientific literature, they often turn to specially crafted summary studies. These are considered the gold standard for evidence. But one of the leading advocates for this practice is now raising alarm about them, because they are increasingly being tainted by commercial interests.\u003c/p>\n\u003cp>For many years, these studies — called meta-analyses and systematic reviews — seemed to solve a big problem. Doctors who had once relied on each other's expert opinions to select the best treatments gradually turned to careful scientific studies instead.\u003c/p>\n\u003cp>But the number of studies mushroomed and often came to different conclusions. So in the 1990s, doctors and medical advisory committees started relying on studies that combined results from many different research projects to streamline the search for answers.\u003c/p>\n\u003cp>These kinds of studies are \"extremely important,\" says \u003ca href=\"https://med.stanford.edu/profiles/john-ioannidis\">Dr. John Ioannidis\u003c/a>, a professor of medicine health research and policy at Stanford University. He has conducted many of these types of studies over the course of his career. \"They're trying to make some sense out of a very convoluted scientific and medical literature.\"\u003c/p>\n\u003cp>But Ioannidis says unfortunately things have gotten out of hand. First, \"the problem is that there are just too many meta-analyses,\" Ioannidis says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In a \u003ca href=\"http://www.milbank.org/wp-content/files/documents/The_Mass_Production_of_Redundant_Misleading_and_Conflicted_Systematic_Reviews_and_Meta-Analyses.pdf\">recent study on the subject\u003c/a>, titled \"The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-Analyses,\" he chose as an example studies involving antidepressant drugs. \"There are 185 of them published in the literature within seven years, which means about 25 of them published every year for the very same drugs and the very same indication, major depression,\" Ioannidis said.\u003c/p>\n\u003cp>What's worse, they're increasingly being generated by scientists who have financial interests in the outcome, Ioannidis \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26399904\">found\u003c/a>.\u003c/p>\n\u003cp>\"About 80 percent of them have been funded or have some other conflicts of interest with manufacturers of these drugs,\" he says. \"If you look at what their conclusions are, those that have been authored by industry employees, practically all of them, with one exception, have claimed that there are no caveats about antidepressants.\"\u003c/p>\n\u003cp>You have to read deep into the studies to find warnings about potential suicide risks, for example — if downsides are mentioned at all.\u003c/p>\n\u003cp>That's potentially misleading to doctors who turn to this kind of analysis to get a quick take on what works and what doesn't. Ioannidis says the drug industry has started using meta-analysis for commercial purposes, rather than as a disinterested look at the evidence.\u003c/p>\n\u003cp>\"They can get the results or at least the interpretation that fits their needs. So you have the most powerful and most prestigious design in current medical evidence, and it can be easily manipulated as an advertisement, as a marketing tool.\"\u003c/p>\n\u003cp>And that defeats one of the main purposes of these studies, which is to make an overflowing scientific literature more manageable.\u003c/p>\n\u003cp>Peter Kramer, a clinical professor emeritus at Brown University and author of \u003cem>Listening to Prozac,\u003c/em> took a deep dive into meta-analyses when he was writing his latest book, \u003ca href=\"http://www.wbur.org/onpoint/2016/06/16/peter-kramers-new-defense-of-antidepressants\">Ordinarily Well\u003c/a>. He found the situation even worse than Ioannidis suggests.\u003c/p>\n\u003cp>\"In some ways my doubts are stronger than his,\" Kramer told Shots.\u003c/p>\n\u003cp>Some analyses he looked at were trying to parse very subtle differences — for example, comparing two very similar antidepressants. You could get any answer you want, depending on how you set up the study, Kramer says.\u003c/p>\n\u003cp>And the problems he found aren't simply commercial conflicts of interest. For example, he saw biases among academics who were wedded to the notion that placebos are just as good as actual drugs for depression.\u003c/p>\n\u003cp>\"Even on that side of the equation, where there's no adverse sponsorship but just an allegiance to an idea, I thought it wasn't always the case that everybody's hands were on the table,\" Kramer said.\u003c/p>\n\u003cp>But financial conflicts are easier to identify. Five years ago, the National Academy's Institute of Medicine (now called the National Academy of Medicine) suggested dozens of standards that should apply to systematic reviews of the research literature.\u003c/p>\n\u003cp>The influence of funders is a concern, says \u003ca href=\"https://depts.washington.edu/fammed/profile/?id=00041\">Dr. Alfred Berg\u003c/a>, a professor emeritus of family medicine at the University of Washington who chaired one of the committees.\u003c/p>\n\u003cp>\"If there's obvious sponsorship from an organization that might have a conflict of interest, that's probably not a good idea,\" he says. It's reasonable to suggest that scientists with clear financial conflicts of interest should not be producing these studies. \"Is it going to happen in my lifetime?\" Berg says. \"Probably not!\"\u003c/p>\n\u003cp>Pfizer, one of the many drug companies that fund meta-analyses involving their own products, declined an interview request. But the company noted in an emailed statement that the drug company \"shares data from its clinical trials with outside members of the research community for them to conduct their own independent meta-analyses.\"\u003c/p>\n\u003cp>Fortunately, scientific journals are starting to do a better job of making sure researchers disclose their financial interests. It's up to readers now to take heed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Email Richard Harris at \u003ca href=\"mailto:rharris@npr.org\">rharris@npr.org.\u003c/a>\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Reviews+Of+Medical+Studies+May+Be+Tainted+By+Funders%27+Influence&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When doctors want to help untangle confusing and sometimes contradictory findings in the scientific literature, they often turn to specially crafted summary studies. These are considered the gold standard for evidence. But one of the leading advocates for this practice is now raising alarm about them, because they are increasingly being tainted by commercial interests.\u003c/p>\n\u003cp>For many years, these studies — called meta-analyses and systematic reviews — seemed to solve a big problem. Doctors who had once relied on each other's expert opinions to select the best treatments gradually turned to careful scientific studies instead.\u003c/p>\n\u003cp>But the number of studies mushroomed and often came to different conclusions. So in the 1990s, doctors and medical advisory committees started relying on studies that combined results from many different research projects to streamline the search for answers.\u003c/p>\n\u003cp>These kinds of studies are \"extremely important,\" says \u003ca href=\"https://med.stanford.edu/profiles/john-ioannidis\">Dr. John Ioannidis\u003c/a>, a professor of medicine health research and policy at Stanford University. He has conducted many of these types of studies over the course of his career. \"They're trying to make some sense out of a very convoluted scientific and medical literature.\"\u003c/p>\n\u003cp>But Ioannidis says unfortunately things have gotten out of hand. First, \"the problem is that there are just too many meta-analyses,\" Ioannidis says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In a \u003ca href=\"http://www.milbank.org/wp-content/files/documents/The_Mass_Production_of_Redundant_Misleading_and_Conflicted_Systematic_Reviews_and_Meta-Analyses.pdf\">recent study on the subject\u003c/a>, titled \"The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-Analyses,\" he chose as an example studies involving antidepressant drugs. \"There are 185 of them published in the literature within seven years, which means about 25 of them published every year for the very same drugs and the very same indication, major depression,\" Ioannidis said.\u003c/p>\n\u003cp>What's worse, they're increasingly being generated by scientists who have financial interests in the outcome, Ioannidis \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26399904\">found\u003c/a>.\u003c/p>\n\u003cp>\"About 80 percent of them have been funded or have some other conflicts of interest with manufacturers of these drugs,\" he says. \"If you look at what their conclusions are, those that have been authored by industry employees, practically all of them, with one exception, have claimed that there are no caveats about antidepressants.\"\u003c/p>\n\u003cp>You have to read deep into the studies to find warnings about potential suicide risks, for example — if downsides are mentioned at all.\u003c/p>\n\u003cp>That's potentially misleading to doctors who turn to this kind of analysis to get a quick take on what works and what doesn't. Ioannidis says the drug industry has started using meta-analysis for commercial purposes, rather than as a disinterested look at the evidence.\u003c/p>\n\u003cp>\"They can get the results or at least the interpretation that fits their needs. So you have the most powerful and most prestigious design in current medical evidence, and it can be easily manipulated as an advertisement, as a marketing tool.\"\u003c/p>\n\u003cp>And that defeats one of the main purposes of these studies, which is to make an overflowing scientific literature more manageable.\u003c/p>\n\u003cp>Peter Kramer, a clinical professor emeritus at Brown University and author of \u003cem>Listening to Prozac,\u003c/em> took a deep dive into meta-analyses when he was writing his latest book, \u003ca href=\"http://www.wbur.org/onpoint/2016/06/16/peter-kramers-new-defense-of-antidepressants\">Ordinarily Well\u003c/a>. He found the situation even worse than Ioannidis suggests.\u003c/p>\n\u003cp>\"In some ways my doubts are stronger than his,\" Kramer told Shots.\u003c/p>\n\u003cp>Some analyses he looked at were trying to parse very subtle differences — for example, comparing two very similar antidepressants. You could get any answer you want, depending on how you set up the study, Kramer says.\u003c/p>\n\u003cp>And the problems he found aren't simply commercial conflicts of interest. For example, he saw biases among academics who were wedded to the notion that placebos are just as good as actual drugs for depression.\u003c/p>\n\u003cp>\"Even on that side of the equation, where there's no adverse sponsorship but just an allegiance to an idea, I thought it wasn't always the case that everybody's hands were on the table,\" Kramer said.\u003c/p>\n\u003cp>But financial conflicts are easier to identify. Five years ago, the National Academy's Institute of Medicine (now called the National Academy of Medicine) suggested dozens of standards that should apply to systematic reviews of the research literature.\u003c/p>\n\u003cp>The influence of funders is a concern, says \u003ca href=\"https://depts.washington.edu/fammed/profile/?id=00041\">Dr. Alfred Berg\u003c/a>, a professor emeritus of family medicine at the University of Washington who chaired one of the committees.\u003c/p>\n\u003cp>\"If there's obvious sponsorship from an organization that might have a conflict of interest, that's probably not a good idea,\" he says. It's reasonable to suggest that scientists with clear financial conflicts of interest should not be producing these studies. \"Is it going to happen in my lifetime?\" Berg says. \"Probably not!\"\u003c/p>\n\u003cp>Pfizer, one of the many drug companies that fund meta-analyses involving their own products, declined an interview request. But the company noted in an emailed statement that the drug company \"shares data from its clinical trials with outside members of the research community for them to conduct their own independent meta-analyses.\"\u003c/p>\n\u003cp>Fortunately, scientific journals are starting to do a better job of making sure researchers disclose their financial interests. It's up to readers now to take heed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Email Richard Harris at \u003ca href=\"mailto:rharris@npr.org\">rharris@npr.org.\u003c/a>\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Reviews+Of+Medical+Studies+May+Be+Tainted+By+Funders%27+Influence&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Law Will Expand Mental Health Services for Low-Income Californians",
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"content": "\u003cp>The staff of Clinica Sierra Vista, which has health centers throughout the Central Valley, screened its mostly low-income patients last year for mental health needs and determined that nearly 30 percent suffered from depression, anxiety or alcoholism.\u003c/p>\n\u003cp>Christopher Reilly, Sierra Vista’s chief of behavioral health services, said he was concerned about the high percentage of patients afflicted, but even more so about the clinic’s ability to treat them.\u003c/p>\n\u003cp>That’s in part because at health centers like Clinica Sierra Vista, a large group of mental health providers are excluded from reimbursement by Medi-Cal, the government program for low-income Californians. But that will soon change. Gov. Jerry Brown last week signed a law allowing federally funded health centers and rural clinics to bill Medi-Cal for the services of licensed marriage and family therapists.\u003c/p>\n\u003cp>“I am ecstatic that this passed,” Reilly said. “It means a lot more people are going to get attention for their behavioral health needs a lot earlier.”\u003c/p>\n\u003cp>The new law, which takes effect Jan. 1, is designed to address gaps in mental health care, particularly in rural areas where recruiting and retaining behavioral health providers is a challenge. Under the current law, clinics hire licensed clinical social workers and psychologists for their Medi-Cal patients, but they often can’t find enough to meet their needs. Many clinics don’t provide behavioral health services at all.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>About 40,000 marriage and family therapists are licensed in the state, compared to about 22,000 social workers and 21,000 psychologists, according to a \u003ca href=\"http://www.legtrack.com/bill.html?bill=201520160AB1863\" target=\"_blank\">state analysis\u003c/a> of the legislation, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1863\" target=\"_blank\">Assembly Bill 1863\u003c/a>.\u003c/p>\n\u003cp>Sierra Vista’s Reilly, who himself is a marriage and family therapist, said he expects another benefit from the law: less reliance on medication. Instead of simply being referred to doctors for prescriptions, the patients will be able to have regular counseling. Often, Reilly noted, patients’ depression or anxiety stems from family problems, domestic violence or substance use. Marriage and family therapists can help with those situations, he said.\u003c/p>\n\u003cp>Access to mental health services has long been a challenge in California, especially for low-income residents. In 2014, millions more Californians became eligible for Medi-Cal and for mental health services under the Affordable Care Act. That put even more pressure on the system.\u003c/p>\n\u003cp>The new law signed by the governor affects nearly 1,000 federally-funded and rural health clinics, according to the state analysis. The clinics accept patients regardless of their ability to pay and rely heavily on Medi-Cal reimbursements.\u003c/p>\n\u003cp>One of them, OLE Health, treats about 25,000 patients each year in Napa. CEO Tanir Ami said it’s been a challenge to find enough social workers to treat patients, many of whom have depression and anxiety, often exacerbated by poverty and inadequate housing.\u003c/p>\n\u003cp>“Now we get to recruit from a whole other pool of qualified candidates,” Ami said. “I am hoping it will make it exponentially easier to find the workforce we need.”\u003c/p>\n\u003cp>Gov. Brown vetoed a similar bill last year. The bill’s author, Assemblyman Jim Wood, (D-Healdsburg), said the governor had been concerned about its cost. But this year, Wood said he and the bill’s supporters convinced Brown that providing more mental health services could actually reduce health care costs.\u003c/p>\n\u003cp>“If you get people the behavioral health they need, you potentially keep them out of emergency rooms, which is a huge savings,” Wood said.\u003c/p>\n\u003cp>The bill was sponsored by CaliforniaHealth+ Advocates, an arm of the California Primary Care Association, and the California Association of Marriage and Family Therapists. The California chapter of the National Association of Social Workers and the California Psychological Association opposed it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"_blank\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The staff of Clinica Sierra Vista, which has health centers throughout the Central Valley, screened its mostly low-income patients last year for mental health needs and determined that nearly 30 percent suffered from depression, anxiety or alcoholism.\u003c/p>\n\u003cp>Christopher Reilly, Sierra Vista’s chief of behavioral health services, said he was concerned about the high percentage of patients afflicted, but even more so about the clinic’s ability to treat them.\u003c/p>\n\u003cp>That’s in part because at health centers like Clinica Sierra Vista, a large group of mental health providers are excluded from reimbursement by Medi-Cal, the government program for low-income Californians. But that will soon change. Gov. Jerry Brown last week signed a law allowing federally funded health centers and rural clinics to bill Medi-Cal for the services of licensed marriage and family therapists.\u003c/p>\n\u003cp>“I am ecstatic that this passed,” Reilly said. “It means a lot more people are going to get attention for their behavioral health needs a lot earlier.”\u003c/p>\n\u003cp>The new law, which takes effect Jan. 1, is designed to address gaps in mental health care, particularly in rural areas where recruiting and retaining behavioral health providers is a challenge. Under the current law, clinics hire licensed clinical social workers and psychologists for their Medi-Cal patients, but they often can’t find enough to meet their needs. Many clinics don’t provide behavioral health services at all.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>About 40,000 marriage and family therapists are licensed in the state, compared to about 22,000 social workers and 21,000 psychologists, according to a \u003ca href=\"http://www.legtrack.com/bill.html?bill=201520160AB1863\" target=\"_blank\">state analysis\u003c/a> of the legislation, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1863\" target=\"_blank\">Assembly Bill 1863\u003c/a>.\u003c/p>\n\u003cp>Sierra Vista’s Reilly, who himself is a marriage and family therapist, said he expects another benefit from the law: less reliance on medication. Instead of simply being referred to doctors for prescriptions, the patients will be able to have regular counseling. Often, Reilly noted, patients’ depression or anxiety stems from family problems, domestic violence or substance use. Marriage and family therapists can help with those situations, he said.\u003c/p>\n\u003cp>Access to mental health services has long been a challenge in California, especially for low-income residents. In 2014, millions more Californians became eligible for Medi-Cal and for mental health services under the Affordable Care Act. That put even more pressure on the system.\u003c/p>\n\u003cp>The new law signed by the governor affects nearly 1,000 federally-funded and rural health clinics, according to the state analysis. The clinics accept patients regardless of their ability to pay and rely heavily on Medi-Cal reimbursements.\u003c/p>\n\u003cp>One of them, OLE Health, treats about 25,000 patients each year in Napa. CEO Tanir Ami said it’s been a challenge to find enough social workers to treat patients, many of whom have depression and anxiety, often exacerbated by poverty and inadequate housing.\u003c/p>\n\u003cp>“Now we get to recruit from a whole other pool of qualified candidates,” Ami said. “I am hoping it will make it exponentially easier to find the workforce we need.”\u003c/p>\n\u003cp>Gov. Brown vetoed a similar bill last year. The bill’s author, Assemblyman Jim Wood, (D-Healdsburg), said the governor had been concerned about its cost. But this year, Wood said he and the bill’s supporters convinced Brown that providing more mental health services could actually reduce health care costs.\u003c/p>\n\u003cp>“If you get people the behavioral health they need, you potentially keep them out of emergency rooms, which is a huge savings,” Wood said.\u003c/p>\n\u003cp>The bill was sponsored by CaliforniaHealth+ Advocates, an arm of the California Primary Care Association, and the California Association of Marriage and Family Therapists. The California chapter of the National Association of Social Workers and the California Psychological Association opposed it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"_blank\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "At California Psychiatric Hospitals, Epidemic of Patients’ Assaults on Staff Goes Untreated",
"title": "At California Psychiatric Hospitals, Epidemic of Patients’ Assaults on Staff Goes Untreated",
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"content": "\u003cp>\u003cem>California’s network of state psychiatric hospitals is charged with treating people with mental illness who pose a danger to themselves or others, but workers faced with ongoing assaults by patients have struggled to provide a therapeutic environment. In this in-depth account, veteran California journalist Liza Gross reports that injured workers at the five psychiatric hospitals, including Napa State Hospital, have lost tens of thousands of workdays while taxpayers pay millions of dollars in workers' compensation and overtime costs.\u003c/em>\u003c/p>\n\u003cp>Stephen Seager felt lucky when Napa State Hospital offered him a job as staff psychiatrist in the spring of 2011. His wife, also a physician, had already relocated to Northern California from their home in Utah, after cutbacks at their hospitals forced the couple to find new positions.\u003c/p>\n\u003cp>Seager had originally trained as an emergency room physician, but the continual stream of traumas burned him out. He switched to psychiatry for a change of pace. He’d been drawn to medicine to help those in need, and people with severe mental disorders certainly fit the bill.\u003c/p>\n\u003cp>Seager had treated patients in acute psychiatric distress at hospitals in Phoenix, Los Angeles and St. George, Utah, but, like most psychiatrists, he’d never set foot in a state mental hospital. He just knew they treated some of society’s sickest psychiatric patients and that most had been judged incompetent to stand trial or not guilty by reason of insanity. He thought he could help them.\u003c/p>\n\u003cp>When Seager took the job at Napa, he says he didn’t know that even people found to have committed violent acts were free to wander the hospital halls. He also didn’t know that the clinical staff doubled as security guards.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And he didn’t know that seven months before he showed up for work, a veteran psychiatric technician named Donna Gross had been murdered right outside his new office.\u003c/p>\n\u003cp>The exact details of Gross’ death are not known, but police investigators and state occupational safety inspectors were able to piece together the general outlines of what happened, the coroner’s and inspector’s reports show.\u003c/p>\n\u003cp>On Sept. 23, 2010, Gross (no relation to the author) was returning from a break for her second shift of the day, around 5:30 p.m., when she entered the hospital’s secure treatment area, which houses patients deemed criminally insane. She walked across the grounds, where many patients congregated unsupervised. Before she reached her unit, a patient grabbed her and dragged her behind a patio wall. Gross pressed the alarm on her belt, but nobody came to her aid. Staff alarms, according to court records, didn’t work outdoors.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>An hour after the 54-year-old grandmother had passed through security, her colleagues found her sprawled on the courtyard patio, dead. Police quickly determined that Gross had been strangled by Jess Massey, a 37-year-old patient known for his violent history and penchant for stalking.\u003c/p>\n\u003cp>Most patients who assault staff, according to Seager and other staff members, remain on the wards.\u003cstrong> \u003c/strong> After all, many came to California’s state psychiatric facilities because they committed violent crimes. Massey had been sent to Napa after pleading not guilty by reason of insanity after repeatedly stabbing a woman in a Sacramento parking garage. Police investigators said Massey confessed to killing Gross. He pleaded no contest in court and is now serving 25 years to life at Corcoran State Prison.\u003c/p>\n\u003cp>Gross’ murder forced California hospital administrators to respond to increasing pressure from employees who’d long protested perilous conditions at the state’s five psychiatric hospitals. \u003ca href=\"https://www.uapd.com/2010/11/uapd-president-dr-stuart-bussey-speaks-out-on-napa-state-hospital-violence/\" target=\"_blank\">Officials offered\u003c/a> shuttles so Napa employees didn’t have to walk through the grounds, and tightened restrictions on grounds passes.\u003c/p>\n\u003cp>A month before Seager started working at Napa State, the Occupational Safety and Health Administration fined the hospital $100,140 for “serious” and “willful” violations that led to Gross’ death. This time, hospital administrators agreed to deploy security teams to patrol the grounds and lifted a hiring ban.\u003cbr>\nIt wasn’t enough -- not for workers at Napa or the state’s other facilities. Since Gross’ death, employees at California’s five psychiatric hospitals have suffered thousands of assaults a year, resulting in tens of thousands of lost days on the job and costing taxpayers at least $135 million in workers' compensation and overtime.\u003c/p>\n\u003cp>As a new employee, Seager had barely stepped onto his unit when a burly patient batted the slightly built doctor aside like a fly, sending him crashing into a wall. Seager’s head hit with a thwack that split open his scalp. The man then grabbed a heavy wooden chair and smashed it over an older patient’s head. Seager, who’d just turned 61, tried to stanch the blood gushing from the man’s head until paramedics arrived. “I’ve kept up my ER skills as a psychiatrist because I have so many emergency beatings and traumas,” he says.\u003c/p>\n\u003cfigure id=\"attachment_240449\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-240449 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/09/seager-photo-1-800x732.jpg\" width=\"800\" height=\"732\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-800x732.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-400x366.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-768x703.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-1180x1079.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-960x878.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1.jpg 1290w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Stephen Seager\u003c/figcaption>\u003c/figure>\n\u003cp>Seager’s colleagues convinced him to go to the county hospital. It took 10 stitches to close his wound. The patient never returned. Seager heard he’d been flown out to a nearby hospital. He found out the patient died only because a colleague’s relative worked at the hospital where he’d been treated.\u003c/p>\n\u003cp>At Napa State, violence was -- and still is -- just part of the routine, as the signs that are posted twice a week reporting assaults on staff indicate. There are steps officials could take to control the violence at California’s state hospitals, Seager says -- steps that would ultimately save taxpayers money. “But the administration and Sacramento don’t seem to care.”\u003c/p>\n\u003cp>\u003cstrong>Safety Measures Fall Short\u003c/strong>\u003c/p>\n\u003cp>Neither the measures taken before Seager’s arrival, nor those taken since, have stopped the bleeding at California’s five psychiatric hospitals. In the years following Gross’ death, workers at Napa, Patton, Metropolitan, Coalinga and Atascadero state hospitals have suffered on average 2,795 assaults a year, costing California taxpayers over $82.7 million in workers’ compensation claims over the past two fiscal years alone, according to data obtained through state public records requests.\u003c/p>\n\u003cp>Patients at the five hospitals committed nearly 26,000 assaults between 2011 and 2014, the latest year for which data are available, according to aggressive incident report records obtained from the Department of State Hospitals, which oversees the facilities.\u003c/p>\n\u003cp>Staff were the victims of 11,000 — more than 42 percent — of those assaults, the records show. Psychiatric technicians, nurses and their colleagues sustained 2,745 assaults at the five facilities in 2014, nearly 150 more than the year before. In the past two fiscal years, 2013-14 and 2014-15, they lost 105,108 days of work, the equivalent of 473 full-time employees.\u003c/p>\n\u003cp>Workers at Napa State alone endured 880 assaults in 2014, up from 866 the previous year. Employees were routinely kicked in the chest, punched in the face, shoved against walls and knocked to the ground, police logs obtained through public records requests show.\u003c/p>\n\u003cp>If you look at the rate of assaults based on the number of staff working at the facilities, it looks like safety has improved. The chances of an employee getting assaulted peaked at 30 percent in 2012, compared with 24 percent in 2014. But those figures are misleading, union reps say. For one thing, paperwork requirements for assaults increased while hospitals were required to report to a federal monitor (which ended in 2013), and it was not uncommon for assaulted staff to suffer in silence rather than fill out more forms.\u003c/p>\n\u003cp>[assaultsHospitals]\u003c/p>\n\u003cp>But perhaps more importantly, not everyone faces the same risks. Although any staff member runs the risk of a beating, says California Association of Psychiatric Technicians representative Coby Pizzotti, psych techs are especially vulnerable because they have the most contact with patients. The state doesn’t release the number of assaults on staff based on job category.\u003c/p>\n\u003cp>With 3,500 psych techs and over 2,700 assaults in a year, Pizzotti says, “It’s not a matter of if you get assaulted, it’s when you’re going to be assaulted and how severe.”\u003c/p>\n\u003cp>The year Gross was killed, staff at Napa State filed 289 workers' comp claims, according to the\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> L\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\">os\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> Ange\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\">les\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> Times\u003c/a>. Over the past two fiscal years, that number jumped to 517 and 519, state records show. As the abuse continued, Seager says, staff and administrators acted like daily assaults were all in a day’s work. “It’s horrifying to me that no one does anything about it or even talks about it,” he says. “It’s not mentioned. Ever.”\u003c/p>\n\u003cp>Frustrated by this culture of silence and the state’s unwillingness to address the rampant violence in its hospitals, Seager documented the ongoing beatings in a 2014 book, “Behind the Gates of Gomorrah: A Year with the Criminally Insane.” He wrote the book, he says, because he wanted the public to know that the people they send to state hospitals to get treatment can’t get better in the midst of so much violence. And staff can’t deliver the care they were trained to provide when they’re constantly worried about their safety.\u003c/p>\n\u003cp>Hospital administrators weren’t happy about it, Seager says. But they didn’t fire him.\u003c/p>\n\u003cp>“The safety of our patients and staff has always been among our top priorities,” says Ralph Montano, spokesman for the Department of State Hospitals. Among recent safety improvements, Montano points to a new personal alarm system, which alerts police and reveals an employee’s location, indoors or out, and what he describes as key pieces of legislation signed by Gov. Jerry Brown in 2014.\u003c/p>\n\u003cp>The laws were designed to improve safety by giving clinical staff the right to access a patient’s \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201320140AB1960\" target=\"_blank\">criminal history\u003c/a> for violence risk assessment and allowing medication orders to follow patients judged incompetent to stand trial. Patients can spend months in prison or jail without treatment before reaching the hospital, Seager says, increasing their risk for violent behavior.\u003c/p>\n\u003cp>Another law authorizes hospital officials to build enhanced treatment facilities, where the most dangerous patients receive treatment in secured areas as part of a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140AB1340\" target=\"_blank\">pilot program\u003c/a>. The department reported last year that a quarter of patients had been involved in aggressive incidents but only a fraction of them were considered “repeatedly violent patients.” The hope is that segregating those prone to violence will make the hospitals safer.\u003c/p>\n\u003cp>\u003cstrong>Hospitals Take on More Mentally Ill Patients Charged with Crimes\u003c/strong>\u003c/p>\n\u003cp>Napa State wasn’t always such a violent place. When psych tech Michael Jarschke started working at the hospital in 1972, most patients came to Napa because they couldn’t take care of themselves, not because they’d committed a crime. In those days, he’d sometimes get clobbered by patients beset by fits, but brutal beatings were rare.\u003c/p>\n\u003cp>More patients started coming to California’s state hospitals through the criminal justice system in the mid-1990s, Jarschke says, just before Donna Gross hired on at Napa State.\u003c/p>\n\u003cp>To ease overcrowding in prisons and jails, Napa and other state hospitals took on more mentally ill patients charged with crimes. In 1995, forensic patients, who have been convicted or accused of a felony linked to mental illness, made up 60 percent of patients in state facilities, state records show.\u003c/p>\n\u003cp>Today, 96 percent of the state’s psychiatric patients came through criminal courts -- accounting for 37 percent of the nation’s criminally insane.\u003c/p>\n\u003cp>But staff weren’t trained to deal with “prison-minded” patients, says Jarschke, who served as president of the California Association of Psychiatric Technicians' Napa chapter until May. Over time, he’d see more and more patients with gang affiliations, anti-social personality disorders and, like Jess Massey, predatory tendencies.\u003c/p>\n\u003cp>In the old days, Jarschke invited patients to his house for dinner, to help them feel normal. “That’s not happening here,” he says. “It’s not the same. It’ll never be the same.”\u003c/p>\n\u003cp>Jarschke soon realized the tools he used in a bike repair class could turn deadly in the wrong hands. But he felt strongly that he should keep teaching his patients skills that would boost their self-worth, so he set up a wheelchair repair program, thinking it would help them get a job when they got out. Some of his patients had committed monstrous crimes, but to him, they were people with mental problems, not criminals.\u003c/p>\n\u003cp>Jarschke had just set up a wheelchair repair program when Gross was killed. Even the wheelchair program was too risky, he realized. He shut it down.\u003c/p>\n\u003cp>The day after Gross’ murder, Jarschke and his colleagues formed the Safety Now Coalition to protect both staff and patients.\u003c/p>\n\u003cp>One of the first things they did was push for fully functional personal alarms and more security and clinical staff at the hospital. In 2012, administrators added a police substation within the secured treatment area outside, where Massey had cornered Gross. The following year, department spokesman Montano says, they finished implementing the alarm system.\u003c/p>\n\u003cp>But police aren’t on the wards when fights break out, so it’s up to staff, usually psych techs, to intervene. Most psych techs at California’s state hospitals are women who routinely find themselves trying to restrain men twice their size.\u003c/p>\n\u003cp>The alarms don’t prevent assaults, Seager says. “They simply allow people to get you medical help faster. We’ve had social workers have their teeth kicked in and bones broken. We’ve had head injuries where they’ve never come back.”\u003c/p>\n\u003cp>Workers often showed up for a shift having no idea there had just been a brutal assault. Last year, Seager says, “Someone was strangled and left for dead, and [the administration] never said anything about it.”\u003c/p>\n\u003cp>Safety Now asked administrators if staff at Napa could post a sign when a peer suffers an injury that requires more than local first aid, Jarschke says. The request was granted.\u003c/p>\n\u003cp>\u003cstrong>Subsidizing Violence on the Job\u003c/strong>\u003c/p>\n\u003cp>Lupe Alonzo-Diaz, the Department of State Hospitals deputy director of administrative services, acknowledged the risks staff face before a state oversight agency last year. “The potential to be assaulted is a daily threat for nursing staff,” she told the Little Hoover Commission, an independent agency that monitors and proposes improvements to state government operations.\u003c/p>\n\u003cp>The Department of State Hospitals defines aggressive acts as “hitting, pushing, kicking or similar acts directed against another individual to cause potential or actual injury.”\u003c/p>\n\u003cp>Verbal assault is not included in statistics released by the state, even though studies show that workers can suffer greater psychological effects from \u003ca href=\"http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No1-Jan-2013/Measurement-and-Monitoring-Worker-Aggression-Exposure.html\" target=\"_blank\">threats of violence than from physical aggression\u003c/a>.\u003c/p>\n\u003cp>With so many battered workers unable to do their jobs (they're out on worker's comp due to the assaults), the Department of State Hospitals has asked psych techs and nurses to work more than 4.7 million hours of overtime — at time and a half — since 2012 to meet legal staffing requirements. Overtime hours for psych techs have increased more than a third since 2012, reaching 1.2 million hours last year at a cost of $53 million, Pizzotti testified before the Little Hoover Commission.\u003c/p>\n\u003cp>[overtimeTech]\u003c/p>\n\u003cp>Nearly 150,000 overtime hours were mandatory during the 2014-15 fiscal year, up from 92,000 the previous year, state records show.\u003c/p>\n\u003cp>The union is fighting mandatory overtime, CAPT’s Pizzotti says, because it leaves workers unable to prepare for an extra shift, by going to bed early the night before or arranging day care for their kids. Sometimes employees don’t know until two hours before they’re scheduled to leave that they have to stay on, he says. “That throws your world into complete upheaval.”\u003c/p>\n\u003cp>California banned mandatory overtime for \u003ca href=\"http://www.seiu1000.org/general-information/local-1000-nurses-call-legislature-stop-mandatory-overtime\" target=\"_blank\">nurses in the private sector\u003c/a> in 2001 because it compromises worker and patient safety. Since then, \u003ca href=\"http://jap.sagepub.com/content/21/1/19.full.pdf+html\" target=\"_blank\">overwhelming evidence\u003c/a> has linked long extended shifts to increased risks of clinical mistakes and \u003ca href=\"https://www.jointcommission.org/assets/1/18/SEA_48.pdf\" target=\"_blank\">higher rates of occupational injury.\u003c/a>\u003c/p>\n\u003cp>Fatigued staff faced with the constant threat of assault are ill-prepared to safeguard their patients. Weak and vulnerable psychiatric patients sustained over 3,400 assaults at the hands of their peers in 2014, state records show. Although the numbers dropped nearly a quarter between 2010 and 2013, they jumped by 100 assaults in the following year.\u003c/p>\n\u003cp>Hospital administrators are forced to rely on mandatory overtime or face serious consequences, such as loss of certification, court sanctions and fines, Alonzo-Diaz told the Little Hoover Commission. It’s difficult to hire new staff, she said, because the risks associated with the work, combined with lower wages compared with private hospitals -- as much as $63,000 less for nurses and $15,000 less for psych techs -- make it hard to attract and retain employees.\u003c/p>\n\u003cp>Pizzotti says the state could solve these problems in part by expediting a hiring process that is so drawn out that job seekers find work elsewhere before they hear if they’re in the running.\u003cbr>\nRelief appeared to be on the horizon in August, when the Legislature passed \u003ca href=\"http://www.psychtechs.net/uploads/eng/sb%20780_introduced.pdf\" target=\"_blank\">SB 780\u003c/a>, a bill prohibiting the state from using mandatory overtime as a staffing tool. But the bill was withdrawn after Gov. Jerry Brown signaled his opposition to the measure, Pizzotti says.\u003c/p>\n\u003cp>“We decided not to move the bill onto his desk, knowing that it would be vetoed,” he says. That means union representatives are back to bargaining with administrators to reduce mandatory overtime.\u003c/p>\n\u003cp>\u003cstrong>‘Everybody’s in the wrong place’\u003c/strong>\u003c/p>\n\u003cp>For psychiatrist Seager, improving safety over the long term requires coming to grips with the systemic failures that left state hospitals ill-equipped to deal with violent criminals. Homeless people with acute psychiatric conditions should be treated in state hospitals, he says, while the nonviolent mentally ill now in prisons and jails should be treated in community treatment centers and people convicted of violent crimes should be treated in prisons.\u003c/p>\n\u003cp>Instead, he says, “Every single person in the mental health care system is in the wrong place.”\u003c/p>\n\u003cp>Even so, the state could implement several reforms now. Every hospital should have enhanced treatment units as soon as possible, staff say, to protect workers and vulnerable patients from the subset of patients who commit the majority of assaults.\u003c/p>\n\u003cp>The state authorized funding for the program this year, and administrators expect to open units at Atascadero and Patton in 2018, says department spokesman Montano.\u003c/p>\n\u003cp>It could be several years before an enhanced unit comes to Napa. “That’s an ominous feeling for us,” says psych tech Jarschke.\u003c/p>\n\u003cp>For now, increasing staffing levels would go a long way toward reducing violence on the wards, union rep Pizzotti says. Last year, the Department of Public Health hit Napa with several citations for failing to protect patients, including one who sustained a head injury and another who suffered a broken jaw. According to police reports and sources, that’s almost inevitable when an alarm draws all hands from one unit, only to leave another unattended. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Taxpayers have been spending tens of millions of dollars a year in overtime that leaves workers exhausted, prone to making mistakes and even more vulnerable to injury, Pizzotti says. Last year, 18.4 million taxpayers filed with the California Franchise Tax Board. The money spent on overtime could have hired hundreds of full-time psych techs, he says, greatly reducing the risk of violence while allowing staff to focus on the therapeutic care they were trained to provide. It would have cost the average taxpayer less than the price of a latte at Starbucks.\u003c/p>\n\u003cp>But those positions remain unstaffed. Meanwhile, Seager says, the assaults at Napa grew bloodier and more frequent.\u003c/p>\n\u003cp>Next month marks the sixth anniversary of Donna Gross’ murder. This will be the first year Seager won’t be there to pay his respects. “I finally had enough of Napa,” he says. Seager left in June to freelance as an emergency services psychiatrist for several Bay Area hospitals.\u003c/p>\n\u003cp>“The medical care at Napa is first rate and the staff is terrific,” Seager says. “It’s just not safe.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article was produced with the support of the California Data Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>California’s network of state psychiatric hospitals is charged with treating people with mental illness who pose a danger to themselves or others, but workers faced with ongoing assaults by patients have struggled to provide a therapeutic environment. In this in-depth account, veteran California journalist Liza Gross reports that injured workers at the five psychiatric hospitals, including Napa State Hospital, have lost tens of thousands of workdays while taxpayers pay millions of dollars in workers' compensation and overtime costs.\u003c/em>\u003c/p>\n\u003cp>Stephen Seager felt lucky when Napa State Hospital offered him a job as staff psychiatrist in the spring of 2011. His wife, also a physician, had already relocated to Northern California from their home in Utah, after cutbacks at their hospitals forced the couple to find new positions.\u003c/p>\n\u003cp>Seager had originally trained as an emergency room physician, but the continual stream of traumas burned him out. He switched to psychiatry for a change of pace. He’d been drawn to medicine to help those in need, and people with severe mental disorders certainly fit the bill.\u003c/p>\n\u003cp>Seager had treated patients in acute psychiatric distress at hospitals in Phoenix, Los Angeles and St. George, Utah, but, like most psychiatrists, he’d never set foot in a state mental hospital. He just knew they treated some of society’s sickest psychiatric patients and that most had been judged incompetent to stand trial or not guilty by reason of insanity. He thought he could help them.\u003c/p>\n\u003cp>When Seager took the job at Napa, he says he didn’t know that even people found to have committed violent acts were free to wander the hospital halls. He also didn’t know that the clinical staff doubled as security guards.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And he didn’t know that seven months before he showed up for work, a veteran psychiatric technician named Donna Gross had been murdered right outside his new office.\u003c/p>\n\u003cp>The exact details of Gross’ death are not known, but police investigators and state occupational safety inspectors were able to piece together the general outlines of what happened, the coroner’s and inspector’s reports show.\u003c/p>\n\u003cp>On Sept. 23, 2010, Gross (no relation to the author) was returning from a break for her second shift of the day, around 5:30 p.m., when she entered the hospital’s secure treatment area, which houses patients deemed criminally insane. She walked across the grounds, where many patients congregated unsupervised. Before she reached her unit, a patient grabbed her and dragged her behind a patio wall. Gross pressed the alarm on her belt, but nobody came to her aid. Staff alarms, according to court records, didn’t work outdoors.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>An hour after the 54-year-old grandmother had passed through security, her colleagues found her sprawled on the courtyard patio, dead. Police quickly determined that Gross had been strangled by Jess Massey, a 37-year-old patient known for his violent history and penchant for stalking.\u003c/p>\n\u003cp>Most patients who assault staff, according to Seager and other staff members, remain on the wards.\u003cstrong> \u003c/strong> After all, many came to California’s state psychiatric facilities because they committed violent crimes. Massey had been sent to Napa after pleading not guilty by reason of insanity after repeatedly stabbing a woman in a Sacramento parking garage. Police investigators said Massey confessed to killing Gross. He pleaded no contest in court and is now serving 25 years to life at Corcoran State Prison.\u003c/p>\n\u003cp>Gross’ murder forced California hospital administrators to respond to increasing pressure from employees who’d long protested perilous conditions at the state’s five psychiatric hospitals. \u003ca href=\"https://www.uapd.com/2010/11/uapd-president-dr-stuart-bussey-speaks-out-on-napa-state-hospital-violence/\" target=\"_blank\">Officials offered\u003c/a> shuttles so Napa employees didn’t have to walk through the grounds, and tightened restrictions on grounds passes.\u003c/p>\n\u003cp>A month before Seager started working at Napa State, the Occupational Safety and Health Administration fined the hospital $100,140 for “serious” and “willful” violations that led to Gross’ death. This time, hospital administrators agreed to deploy security teams to patrol the grounds and lifted a hiring ban.\u003cbr>\nIt wasn’t enough -- not for workers at Napa or the state’s other facilities. Since Gross’ death, employees at California’s five psychiatric hospitals have suffered thousands of assaults a year, resulting in tens of thousands of lost days on the job and costing taxpayers at least $135 million in workers' compensation and overtime.\u003c/p>\n\u003cp>As a new employee, Seager had barely stepped onto his unit when a burly patient batted the slightly built doctor aside like a fly, sending him crashing into a wall. Seager’s head hit with a thwack that split open his scalp. The man then grabbed a heavy wooden chair and smashed it over an older patient’s head. Seager, who’d just turned 61, tried to stanch the blood gushing from the man’s head until paramedics arrived. “I’ve kept up my ER skills as a psychiatrist because I have so many emergency beatings and traumas,” he says.\u003c/p>\n\u003cfigure id=\"attachment_240449\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-240449 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/09/seager-photo-1-800x732.jpg\" width=\"800\" height=\"732\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-800x732.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-400x366.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-768x703.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-1180x1079.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-960x878.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1.jpg 1290w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Stephen Seager\u003c/figcaption>\u003c/figure>\n\u003cp>Seager’s colleagues convinced him to go to the county hospital. It took 10 stitches to close his wound. The patient never returned. Seager heard he’d been flown out to a nearby hospital. He found out the patient died only because a colleague’s relative worked at the hospital where he’d been treated.\u003c/p>\n\u003cp>At Napa State, violence was -- and still is -- just part of the routine, as the signs that are posted twice a week reporting assaults on staff indicate. There are steps officials could take to control the violence at California’s state hospitals, Seager says -- steps that would ultimately save taxpayers money. “But the administration and Sacramento don’t seem to care.”\u003c/p>\n\u003cp>\u003cstrong>Safety Measures Fall Short\u003c/strong>\u003c/p>\n\u003cp>Neither the measures taken before Seager’s arrival, nor those taken since, have stopped the bleeding at California’s five psychiatric hospitals. In the years following Gross’ death, workers at Napa, Patton, Metropolitan, Coalinga and Atascadero state hospitals have suffered on average 2,795 assaults a year, costing California taxpayers over $82.7 million in workers’ compensation claims over the past two fiscal years alone, according to data obtained through state public records requests.\u003c/p>\n\u003cp>Patients at the five hospitals committed nearly 26,000 assaults between 2011 and 2014, the latest year for which data are available, according to aggressive incident report records obtained from the Department of State Hospitals, which oversees the facilities.\u003c/p>\n\u003cp>Staff were the victims of 11,000 — more than 42 percent — of those assaults, the records show. Psychiatric technicians, nurses and their colleagues sustained 2,745 assaults at the five facilities in 2014, nearly 150 more than the year before. In the past two fiscal years, 2013-14 and 2014-15, they lost 105,108 days of work, the equivalent of 473 full-time employees.\u003c/p>\n\u003cp>Workers at Napa State alone endured 880 assaults in 2014, up from 866 the previous year. Employees were routinely kicked in the chest, punched in the face, shoved against walls and knocked to the ground, police logs obtained through public records requests show.\u003c/p>\n\u003cp>If you look at the rate of assaults based on the number of staff working at the facilities, it looks like safety has improved. The chances of an employee getting assaulted peaked at 30 percent in 2012, compared with 24 percent in 2014. But those figures are misleading, union reps say. For one thing, paperwork requirements for assaults increased while hospitals were required to report to a federal monitor (which ended in 2013), and it was not uncommon for assaulted staff to suffer in silence rather than fill out more forms.\u003c/p>\n\u003cp>[assaultsHospitals]\u003c/p>\n\u003cp>But perhaps more importantly, not everyone faces the same risks. Although any staff member runs the risk of a beating, says California Association of Psychiatric Technicians representative Coby Pizzotti, psych techs are especially vulnerable because they have the most contact with patients. The state doesn’t release the number of assaults on staff based on job category.\u003c/p>\n\u003cp>With 3,500 psych techs and over 2,700 assaults in a year, Pizzotti says, “It’s not a matter of if you get assaulted, it’s when you’re going to be assaulted and how severe.”\u003c/p>\n\u003cp>The year Gross was killed, staff at Napa State filed 289 workers' comp claims, according to the\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> L\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\">os\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> Ange\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\">les\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> Times\u003c/a>. Over the past two fiscal years, that number jumped to 517 and 519, state records show. As the abuse continued, Seager says, staff and administrators acted like daily assaults were all in a day’s work. “It’s horrifying to me that no one does anything about it or even talks about it,” he says. “It’s not mentioned. Ever.”\u003c/p>\n\u003cp>Frustrated by this culture of silence and the state’s unwillingness to address the rampant violence in its hospitals, Seager documented the ongoing beatings in a 2014 book, “Behind the Gates of Gomorrah: A Year with the Criminally Insane.” He wrote the book, he says, because he wanted the public to know that the people they send to state hospitals to get treatment can’t get better in the midst of so much violence. And staff can’t deliver the care they were trained to provide when they’re constantly worried about their safety.\u003c/p>\n\u003cp>Hospital administrators weren’t happy about it, Seager says. But they didn’t fire him.\u003c/p>\n\u003cp>“The safety of our patients and staff has always been among our top priorities,” says Ralph Montano, spokesman for the Department of State Hospitals. Among recent safety improvements, Montano points to a new personal alarm system, which alerts police and reveals an employee’s location, indoors or out, and what he describes as key pieces of legislation signed by Gov. Jerry Brown in 2014.\u003c/p>\n\u003cp>The laws were designed to improve safety by giving clinical staff the right to access a patient’s \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201320140AB1960\" target=\"_blank\">criminal history\u003c/a> for violence risk assessment and allowing medication orders to follow patients judged incompetent to stand trial. Patients can spend months in prison or jail without treatment before reaching the hospital, Seager says, increasing their risk for violent behavior.\u003c/p>\n\u003cp>Another law authorizes hospital officials to build enhanced treatment facilities, where the most dangerous patients receive treatment in secured areas as part of a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140AB1340\" target=\"_blank\">pilot program\u003c/a>. The department reported last year that a quarter of patients had been involved in aggressive incidents but only a fraction of them were considered “repeatedly violent patients.” The hope is that segregating those prone to violence will make the hospitals safer.\u003c/p>\n\u003cp>\u003cstrong>Hospitals Take on More Mentally Ill Patients Charged with Crimes\u003c/strong>\u003c/p>\n\u003cp>Napa State wasn’t always such a violent place. When psych tech Michael Jarschke started working at the hospital in 1972, most patients came to Napa because they couldn’t take care of themselves, not because they’d committed a crime. In those days, he’d sometimes get clobbered by patients beset by fits, but brutal beatings were rare.\u003c/p>\n\u003cp>More patients started coming to California’s state hospitals through the criminal justice system in the mid-1990s, Jarschke says, just before Donna Gross hired on at Napa State.\u003c/p>\n\u003cp>To ease overcrowding in prisons and jails, Napa and other state hospitals took on more mentally ill patients charged with crimes. In 1995, forensic patients, who have been convicted or accused of a felony linked to mental illness, made up 60 percent of patients in state facilities, state records show.\u003c/p>\n\u003cp>Today, 96 percent of the state’s psychiatric patients came through criminal courts -- accounting for 37 percent of the nation’s criminally insane.\u003c/p>\n\u003cp>But staff weren’t trained to deal with “prison-minded” patients, says Jarschke, who served as president of the California Association of Psychiatric Technicians' Napa chapter until May. Over time, he’d see more and more patients with gang affiliations, anti-social personality disorders and, like Jess Massey, predatory tendencies.\u003c/p>\n\u003cp>In the old days, Jarschke invited patients to his house for dinner, to help them feel normal. “That’s not happening here,” he says. “It’s not the same. It’ll never be the same.”\u003c/p>\n\u003cp>Jarschke soon realized the tools he used in a bike repair class could turn deadly in the wrong hands. But he felt strongly that he should keep teaching his patients skills that would boost their self-worth, so he set up a wheelchair repair program, thinking it would help them get a job when they got out. Some of his patients had committed monstrous crimes, but to him, they were people with mental problems, not criminals.\u003c/p>\n\u003cp>Jarschke had just set up a wheelchair repair program when Gross was killed. Even the wheelchair program was too risky, he realized. He shut it down.\u003c/p>\n\u003cp>The day after Gross’ murder, Jarschke and his colleagues formed the Safety Now Coalition to protect both staff and patients.\u003c/p>\n\u003cp>One of the first things they did was push for fully functional personal alarms and more security and clinical staff at the hospital. In 2012, administrators added a police substation within the secured treatment area outside, where Massey had cornered Gross. The following year, department spokesman Montano says, they finished implementing the alarm system.\u003c/p>\n\u003cp>But police aren’t on the wards when fights break out, so it’s up to staff, usually psych techs, to intervene. Most psych techs at California’s state hospitals are women who routinely find themselves trying to restrain men twice their size.\u003c/p>\n\u003cp>The alarms don’t prevent assaults, Seager says. “They simply allow people to get you medical help faster. We’ve had social workers have their teeth kicked in and bones broken. We’ve had head injuries where they’ve never come back.”\u003c/p>\n\u003cp>Workers often showed up for a shift having no idea there had just been a brutal assault. Last year, Seager says, “Someone was strangled and left for dead, and [the administration] never said anything about it.”\u003c/p>\n\u003cp>Safety Now asked administrators if staff at Napa could post a sign when a peer suffers an injury that requires more than local first aid, Jarschke says. The request was granted.\u003c/p>\n\u003cp>\u003cstrong>Subsidizing Violence on the Job\u003c/strong>\u003c/p>\n\u003cp>Lupe Alonzo-Diaz, the Department of State Hospitals deputy director of administrative services, acknowledged the risks staff face before a state oversight agency last year. “The potential to be assaulted is a daily threat for nursing staff,” she told the Little Hoover Commission, an independent agency that monitors and proposes improvements to state government operations.\u003c/p>\n\u003cp>The Department of State Hospitals defines aggressive acts as “hitting, pushing, kicking or similar acts directed against another individual to cause potential or actual injury.”\u003c/p>\n\u003cp>Verbal assault is not included in statistics released by the state, even though studies show that workers can suffer greater psychological effects from \u003ca href=\"http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No1-Jan-2013/Measurement-and-Monitoring-Worker-Aggression-Exposure.html\" target=\"_blank\">threats of violence than from physical aggression\u003c/a>.\u003c/p>\n\u003cp>With so many battered workers unable to do their jobs (they're out on worker's comp due to the assaults), the Department of State Hospitals has asked psych techs and nurses to work more than 4.7 million hours of overtime — at time and a half — since 2012 to meet legal staffing requirements. Overtime hours for psych techs have increased more than a third since 2012, reaching 1.2 million hours last year at a cost of $53 million, Pizzotti testified before the Little Hoover Commission.\u003c/p>\n\u003cp>[overtimeTech]\u003c/p>\n\u003cp>Nearly 150,000 overtime hours were mandatory during the 2014-15 fiscal year, up from 92,000 the previous year, state records show.\u003c/p>\n\u003cp>The union is fighting mandatory overtime, CAPT’s Pizzotti says, because it leaves workers unable to prepare for an extra shift, by going to bed early the night before or arranging day care for their kids. Sometimes employees don’t know until two hours before they’re scheduled to leave that they have to stay on, he says. “That throws your world into complete upheaval.”\u003c/p>\n\u003cp>California banned mandatory overtime for \u003ca href=\"http://www.seiu1000.org/general-information/local-1000-nurses-call-legislature-stop-mandatory-overtime\" target=\"_blank\">nurses in the private sector\u003c/a> in 2001 because it compromises worker and patient safety. Since then, \u003ca href=\"http://jap.sagepub.com/content/21/1/19.full.pdf+html\" target=\"_blank\">overwhelming evidence\u003c/a> has linked long extended shifts to increased risks of clinical mistakes and \u003ca href=\"https://www.jointcommission.org/assets/1/18/SEA_48.pdf\" target=\"_blank\">higher rates of occupational injury.\u003c/a>\u003c/p>\n\u003cp>Fatigued staff faced with the constant threat of assault are ill-prepared to safeguard their patients. Weak and vulnerable psychiatric patients sustained over 3,400 assaults at the hands of their peers in 2014, state records show. Although the numbers dropped nearly a quarter between 2010 and 2013, they jumped by 100 assaults in the following year.\u003c/p>\n\u003cp>Hospital administrators are forced to rely on mandatory overtime or face serious consequences, such as loss of certification, court sanctions and fines, Alonzo-Diaz told the Little Hoover Commission. It’s difficult to hire new staff, she said, because the risks associated with the work, combined with lower wages compared with private hospitals -- as much as $63,000 less for nurses and $15,000 less for psych techs -- make it hard to attract and retain employees.\u003c/p>\n\u003cp>Pizzotti says the state could solve these problems in part by expediting a hiring process that is so drawn out that job seekers find work elsewhere before they hear if they’re in the running.\u003cbr>\nRelief appeared to be on the horizon in August, when the Legislature passed \u003ca href=\"http://www.psychtechs.net/uploads/eng/sb%20780_introduced.pdf\" target=\"_blank\">SB 780\u003c/a>, a bill prohibiting the state from using mandatory overtime as a staffing tool. But the bill was withdrawn after Gov. Jerry Brown signaled his opposition to the measure, Pizzotti says.\u003c/p>\n\u003cp>“We decided not to move the bill onto his desk, knowing that it would be vetoed,” he says. That means union representatives are back to bargaining with administrators to reduce mandatory overtime.\u003c/p>\n\u003cp>\u003cstrong>‘Everybody’s in the wrong place’\u003c/strong>\u003c/p>\n\u003cp>For psychiatrist Seager, improving safety over the long term requires coming to grips with the systemic failures that left state hospitals ill-equipped to deal with violent criminals. Homeless people with acute psychiatric conditions should be treated in state hospitals, he says, while the nonviolent mentally ill now in prisons and jails should be treated in community treatment centers and people convicted of violent crimes should be treated in prisons.\u003c/p>\n\u003cp>Instead, he says, “Every single person in the mental health care system is in the wrong place.”\u003c/p>\n\u003cp>Even so, the state could implement several reforms now. Every hospital should have enhanced treatment units as soon as possible, staff say, to protect workers and vulnerable patients from the subset of patients who commit the majority of assaults.\u003c/p>\n\u003cp>The state authorized funding for the program this year, and administrators expect to open units at Atascadero and Patton in 2018, says department spokesman Montano.\u003c/p>\n\u003cp>It could be several years before an enhanced unit comes to Napa. “That’s an ominous feeling for us,” says psych tech Jarschke.\u003c/p>\n\u003cp>For now, increasing staffing levels would go a long way toward reducing violence on the wards, union rep Pizzotti says. Last year, the Department of Public Health hit Napa with several citations for failing to protect patients, including one who sustained a head injury and another who suffered a broken jaw. According to police reports and sources, that’s almost inevitable when an alarm draws all hands from one unit, only to leave another unattended. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Taxpayers have been spending tens of millions of dollars a year in overtime that leaves workers exhausted, prone to making mistakes and even more vulnerable to injury, Pizzotti says. Last year, 18.4 million taxpayers filed with the California Franchise Tax Board. The money spent on overtime could have hired hundreds of full-time psych techs, he says, greatly reducing the risk of violence while allowing staff to focus on the therapeutic care they were trained to provide. It would have cost the average taxpayer less than the price of a latte at Starbucks.\u003c/p>\n\u003cp>But those positions remain unstaffed. Meanwhile, Seager says, the assaults at Napa grew bloodier and more frequent.\u003c/p>\n\u003cp>Next month marks the sixth anniversary of Donna Gross’ murder. This will be the first year Seager won’t be there to pay his respects. “I finally had enough of Napa,” he says. Seager left in June to freelance as an emergency services psychiatrist for several Bay Area hospitals.\u003c/p>\n\u003cp>“The medical care at Napa is first rate and the staff is terrific,” Seager says. “It’s just not safe.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"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",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
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