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"content": "\u003cp>A San Francisco birthday party took an upsetting turn on Saturday when guests began feeling ill after consuming orange candy gummy rings that were later found to contain edible marijuana.\u003c/p>\n\u003cp>The candy sickened 19 people who unknowingly ate the marijuana-laced candy at a quinceañera party. They were all taken to area hospitals after experiencing symptoms including rapid heart rate, high blood pressure, dilated pupils, dizziness, light-headedness, nausea, lethargy and confusion, which can occur with edible marijuana consumption, San Francisco Department of Public Health officials said.\u003c/p>\n\u003cp>Thirteen of the patients were aged 18 or younger, ranging in age from 6 to 18, the health department said.\u003c/p>\n\u003cp>Lab results on the orange-colored gummy ring candies along with lab work from 12 of the hospitalized patients showed positive findings for THC, (tetrahydrocannabinol), the main psychoactive ingredient in marijuana, health department officials said.\u003c/p>\n\u003cp>A public health official called the incident \"a strong warning about the dangers of edibles.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Tomas Aragon, Health Officer for the City and County of San Francisco, said in a written statement that edibles can be \"very potent and hard to control dosage in the best circumstances.\"\u003c/p>\n\u003cp>\u003cspan style=\"line-height: 1.5\">“A situation like this, where they were consumed by unsuspecting people, and many children, is greatly concerning.” Aragon said.\u003c/span>\u003c/p>\n\u003cp>Public health advocates said the incident raised questions about how to safely legalize marijuana.\u003c/p>\n\u003cp>\"The poisoning of a large group is horrifying but not surprising,\" said Larry Cohen, executive director of the Prevention Institute, an Oakland-based public health nonprofit.\u003c/p>\n\u003cp>\"While there is talk about legalizing marijuana it should not imply somehow that it is not a dangerous substance that always needs to be approached with care. Making marijuana edible and in some cases delicious is going to increase the amount that is consumed and is particularly of danger to kids -- especially in cases where it is packaged like children’s candy.\"\u003c/p>\n\u003cp>The party was catered by a company in Oakland. The Alameda County Department of Public Health will also investigate the situation.\u003c/p>\n\u003cp>“The question remains, where did the candies come from?” said Aragon. “We are working with the catering company and our colleagues in Alameda to find out.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>This post has been updated. \u003c/strong>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Tomas Aragon, Health Officer for the City and County of San Francisco, said in a written statement that edibles can be \"very potent and hard to control dosage in the best circumstances.\"\u003c/p>\n\u003cp>\u003cspan style=\"line-height: 1.5\">“A situation like this, where they were consumed by unsuspecting people, and many children, is greatly concerning.” Aragon said.\u003c/span>\u003c/p>\n\u003cp>Public health advocates said the incident raised questions about how to safely legalize marijuana.\u003c/p>\n\u003cp>\"The poisoning of a large group is horrifying but not surprising,\" said Larry Cohen, executive director of the Prevention Institute, an Oakland-based public health nonprofit.\u003c/p>\n\u003cp>\"While there is talk about legalizing marijuana it should not imply somehow that it is not a dangerous substance that always needs to be approached with care. Making marijuana edible and in some cases delicious is going to increase the amount that is consumed and is particularly of danger to kids -- especially in cases where it is packaged like children’s candy.\"\u003c/p>\n\u003cp>The party was catered by a company in Oakland. The Alameda County Department of Public Health will also investigate the situation.\u003c/p>\n\u003cp>“The question remains, where did the candies come from?” said Aragon. “We are working with the catering company and our colleagues in Alameda to find out.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>This post has been updated. \u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A California \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1306\" target=\"_blank\">bill\u003c/a> that would allow certified nurse-midwives to practice independently is pitting the state’s doctors against its hospitals, even though both sides support the main goal of the legislation.\u003c/p>\n\u003cp>The California Hospital Association and the California Medical Association, which represents doctors, agree that nurse-midwives have the training and qualifications to practice without physician supervision.\u003c/p>\n\u003cp>But they differ sharply over whether hospitals should be able to employ midwives directly — a dispute the certified nurse-midwives fear could derail the proposed law.\u003c/p>\n\u003cp>“We are very much caught in the middle,” said Linda Walsh, president of the California Nurse-Midwives Association.\u003c/p>\n\u003cp>The bill would override an existing law that requires certified nurse-midwives to practice under the supervision of medical doctors. California is one of only six states that requires full supervision. Several other states mandate other forms of collaboration, such as in prescribing medications.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The American College of Nurse-Midwives has been chipping away for decades at state laws that require physician supervision, and it has finally passed the tipping point nationally, said Jesse Bushman, director of federal government affairs for the organization. Nurse-midwives aren’t seeking permission to go off and do whatever they want without consulting anyone, Bushman said. “They’re just asking to be able to do what they are trained to do.”\u003c/p>\n\u003cp>In states where nurse-midwives can practice independently, there is more access to care, he said, citing a \u003ca href=\"http://www.whijournal.com/article/S1049-3867%2816%2900025-6/fulltext\" target=\"_blank\">recent report\u003c/a> published by the George Washington University’s Jacobs Institute of Women’s Health.\u003c/p>\n\u003cp>There are more than 11,200 nurse-midwives around the nation, including about 1,200 in California. They provide maternity care, family planning services and other primary care for women.\u003c/p>\n\u003cp>In 2013, California eliminated the physician supervision requirement for licensed midwives, who require significantly less training than nurse-midwives. Unlike licensed midwives, certified nurse-midwives must become registered nurses and obtain a graduate degree in midwifery. They primarily deliver babies in hospitals, while licensed midwives usually work in homes or birth centers.\u003c/p>\n\u003cp>Walsh said her association is trying to make it easier for certified nurse-midwives to practice around the state, especially in areas where there may not be any obstetricians. It can be challenging to find physicians willing to oversee nurse-midwives, because of the responsibility and liability involved, she said.\u003c/p>\n\u003cp>“We have an access issue in California,” Walsh said. “Yet we have this supervisory language that prevents an increase in access for the people who need it most.”\u003c/p>\n\u003cp>Lisa Catterall, who works in a hospital-based midwifery practice at Feather River Hospital in Paradise, Calif., said getting physician supervision is not easy. For one thing, some nurse-midwives have to pay extra malpractice insurance in addition to paying doctors for their supervision. Even with the supervision, the doctors are not required to be present to oversee the care, added Catterall, who delivers about 100 babies a year and sees patients from throughout the rural region north of Sacramento where her hospital is located.\u003c/p>\n\u003cp>The debate between the doctors and the hospitals centers on the state’s prohibition of what’s known as the “corporate practice of medicine.” California does not allow corporations, including hospitals, to hire physicians, though there are several exceptions. The intent of the ban is to avoid undue corporate influence on doctors’ medical judgment and patient care. Under current law, hospitals can hire nurse-midwives, though many don’t.\u003c/p>\n\u003cp>One of the bill’s co-authors, Assemblywoman Autumn Burke, recently withdrew an amendment that would have mirrored the law applying to doctors by barring hospitals from hiring nurse-midwives. With that provision withdrawn, the California Medical Association now opposes the legislation and the California Hospital Association supports it.\u003c/p>\n\u003cp>The physicians’ group believes that the health care decisions of nurse-midwives employed directly by hospitals could be influenced by their administrators, and it says it will only back the bill if the amendment is reinstated.\u003c/p>\n\u003cp>Patients should have the same consumer protections whether they see a nurse-midwife or a doctor, said Juan Thomas, a lobbyist with the medical association. “It should be a level playing field,” he said. “We believe very strongly that the corporate practice of medicine bar language provides an important layer of patient protection.”\u003c/p>\n\u003cp>The California Hospital Association, meanwhile, won’t support the bill if the amendment is reinstated. The association believes hospitals need to retain the freedom to hire nurse-midwives.\u003c/p>\n\u003cp>A ban on hiring would make it more difficult for nurse-midwives to work in hospitals, forcing them into roundabout contracts that are “unduly cumbersome, unduly burdensome and unnecessary,” said Jackie Garman, a vice president of the hospital association.\u003c/p>\n\u003cp>In addition, Garman said, some nurse-midwives are already employed by hospitals. “What happens to them?” she asked.\u003c/p>\n\u003cp>The nonprofit Pacific Business Group on Health recently announced its support of the midwife bill, saying it would help expand women’s choices in pregnancy care and lead to better maternal health. In the spring, the group had sponsored a roundtable with more than 30 organizations from around California to discuss increasing access to nurse-midwives.\u003c/p>\n\u003cp>“It is really hard to argue with the evidence about the value that midwives offer pregnant women,” said Brynn Rubinstein, the group’s senior manager for transforming maternity care. “They are delivering more patient-friendly care, yielding better outcomes and saving money for purchasers,” she said. “But they are not always easy to find.”\u003c/p>\n\u003cp>Research shows that patients of certified nurse-midwives have fewer cesarean deliveries and \u003ca href=\"http://www.whijournal.com/article/S1049-3867(11)00160-5/abstract\" target=\"_blank\">lower epidural rates.\u003c/a>\u003c/p>\n\u003cp>Assemblywoman Burke’s office is continuing to talk to representatives of both the physicians and the hospitals to try and find a solution to the contentious issue of whether hospitals should be allowed to hire nurse-midwives, said Allison Ruff, a senior aide to Burke.\u003c/p>\n\u003cp>“For both of them, it is an issue they don’t want to compromise on,” she said. “The bill became a pawn in the fight between the hospitals and the physicians. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A California \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1306\" target=\"_blank\">bill\u003c/a> that would allow certified nurse-midwives to practice independently is pitting the state’s doctors against its hospitals, even though both sides support the main goal of the legislation.\u003c/p>\n\u003cp>The California Hospital Association and the California Medical Association, which represents doctors, agree that nurse-midwives have the training and qualifications to practice without physician supervision.\u003c/p>\n\u003cp>But they differ sharply over whether hospitals should be able to employ midwives directly — a dispute the certified nurse-midwives fear could derail the proposed law.\u003c/p>\n\u003cp>“We are very much caught in the middle,” said Linda Walsh, president of the California Nurse-Midwives Association.\u003c/p>\n\u003cp>The bill would override an existing law that requires certified nurse-midwives to practice under the supervision of medical doctors. California is one of only six states that requires full supervision. Several other states mandate other forms of collaboration, such as in prescribing medications.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The American College of Nurse-Midwives has been chipping away for decades at state laws that require physician supervision, and it has finally passed the tipping point nationally, said Jesse Bushman, director of federal government affairs for the organization. Nurse-midwives aren’t seeking permission to go off and do whatever they want without consulting anyone, Bushman said. “They’re just asking to be able to do what they are trained to do.”\u003c/p>\n\u003cp>In states where nurse-midwives can practice independently, there is more access to care, he said, citing a \u003ca href=\"http://www.whijournal.com/article/S1049-3867%2816%2900025-6/fulltext\" target=\"_blank\">recent report\u003c/a> published by the George Washington University’s Jacobs Institute of Women’s Health.\u003c/p>\n\u003cp>There are more than 11,200 nurse-midwives around the nation, including about 1,200 in California. They provide maternity care, family planning services and other primary care for women.\u003c/p>\n\u003cp>In 2013, California eliminated the physician supervision requirement for licensed midwives, who require significantly less training than nurse-midwives. Unlike licensed midwives, certified nurse-midwives must become registered nurses and obtain a graduate degree in midwifery. They primarily deliver babies in hospitals, while licensed midwives usually work in homes or birth centers.\u003c/p>\n\u003cp>Walsh said her association is trying to make it easier for certified nurse-midwives to practice around the state, especially in areas where there may not be any obstetricians. It can be challenging to find physicians willing to oversee nurse-midwives, because of the responsibility and liability involved, she said.\u003c/p>\n\u003cp>“We have an access issue in California,” Walsh said. “Yet we have this supervisory language that prevents an increase in access for the people who need it most.”\u003c/p>\n\u003cp>Lisa Catterall, who works in a hospital-based midwifery practice at Feather River Hospital in Paradise, Calif., said getting physician supervision is not easy. For one thing, some nurse-midwives have to pay extra malpractice insurance in addition to paying doctors for their supervision. Even with the supervision, the doctors are not required to be present to oversee the care, added Catterall, who delivers about 100 babies a year and sees patients from throughout the rural region north of Sacramento where her hospital is located.\u003c/p>\n\u003cp>The debate between the doctors and the hospitals centers on the state’s prohibition of what’s known as the “corporate practice of medicine.” California does not allow corporations, including hospitals, to hire physicians, though there are several exceptions. The intent of the ban is to avoid undue corporate influence on doctors’ medical judgment and patient care. Under current law, hospitals can hire nurse-midwives, though many don’t.\u003c/p>\n\u003cp>One of the bill’s co-authors, Assemblywoman Autumn Burke, recently withdrew an amendment that would have mirrored the law applying to doctors by barring hospitals from hiring nurse-midwives. With that provision withdrawn, the California Medical Association now opposes the legislation and the California Hospital Association supports it.\u003c/p>\n\u003cp>The physicians’ group believes that the health care decisions of nurse-midwives employed directly by hospitals could be influenced by their administrators, and it says it will only back the bill if the amendment is reinstated.\u003c/p>\n\u003cp>Patients should have the same consumer protections whether they see a nurse-midwife or a doctor, said Juan Thomas, a lobbyist with the medical association. “It should be a level playing field,” he said. “We believe very strongly that the corporate practice of medicine bar language provides an important layer of patient protection.”\u003c/p>\n\u003cp>The California Hospital Association, meanwhile, won’t support the bill if the amendment is reinstated. The association believes hospitals need to retain the freedom to hire nurse-midwives.\u003c/p>\n\u003cp>A ban on hiring would make it more difficult for nurse-midwives to work in hospitals, forcing them into roundabout contracts that are “unduly cumbersome, unduly burdensome and unnecessary,” said Jackie Garman, a vice president of the hospital association.\u003c/p>\n\u003cp>In addition, Garman said, some nurse-midwives are already employed by hospitals. “What happens to them?” she asked.\u003c/p>\n\u003cp>The nonprofit Pacific Business Group on Health recently announced its support of the midwife bill, saying it would help expand women’s choices in pregnancy care and lead to better maternal health. In the spring, the group had sponsored a roundtable with more than 30 organizations from around California to discuss increasing access to nurse-midwives.\u003c/p>\n\u003cp>“It is really hard to argue with the evidence about the value that midwives offer pregnant women,” said Brynn Rubinstein, the group’s senior manager for transforming maternity care. “They are delivering more patient-friendly care, yielding better outcomes and saving money for purchasers,” she said. “But they are not always easy to find.”\u003c/p>\n\u003cp>Research shows that patients of certified nurse-midwives have fewer cesarean deliveries and \u003ca href=\"http://www.whijournal.com/article/S1049-3867(11)00160-5/abstract\" target=\"_blank\">lower epidural rates.\u003c/a>\u003c/p>\n\u003cp>Assemblywoman Burke’s office is continuing to talk to representatives of both the physicians and the hospitals to try and find a solution to the contentious issue of whether hospitals should be allowed to hire nurse-midwives, said Allison Ruff, a senior aide to Burke.\u003c/p>\n\u003cp>“For both of them, it is an issue they don’t want to compromise on,” she said. “The bill became a pawn in the fight between the hospitals and the physicians. It still is.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\u003csection class=\"meta-tags\">\u003c/section>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "2 California Babies Born with Zika-Related Defects",
"title": "2 California Babies Born with Zika-Related Defects",
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"content": "\u003cp>Two babies have been born with Zika-related birth defects in California to mothers who were infected in other countries, health officials said Thursday.\u003c/p>\n\u003cp>The newborns survived. One of the mothers returned to her home country with her baby while the other remains in the state, according to the California Department of Public Health.\u003c/p>\n\u003cp>Health officials declined to release additional details about the cases, citing patient privacy.\u003c/p>\n\u003cp>Nineteen other pregnant women in California who contracted Zika while traveling abroad were being monitored by doctors.\u003c/p>\n\u003cp>[contextly_sidebar id=\"shIj3mZGWqg2l3o67ngbxdV3kzI8cSTt\"]Babies born to Zika-infected mothers will be followed for up to a year. Health officials will check their hearing, vision and development, said Dr. Connie Mitchell, deputy director of the Center for Family Health.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.cdc.gov/zika/geo/pregnancy-outcomes.html\" target=\"_blank\">15 babies\u003c/a> have been born with Zika-related birth defects, according to the federal Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The CDC has advised pregnant women not to travel to parts of Latin America and the Caribbean where Zika transmission is active. The virus is usually spread by mosquitoes, but it can also be passed through sex.\u003c/p>\n\u003cp>Most people infected with Zika experience mild symptoms such as fever, rash and joint pain. Zika infection during pregnancy can cause babies to be born with unusually small heads, called microcephaly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Aedes aegypti mosquito which can transmit Zika \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/06/30/map-where-zika-mosquitoes-are-likely-found-in-california/\" target=\"_blank\">is present in a handful of California counties\u003c/a>. But Florida is the only U.S. state so far that has reported homegrown Zika transmission by mosquitoes. One square-mile neighborhood in Miami-Dade County is affected. The CDC has urged expectant mothers to avoid Miami's Wynwood neighborhood, where at least 15 people are believed to have been infected with the Zika virus through mosquito bites.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two babies have been born with Zika-related birth defects in California to mothers who were infected in other countries, health officials said Thursday.\u003c/p>\n\u003cp>The newborns survived. One of the mothers returned to her home country with her baby while the other remains in the state, according to the California Department of Public Health.\u003c/p>\n\u003cp>Health officials declined to release additional details about the cases, citing patient privacy.\u003c/p>\n\u003cp>Nineteen other pregnant women in California who contracted Zika while traveling abroad were being monitored by doctors.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Babies born to Zika-infected mothers will be followed for up to a year. Health officials will check their hearing, vision and development, said Dr. Connie Mitchell, deputy director of the Center for Family Health.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.cdc.gov/zika/geo/pregnancy-outcomes.html\" target=\"_blank\">15 babies\u003c/a> have been born with Zika-related birth defects, according to the federal Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The CDC has advised pregnant women not to travel to parts of Latin America and the Caribbean where Zika transmission is active. The virus is usually spread by mosquitoes, but it can also be passed through sex.\u003c/p>\n\u003cp>Most people infected with Zika experience mild symptoms such as fever, rash and joint pain. Zika infection during pregnancy can cause babies to be born with unusually small heads, called microcephaly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Aedes aegypti mosquito which can transmit Zika \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/06/30/map-where-zika-mosquitoes-are-likely-found-in-california/\" target=\"_blank\">is present in a handful of California counties\u003c/a>. But Florida is the only U.S. state so far that has reported homegrown Zika transmission by mosquitoes. One square-mile neighborhood in Miami-Dade County is affected. The CDC has urged expectant mothers to avoid Miami's Wynwood neighborhood, where at least 15 people are believed to have been infected with the Zika virus through mosquito bites.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Overhauling Foster Care Rates to Support Family Caregivers",
"title": "California Overhauling Foster Care Rates to Support Family Caregivers",
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"content": "\u003cp>After years of complaints, California is drastically changing the way it financially supports foster families. It's a move that aims to prioritize the needs of the state's \u003ca href=\"http://www.kidsdata.org/topic/20/fostercare/table#fmt=16&loc=2,127,347,1763,331,348,336,171,321,345,357,332,324,369,358,362,360,337,327,364,356,217,353,328,354,323,352,320,339,334,365,343,330,367,344,355,366,368,265,349,361,4,273,59,370,326,333,322,341,338,350,342,329,325,359,351,363,340,335&tf=79\" target=\"_blank\">62,000 foster children \u003c/a>and make it easier for grandparents and other relatives to care for them.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This is the very first time in California's history that we will be treating our relatives and our non-relative foster parents equally.' \u003ccite>Angie Schwartz, Alliance for Children's Rights \u003c/cite>\u003c/aside>\n\u003cp>Starting Jan. 1, California's foster care rates will be tied to the health and behavioral needs of each child. In the present system, the income of the home the child was removed from and whether the child was placed with relatives or non-relatives were bigger factors in determining support.\u003c/p>\n\u003cp>The new system will replace a \"tangled mess of rules\" that ends up penalizing thousands of foster children who are cared for by relatives -- even though such children have better educational outcomes and less trauma when cared for by a person with family ties, says Angie Schwartz, policy director for the Alliance for Children's Rights, which advocated for the changes.\u003c/p>\n\u003cp>\"This is a very historic change in California,\" says Schwartz, whose nonprofit provides legal services for children in foster care.\u003c/p>\n\u003cp>\"This is the very first time in California's history that we will be treating our relatives and our non-relative foster parents equally.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California Gov. Jerry Brown approved the new rate system in June as part of the state budget, and allocated about $40 million to begin implementing the payment changes.\u003c/p>\n\u003cp>\u003cstrong>'Major Transformational Effort'\u003c/strong>\u003c/p>\n\u003cp>The policy is part of a larger effort that has been at least five years in the making to improve how children and youth do in the state's foster care system, the \u003ca href=\"http://www.cdss.ca.gov/cdssweb/PG4869.htm\" target=\"_blank\">Continuum of Care Reform\u003c/a>. The reform also aims to significantly expand mental health and other support services to all foster families, says Greg Rose, who oversees child welfare \u003cspan style=\"font-weight: 400\">at the California Department of Social Services.\u003c/span>\u003c/p>\n\u003cp>\"It is the major transformational effort that we are putting in place so that young people in foster care can have as traditional a family life as reasonably possible,\" says Rose, adding that a goal of the reform is to reduce the use of more expensive institutionalized group homes, where foster youth tend to have the worst outcomes.\u003c/p>\n\u003cp>\"Ultimately, we'll have healthier, happier youth that experience the foster care system,\" says Rose.\u003c/p>\n\u003cp>The foster care rate changes will impact at least 10,000 families statewide who will be able to access similar resources as other foster families, says Rose.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/276496072\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Over the next several weeks, a stakeholder group will define new rates, says Rose, which are expected to be at least slightly higher than they are at present.\u003c/p>\n\u003cp>Once new rates are established county social workers are expected to begin assessing each child in foster care statewide to determine where the child fits in the new rate structure.\u003c/p>\n\u003cp>\u003cstrong>One Mom's Story\u003c/strong>\u003c/p>\n\u003cp>In California, all foster parents -- whether related to the child or not -- must pass similar licensing and approval standards. But the stipends they receive may vary dramatically depending on whether they are related to the child.\u003c/p>\n\u003cp>Donita Escamilla experienced the discrepancy first hand when she became a foster parent to her niece, Isabella, two years ago.\u003c/p>\n\u003cp>While Escamilla received about $300 monthly to help care for Isabella, she would have received as much as $1,100 more is she were not related to the child.\u003c/p>\n\u003cp>\"I did not ever look at Isabella as a dollar sign. I was ready to take care of Isabella funding or no funding,\" says Escamilla, who was working as a waitress at a casino and already a single mother of four when she took Isabella in.\u003c/p>\n\u003cp>\"I knew that no matter what the struggle for me was, that that’s what was best for her, and that she needed to be with us,\" she says. \"I just couldn’t imagine her going with strangers, with people that we didn’t know.\"\u003c/p>\n\u003cp>The lack of resources was stressful, says Escamilla. Isabella's birth mother had used drugs throughout her pregnancy, and the newborn tested positive for methampethamines which has impacted Isabella's development and lungs. Escamilla spent sleepless nights taking the baby to the emergency room for bouts of asthma and bronchitis.\u003c/p>\n\u003cfigure id=\"attachment_220439\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-220439 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS20497_IMG_0182-qut.jpg\" alt=\"Stephanie Okada, an occupational therapist, and Isabella look for ants near a playground in the Sacramento area, as part of Isabella's weekly play and speech therapy session. Donita Escamilla, who became a foster parent for Isabella and recently adopted her, says therapy is helping the toddler develop her emotions and social skills.\" width=\"1920\" height=\"1369\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-400x285.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-800x570.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-768x548.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-1440x1027.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-1180x841.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-960x685.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Isabella and Stephanie Okada, an occupational therapist, look for ants near a playground in the Sacramento area, as part of Isabella's weekly play therapy sessions. Donita Escamilla, who became a foster parent for Isabella and recently adopted her, says the toddler struggles with social interactions and therapy helps to address her needs. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Isabella's medical needs were covered through Medi-Cal, the state's insurance for low income people. But Escamilla worried about losing her job, and not being there for her other children.\u003c/p>\n\u003cp>\"I was always in this state of trying to balance the needs of my family as a whole, versus Isabella’s medical needs, trying to get people to take her to the doctor for me, not being able to miss work because she was ill,\" she says.\u003c/p>\n\u003cp>Escamilla adapted. She left her casino job and opened a child care center so that she could care for Isabella herself, instead of shuttling her to other caregivers. She takes Isabella weekly for play, speech and other therapy sessions to aid her social and emotional development.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Escamilla ended up adopting Isabella, so the new foster rate changes won't affect her, but she considers the development \"a huge victory.\" She says she hopes other relative foster parents in the state won't struggle the way she did.\u003c/p>\n\n",
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"excerpt": "Next year, California adopts new monthly foster care stipends to make it easier for relatives to care for foster children.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After years of complaints, California is drastically changing the way it financially supports foster families. It's a move that aims to prioritize the needs of the state's \u003ca href=\"http://www.kidsdata.org/topic/20/fostercare/table#fmt=16&loc=2,127,347,1763,331,348,336,171,321,345,357,332,324,369,358,362,360,337,327,364,356,217,353,328,354,323,352,320,339,334,365,343,330,367,344,355,366,368,265,349,361,4,273,59,370,326,333,322,341,338,350,342,329,325,359,351,363,340,335&tf=79\" target=\"_blank\">62,000 foster children \u003c/a>and make it easier for grandparents and other relatives to care for them.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This is the very first time in California's history that we will be treating our relatives and our non-relative foster parents equally.' \u003ccite>Angie Schwartz, Alliance for Children's Rights \u003c/cite>\u003c/aside>\n\u003cp>Starting Jan. 1, California's foster care rates will be tied to the health and behavioral needs of each child. In the present system, the income of the home the child was removed from and whether the child was placed with relatives or non-relatives were bigger factors in determining support.\u003c/p>\n\u003cp>The new system will replace a \"tangled mess of rules\" that ends up penalizing thousands of foster children who are cared for by relatives -- even though such children have better educational outcomes and less trauma when cared for by a person with family ties, says Angie Schwartz, policy director for the Alliance for Children's Rights, which advocated for the changes.\u003c/p>\n\u003cp>\"This is a very historic change in California,\" says Schwartz, whose nonprofit provides legal services for children in foster care.\u003c/p>\n\u003cp>\"This is the very first time in California's history that we will be treating our relatives and our non-relative foster parents equally.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California Gov. Jerry Brown approved the new rate system in June as part of the state budget, and allocated about $40 million to begin implementing the payment changes.\u003c/p>\n\u003cp>\u003cstrong>'Major Transformational Effort'\u003c/strong>\u003c/p>\n\u003cp>The policy is part of a larger effort that has been at least five years in the making to improve how children and youth do in the state's foster care system, the \u003ca href=\"http://www.cdss.ca.gov/cdssweb/PG4869.htm\" target=\"_blank\">Continuum of Care Reform\u003c/a>. The reform also aims to significantly expand mental health and other support services to all foster families, says Greg Rose, who oversees child welfare \u003cspan style=\"font-weight: 400\">at the California Department of Social Services.\u003c/span>\u003c/p>\n\u003cp>\"It is the major transformational effort that we are putting in place so that young people in foster care can have as traditional a family life as reasonably possible,\" says Rose, adding that a goal of the reform is to reduce the use of more expensive institutionalized group homes, where foster youth tend to have the worst outcomes.\u003c/p>\n\u003cp>\"Ultimately, we'll have healthier, happier youth that experience the foster care system,\" says Rose.\u003c/p>\n\u003cp>The foster care rate changes will impact at least 10,000 families statewide who will be able to access similar resources as other foster families, says Rose.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/276496072&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/276496072'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Over the next several weeks, a stakeholder group will define new rates, says Rose, which are expected to be at least slightly higher than they are at present.\u003c/p>\n\u003cp>Once new rates are established county social workers are expected to begin assessing each child in foster care statewide to determine where the child fits in the new rate structure.\u003c/p>\n\u003cp>\u003cstrong>One Mom's Story\u003c/strong>\u003c/p>\n\u003cp>In California, all foster parents -- whether related to the child or not -- must pass similar licensing and approval standards. But the stipends they receive may vary dramatically depending on whether they are related to the child.\u003c/p>\n\u003cp>Donita Escamilla experienced the discrepancy first hand when she became a foster parent to her niece, Isabella, two years ago.\u003c/p>\n\u003cp>While Escamilla received about $300 monthly to help care for Isabella, she would have received as much as $1,100 more is she were not related to the child.\u003c/p>\n\u003cp>\"I did not ever look at Isabella as a dollar sign. I was ready to take care of Isabella funding or no funding,\" says Escamilla, who was working as a waitress at a casino and already a single mother of four when she took Isabella in.\u003c/p>\n\u003cp>\"I knew that no matter what the struggle for me was, that that’s what was best for her, and that she needed to be with us,\" she says. \"I just couldn’t imagine her going with strangers, with people that we didn’t know.\"\u003c/p>\n\u003cp>The lack of resources was stressful, says Escamilla. Isabella's birth mother had used drugs throughout her pregnancy, and the newborn tested positive for methampethamines which has impacted Isabella's development and lungs. Escamilla spent sleepless nights taking the baby to the emergency room for bouts of asthma and bronchitis.\u003c/p>\n\u003cfigure id=\"attachment_220439\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-220439 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS20497_IMG_0182-qut.jpg\" alt=\"Stephanie Okada, an occupational therapist, and Isabella look for ants near a playground in the Sacramento area, as part of Isabella's weekly play and speech therapy session. Donita Escamilla, who became a foster parent for Isabella and recently adopted her, says therapy is helping the toddler develop her emotions and social skills.\" width=\"1920\" height=\"1369\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-400x285.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-800x570.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-768x548.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-1440x1027.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-1180x841.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20497_IMG_0182-qut-960x685.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Isabella and Stephanie Okada, an occupational therapist, look for ants near a playground in the Sacramento area, as part of Isabella's weekly play therapy sessions. Donita Escamilla, who became a foster parent for Isabella and recently adopted her, says the toddler struggles with social interactions and therapy helps to address her needs. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Isabella's medical needs were covered through Medi-Cal, the state's insurance for low income people. But Escamilla worried about losing her job, and not being there for her other children.\u003c/p>\n\u003cp>\"I was always in this state of trying to balance the needs of my family as a whole, versus Isabella’s medical needs, trying to get people to take her to the doctor for me, not being able to miss work because she was ill,\" she says.\u003c/p>\n\u003cp>Escamilla adapted. She left her casino job and opened a child care center so that she could care for Isabella herself, instead of shuttling her to other caregivers. She takes Isabella weekly for play, speech and other therapy sessions to aid her social and emotional development.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Escamilla ended up adopting Isabella, so the new foster rate changes won't affect her, but she considers the development \"a huge victory.\" She says she hopes other relative foster parents in the state won't struggle the way she did.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Whaaaa? Little Evidence that Flossing Works",
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"content": "\u003cp>It's one of the most universal recommendations in all of public health: Floss daily to prevent gum disease and cavities.\u003c/p>\n\u003cp>Except there's little proof that flossing works.\u003c/p>\n\u003caside class=\"pullquote alignright\">In a letter to the Associated Press, the federal government acknowledged the effectiveness of flossing had never been researched, as required.\u003c/aside>\n\u003cp>Still, the federal government, dental organizations and manufacturers of floss have pushed the practice for decades. Dentists provide samples to their patients, and the American Dental Association insists on its website that \"flossing is an essential part of taking care of your teeth and gums.\"\u003c/p>\n\u003cp>The federal government has recommended flossing since 1979, first in a surgeon general's report and later in the Dietary Guidelines for Americans issued every five years. The guidelines must be based on scientific evidence, under the law.\u003c/p>\n\u003cp>Last year, the Associated Press asked the departments of Health and Human Services and Agriculture for their evidence, and followed up with written requests under the Freedom of Information Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the federal government issued its latest dietary guidelines this year, the flossing recommendation had been removed, without notice. In a letter to the AP, the government acknowledged the effectiveness of flossing had never been researched, as required.\u003c/p>\n\u003cp>The AP looked at the most rigorous research conducted over the past decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss. The findings? The evidence for flossing is \"weak, very unreliable,\" of \"very low\" quality, and carries \"a moderate to large potential for bias.\"\u003c/p>\n\u003cp>\"The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal,\" said one review conducted last year. Another 2015 review cites \"inconsistent/weak evidence\" for flossing and a \"lack of efficacy.\"\u003c/p>\n\u003cp>One study review in 2011 did credit floss with a slight reduction in gum inflammation — which can sometimes develop over time into full-fledged gum disease. However, the reviewers ranked the evidence as \"very unreliable.\" A commentary in a dental magazine stated that any benefit would be so minute it might not be noticed by users.\u003c/p>\n\u003cp>The two leading professional groups — the American Dental Association and the American Academy of Periodontology, for specialists in gum disease and implants — cited other studies as proof of their claims that flossing prevents buildup of gunk known as plaque, early gum inflammation called gingivitis and tooth decay. However, most of these studies used outdated methods or tested few people. Some lasted only two weeks, far too brief for a cavity or dental disease to develop. One tested 25 people after only a single use of floss. Such research, like the reviewed studies, focused on warning signs like bleeding and inflammation, barely dealing with gum disease or cavities.\u003c/p>\n\u003cp>Wayne Aldredge, president of the periodontists' group, acknowledged the weak scientific evidence and the brief duration of many studies. In an interview at his private practice in New Jersey, he said that the impact of floss might be clearer if researchers focused on patients at highest risk of gum disease, such as diabetics and smokers.\u003c/p>\n\u003cp>Still, he urges his patients to floss to help avoid gum disease. \"It's like building a house and not painting two sides of it,\" he said. \"Ultimately those two sides are going to rot away quicker.\"\u003c/p>\n\u003cp>Aldredge also said many people use floss incorrectly, moving it in a sawing motion instead of up and down the sides of the teeth. Pressed about the origins of his organization's endorsement of flossing, he said it may simply have \"taken the ADA's lead.\"\u003c/p>\n\u003cp>When the ADA was asked for proof of its claim that flossing helps prevent early gum disease and cavities, the group cited the 2011 review and a 2008 two-week study that measured bacteria and did not even consider gum disease.\u003c/p>\n\u003cp>In a later statement to the AP, the ADA said flossing \"removes plaque\" and \"is proven to help remove\" debris from between teeth. A video on its website proclaims that flossing \"helps prevent gum disease.\" When pressed, Matthew J. Messina, a practicing dentist and spokesman for the dental association, acknowledged weak evidence, but he blamed research participants who didn't floss correctly.\u003c/p>\n\u003cp>Even companies with a big market share of the flossing business — by next year, the global market is predicted to reach almost $2 billion, with half in the United States, according to publisher MarketSizeInfo.com — struggled to provide convincing evidence of their claims that floss reduces plaque or gingivitis. Yet the industry has paid for most studies and sometimes designed and conducted the research.\u003c/p>\n\u003cp>Procter & Gamble, which claims that its floss fights plaque and gingivitis, pointed to a two-week study, which was discounted as irrelevant in the 2011 research review.\u003c/p>\n\u003cp>Johnson & Johnson spokesman Marc Boston said floss helps remove plaque. When the AP sent him a list of contradicting studies, he declined comment.\u003c/p>\n\u003cp>The floss-making companies partner with the ADA through its Seal of Acceptance program. The ADA promotes the seal to companies as something that \"directly affects the purchase decisions of consumers,\" and each manufacturer is charged $14,500 for the evaluation. If it approves the product, the ADA then charges an additional annual fee of $3,500.\u003c/p>\n\u003cp>The ADA says it rigorously evaluates products and makes no profit from the program. However, floss companies themselves are allowed to design the studies.\u003c/p>\n\u003cp>\"The funding can come from companies — no problem at all,\" said dentist Marcelo W.B. Araujo, vice president of the ADA's Science Institute, who joined the organization after serving as an executive for Johnson & Johnson. \"The design can start from the company.\"\u003c/p>\n\u003cp>When flossing first gained acceptance, no proof was required of remedies. Dentist Levi Spear Parmly is credited with inventing floss in the early 19th century. By the time the first floss patent was issued, in 1874, the applicant noted that dentists were widely recommending its use.\u003c/p>\n\u003cp>The ADA has been promoting floss universally since 1908. \"They just looked into what they did every day in their clinical practice and what they would recommend for patients,\" said Araujo.\u003c/p>\n\u003cp>Count dentist Damien Walmsley, scientific adviser to the British Dental Association, among the skeptics. \"It's important to tell people to do the basics. Flossing is not part of the basics.\"\u003c/p>\n\u003cp>Floss can occasionally cause harm. Careless flossing can damage gums, teeth and dental work. Though frequency is unclear, floss can dislodge bad bacteria that invade the bloodstream and cause dangerous infections, especially in people with weak immunity, according to the medical literature.\u003c/p>\n\u003cp>National Institutes of Health dentist Tim Iafolla acknowledged that if the highest standards of science were applied in keeping with the flossing reviews of the past decade, \"then it would be appropriate to drop the floss guidelines.\"\u003c/p>\n\u003cp>Regardless, he added, Americans should still floss.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"It's low risk, low cost,\" he said. \"We know there's a possibility that it works, so we feel comfortable telling people to go ahead and do it.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's one of the most universal recommendations in all of public health: Floss daily to prevent gum disease and cavities.\u003c/p>\n\u003cp>Except there's little proof that flossing works.\u003c/p>\n\u003caside class=\"pullquote alignright\">In a letter to the Associated Press, the federal government acknowledged the effectiveness of flossing had never been researched, as required.\u003c/aside>\n\u003cp>Still, the federal government, dental organizations and manufacturers of floss have pushed the practice for decades. Dentists provide samples to their patients, and the American Dental Association insists on its website that \"flossing is an essential part of taking care of your teeth and gums.\"\u003c/p>\n\u003cp>The federal government has recommended flossing since 1979, first in a surgeon general's report and later in the Dietary Guidelines for Americans issued every five years. The guidelines must be based on scientific evidence, under the law.\u003c/p>\n\u003cp>Last year, the Associated Press asked the departments of Health and Human Services and Agriculture for their evidence, and followed up with written requests under the Freedom of Information Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When the federal government issued its latest dietary guidelines this year, the flossing recommendation had been removed, without notice. In a letter to the AP, the government acknowledged the effectiveness of flossing had never been researched, as required.\u003c/p>\n\u003cp>The AP looked at the most rigorous research conducted over the past decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss. The findings? The evidence for flossing is \"weak, very unreliable,\" of \"very low\" quality, and carries \"a moderate to large potential for bias.\"\u003c/p>\n\u003cp>\"The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal,\" said one review conducted last year. Another 2015 review cites \"inconsistent/weak evidence\" for flossing and a \"lack of efficacy.\"\u003c/p>\n\u003cp>One study review in 2011 did credit floss with a slight reduction in gum inflammation — which can sometimes develop over time into full-fledged gum disease. However, the reviewers ranked the evidence as \"very unreliable.\" A commentary in a dental magazine stated that any benefit would be so minute it might not be noticed by users.\u003c/p>\n\u003cp>The two leading professional groups — the American Dental Association and the American Academy of Periodontology, for specialists in gum disease and implants — cited other studies as proof of their claims that flossing prevents buildup of gunk known as plaque, early gum inflammation called gingivitis and tooth decay. However, most of these studies used outdated methods or tested few people. Some lasted only two weeks, far too brief for a cavity or dental disease to develop. One tested 25 people after only a single use of floss. Such research, like the reviewed studies, focused on warning signs like bleeding and inflammation, barely dealing with gum disease or cavities.\u003c/p>\n\u003cp>Wayne Aldredge, president of the periodontists' group, acknowledged the weak scientific evidence and the brief duration of many studies. In an interview at his private practice in New Jersey, he said that the impact of floss might be clearer if researchers focused on patients at highest risk of gum disease, such as diabetics and smokers.\u003c/p>\n\u003cp>Still, he urges his patients to floss to help avoid gum disease. \"It's like building a house and not painting two sides of it,\" he said. \"Ultimately those two sides are going to rot away quicker.\"\u003c/p>\n\u003cp>Aldredge also said many people use floss incorrectly, moving it in a sawing motion instead of up and down the sides of the teeth. Pressed about the origins of his organization's endorsement of flossing, he said it may simply have \"taken the ADA's lead.\"\u003c/p>\n\u003cp>When the ADA was asked for proof of its claim that flossing helps prevent early gum disease and cavities, the group cited the 2011 review and a 2008 two-week study that measured bacteria and did not even consider gum disease.\u003c/p>\n\u003cp>In a later statement to the AP, the ADA said flossing \"removes plaque\" and \"is proven to help remove\" debris from between teeth. A video on its website proclaims that flossing \"helps prevent gum disease.\" When pressed, Matthew J. Messina, a practicing dentist and spokesman for the dental association, acknowledged weak evidence, but he blamed research participants who didn't floss correctly.\u003c/p>\n\u003cp>Even companies with a big market share of the flossing business — by next year, the global market is predicted to reach almost $2 billion, with half in the United States, according to publisher MarketSizeInfo.com — struggled to provide convincing evidence of their claims that floss reduces plaque or gingivitis. Yet the industry has paid for most studies and sometimes designed and conducted the research.\u003c/p>\n\u003cp>Procter & Gamble, which claims that its floss fights plaque and gingivitis, pointed to a two-week study, which was discounted as irrelevant in the 2011 research review.\u003c/p>\n\u003cp>Johnson & Johnson spokesman Marc Boston said floss helps remove plaque. When the AP sent him a list of contradicting studies, he declined comment.\u003c/p>\n\u003cp>The floss-making companies partner with the ADA through its Seal of Acceptance program. The ADA promotes the seal to companies as something that \"directly affects the purchase decisions of consumers,\" and each manufacturer is charged $14,500 for the evaluation. If it approves the product, the ADA then charges an additional annual fee of $3,500.\u003c/p>\n\u003cp>The ADA says it rigorously evaluates products and makes no profit from the program. However, floss companies themselves are allowed to design the studies.\u003c/p>\n\u003cp>\"The funding can come from companies — no problem at all,\" said dentist Marcelo W.B. Araujo, vice president of the ADA's Science Institute, who joined the organization after serving as an executive for Johnson & Johnson. \"The design can start from the company.\"\u003c/p>\n\u003cp>When flossing first gained acceptance, no proof was required of remedies. Dentist Levi Spear Parmly is credited with inventing floss in the early 19th century. By the time the first floss patent was issued, in 1874, the applicant noted that dentists were widely recommending its use.\u003c/p>\n\u003cp>The ADA has been promoting floss universally since 1908. \"They just looked into what they did every day in their clinical practice and what they would recommend for patients,\" said Araujo.\u003c/p>\n\u003cp>Count dentist Damien Walmsley, scientific adviser to the British Dental Association, among the skeptics. \"It's important to tell people to do the basics. Flossing is not part of the basics.\"\u003c/p>\n\u003cp>Floss can occasionally cause harm. Careless flossing can damage gums, teeth and dental work. Though frequency is unclear, floss can dislodge bad bacteria that invade the bloodstream and cause dangerous infections, especially in people with weak immunity, according to the medical literature.\u003c/p>\n\u003cp>National Institutes of Health dentist Tim Iafolla acknowledged that if the highest standards of science were applied in keeping with the flossing reviews of the past decade, \"then it would be appropriate to drop the floss guidelines.\"\u003c/p>\n\u003cp>Regardless, he added, Americans should still floss.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It's low risk, low cost,\" he said. \"We know there's a possibility that it works, so we feel comfortable telling people to go ahead and do it.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"headTitle": "CDC Tells Pregnant Women to Avoid Parts of Miami Hit by Zika | KQED",
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"content": "\u003cp>Government health officials warned pregnant women Monday to avoid a Zika-stricken part of Miami and told couples who have been there recently to put off having children for at least two months, after the number of people feared infected through mosquito bites in the U.S. climbed to 14.\u003c/p>\n\u003caside class=\"pullquote alignright\">The travel warning is highly unusual. Officials cannot remember another warning against travel within the U.S. in the CDC’s 70-year history.\u003c/aside>\n\u003cp>In its highly unusual and perhaps unprecedented \u003ca href=\"http://www.cdc.gov/zika/intheus/florida-update.html\" target=\"_blank\" rel=\"noopener\">travel warning\u003c/a>, the Centers for Disease Control and Prevention also said expectant mothers should get tested for the virus if they have visited the neighborhood since mid-June.\u003c/p>\n\u003cp>All 14 cases are thought to have occurred in Miami’s Wynwood arts district, a trendy, fast-gentrifying neighborhood of warehouses, art galleries, restaurants and boutiques.\u003c/p>\n\u003cp>Florida Gov. Rick Scott asked for a CDC emergency response team to help the state combat Zika, which after sweeping Latin America and the Caribbean, is beginning to spread in the U.S. The White House said a team will be sent quickly.\u003c/p>\n\u003cp>Health officials\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/29/4-zika-cases-in-florida-are-likely-from-mosquitoes/\" target=\"_blank\" rel=\"noopener\"> last Friday announced\u003c/a> that mosquitoes have apparently started spreading Zika on the U.S. mainland, citing four cases they strongly believe were caused by bites. Ten more cases were announced Monday, even though Florida authorities have yet to find any mosquitoes actually carrying the virus.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Zika infections in pregnant women can cause severe brain-related birth defects, including extremely small skulls. The global outbreak has led to more than 1,800 serious defects.\u003c/p>\n\u003cp>CDC officials said they could not remember another time in the 70-year history of the disease-fighting agency when it told members of the public not to travel someplace in the U.S.\u003c/p>\n\u003cp>The virus can linger in the blood and urine for weeks, and has been found in sperm for months. As a result, the CDC said men and women who have recently been in the affected area should wait at least eight weeks before trying to conceive a child.\u003c/p>\n\u003cp>The travel warning covers an area of about 1 square mile in Wynwood, to the east of Interstate 95 and south of I-195. It’s large enough, health officials said, to provide a buffer around the suspected hot zone. The tropical mosquito that spreads Zika travels less than 200 yards in its lifetime.\u003c/p>\n\u003cp>Yet some experts said that’s far too small a radius. Dr. Peter Hotez, a tropical medicine expert at the Baylor College of Medicine in Texas, said the CDC should be more cautious and expand the travel advisory to all of Miami-Dade County.\u003c/p>\n\u003cp>“If you’re pregnant or think you might be pregnant, avoid travel to Miami, and possible elsewhere in South Florida,” he said. “I’m guessing most women who are pregnant are doing that. I don’t think they’re sitting around for the CDC to split hairs and fine-tune it to a specific area.”\u003c/p>\n\u003cp>CDC Director Dr. Tom Frieden said the narrowly drawn warning was dictated by science and not by any concern for Florida’s crucial tourism industry. He said it was based on the nation’s ability to contain outbreaks of other diseases carried by the same mosquito.\u003c/p>\n\u003cp>“There wouldn’t be a technical or scientific basis to give a broader recommendation,” Frieden said.\u003c/p>\n\u003cp>U.S. health officials have said all along that while isolated clusters of Zika may occur in this country, they do not expect major outbreaks like those seen in Latin America, because of better sanitation and mosquito control and widespread use of air conditioners and window screens.\u003c/p>\n\u003cp>At the same time, health officials expressed concern that they continue to see “moderately high” numbers of the type of mosquito that carries Zika, despite aggressive use of insecticides.\u003c/p>\n\u003cp>“This is a very difficult mosquito to control,” Frieden said.\u003c/p>\n\u003cp>Florida health officials said they have tested more than 200 people in Miami-Dade and Broward Counties since early July. The CDC emergency team will help Florida officials investigate the outbreak, collect samples and control mosquitoes.\u003c/p>\n\u003cp>Of the 14 people infected, two are women and 12 are men. Eight patients showed symptoms of Zika, which can include fever, rash, joint pain and red eyes. The others had no symptoms. The disease is often so mild that most people don’t know they are infected.\u003c/p>\n\u003cp>“We will continue to keep our residents and visitors safe utilizing constant surveillance and aggressive strategies, such as increased mosquito spraying, that have allowed our state to fight similar viruses,” the governor said in a statement.\u003c/p>\n\u003cp>Rosemary LeBranch was doing laundry in Wynwood when health officials came to her house a few days ago and took urine samples from her, her daughter and her father. Her father, Gabriel Jean, tested positive, she said Monday.\u003c/p>\n\u003cp>He had already spoken with a doctor and was advised to wear long shirts and pants outdoors.\u003c/p>\n\u003cp>“He said nothing hurts, he doesn’t have any pain. He doesn’t feel anything,” she said.\u003c/p>\n\u003cp>Jordan Davison and Melissa Felix work for a cruise line and were enjoying their day off Monday looking at Wynwood’s spray-painted murals.\u003c/p>\n\u003cp>“It’s not like a big thing, right?” the 25-year-old Davidson said. “It’s kind of freaky — there’s so much going on we didn’t know, didn’t really think about it. … I might wear bug spray going forward.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>More than 1,650 cases of Zika have been reported in U.S. states, nearly all the result of travel to a Zika-stricken country or sex with someone who was infected abroad.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Government health officials warned pregnant women Monday to avoid a Zika-stricken part of Miami and told couples who have been there recently to put off having children for at least two months, after the number of people feared infected through mosquito bites in the U.S. climbed to 14.\u003c/p>\n\u003caside class=\"pullquote alignright\">The travel warning is highly unusual. Officials cannot remember another warning against travel within the U.S. in the CDC’s 70-year history.\u003c/aside>\n\u003cp>In its highly unusual and perhaps unprecedented \u003ca href=\"http://www.cdc.gov/zika/intheus/florida-update.html\" target=\"_blank\" rel=\"noopener\">travel warning\u003c/a>, the Centers for Disease Control and Prevention also said expectant mothers should get tested for the virus if they have visited the neighborhood since mid-June.\u003c/p>\n\u003cp>All 14 cases are thought to have occurred in Miami’s Wynwood arts district, a trendy, fast-gentrifying neighborhood of warehouses, art galleries, restaurants and boutiques.\u003c/p>\n\u003cp>Florida Gov. Rick Scott asked for a CDC emergency response team to help the state combat Zika, which after sweeping Latin America and the Caribbean, is beginning to spread in the U.S. The White House said a team will be sent quickly.\u003c/p>\n\u003cp>Health officials\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/29/4-zika-cases-in-florida-are-likely-from-mosquitoes/\" target=\"_blank\" rel=\"noopener\"> last Friday announced\u003c/a> that mosquitoes have apparently started spreading Zika on the U.S. mainland, citing four cases they strongly believe were caused by bites. Ten more cases were announced Monday, even though Florida authorities have yet to find any mosquitoes actually carrying the virus.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Zika infections in pregnant women can cause severe brain-related birth defects, including extremely small skulls. The global outbreak has led to more than 1,800 serious defects.\u003c/p>\n\u003cp>CDC officials said they could not remember another time in the 70-year history of the disease-fighting agency when it told members of the public not to travel someplace in the U.S.\u003c/p>\n\u003cp>The virus can linger in the blood and urine for weeks, and has been found in sperm for months. As a result, the CDC said men and women who have recently been in the affected area should wait at least eight weeks before trying to conceive a child.\u003c/p>\n\u003cp>The travel warning covers an area of about 1 square mile in Wynwood, to the east of Interstate 95 and south of I-195. It’s large enough, health officials said, to provide a buffer around the suspected hot zone. The tropical mosquito that spreads Zika travels less than 200 yards in its lifetime.\u003c/p>\n\u003cp>Yet some experts said that’s far too small a radius. Dr. Peter Hotez, a tropical medicine expert at the Baylor College of Medicine in Texas, said the CDC should be more cautious and expand the travel advisory to all of Miami-Dade County.\u003c/p>\n\u003cp>“If you’re pregnant or think you might be pregnant, avoid travel to Miami, and possible elsewhere in South Florida,” he said. “I’m guessing most women who are pregnant are doing that. I don’t think they’re sitting around for the CDC to split hairs and fine-tune it to a specific area.”\u003c/p>\n\u003cp>CDC Director Dr. Tom Frieden said the narrowly drawn warning was dictated by science and not by any concern for Florida’s crucial tourism industry. He said it was based on the nation’s ability to contain outbreaks of other diseases carried by the same mosquito.\u003c/p>\n\u003cp>“There wouldn’t be a technical or scientific basis to give a broader recommendation,” Frieden said.\u003c/p>\n\u003cp>U.S. health officials have said all along that while isolated clusters of Zika may occur in this country, they do not expect major outbreaks like those seen in Latin America, because of better sanitation and mosquito control and widespread use of air conditioners and window screens.\u003c/p>\n\u003cp>At the same time, health officials expressed concern that they continue to see “moderately high” numbers of the type of mosquito that carries Zika, despite aggressive use of insecticides.\u003c/p>\n\u003cp>“This is a very difficult mosquito to control,” Frieden said.\u003c/p>\n\u003cp>Florida health officials said they have tested more than 200 people in Miami-Dade and Broward Counties since early July. The CDC emergency team will help Florida officials investigate the outbreak, collect samples and control mosquitoes.\u003c/p>\n\u003cp>Of the 14 people infected, two are women and 12 are men. Eight patients showed symptoms of Zika, which can include fever, rash, joint pain and red eyes. The others had no symptoms. The disease is often so mild that most people don’t know they are infected.\u003c/p>\n\u003cp>“We will continue to keep our residents and visitors safe utilizing constant surveillance and aggressive strategies, such as increased mosquito spraying, that have allowed our state to fight similar viruses,” the governor said in a statement.\u003c/p>\n\u003cp>Rosemary LeBranch was doing laundry in Wynwood when health officials came to her house a few days ago and took urine samples from her, her daughter and her father. Her father, Gabriel Jean, tested positive, she said Monday.\u003c/p>\n\u003cp>He had already spoken with a doctor and was advised to wear long shirts and pants outdoors.\u003c/p>\n\u003cp>“He said nothing hurts, he doesn’t have any pain. He doesn’t feel anything,” she said.\u003c/p>\n\u003cp>Jordan Davison and Melissa Felix work for a cruise line and were enjoying their day off Monday looking at Wynwood’s spray-painted murals.\u003c/p>\n\u003cp>“It’s not like a big thing, right?” the 25-year-old Davidson said. “It’s kind of freaky — there’s so much going on we didn’t know, didn’t really think about it. … I might wear bug spray going forward.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>More than 1,650 cases of Zika have been reported in U.S. states, nearly all the result of travel to a Zika-stricken country or sex with someone who was infected abroad.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Heather Bottoms' two sons had been asking to go to a local indoor trampoline park for a while, so last September she took them. Her older son, then age 13, was jumping up and down when he bounced off the wall, fell and broke both the bones in one arm. The injury required surgery to insert two pins into his arm.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I don't think parents realize how significant the injuries can be or how frequently they occur.' \u003ccite> Katherine Leaming-Van Zandt, emergency room physician \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>The number of trampoline-park injuries like this has soared, according to research published Monday in the journal \u003cem>Pediatrics\u003c/em>. Using data from a \u003ca href=\"http://www.cpsc.gov/en/Research--Statistics/NEISS-Injury-Data/\" target=\"_blank\">government injury surveillance system\u003c/a>, the study authors estimate that the number of ER visits from injuries incurred at an indoor park — typically a series of connected trampolines in a big room surrounded by padded or trampoline walls — rose from fewer than 600 in 2010 to 6,932 in 2014.\u003c/p>\n\u003cp>The International Association of Trampoline Parks notes, however, that there were an estimated 50 million North American visits in the past year to the parks, which are becoming increasingly popular.\u003c/p>\n\u003cp>Despite that, most injuries still occur on home trampolines, the use of which the \u003ca href=\"http://www.npr.org/sections/health-shots/2012/09/24/161679143/pediatricians-bounce-trampolines-from-homes-to-protect-kids\" target=\"_blank\">American Academy of Pediatrics \"strongly\" discourages\u003c/a>. And the overall number of annual ER visits for trampoline-related injuries held steady over the study period, averaging about 91,750.\u003c/p>\n\u003cp>\"Our concern is that there are more serious trampoline injuries [at parks] than on home trampolines,\" says \u003ca href=\"http://gme.uchc.edu/programs/pedsfellowships/pedem_currentfellows.html\" target=\"_blank\">Kathryn Kasmire\u003c/a>, a pediatric emergency medicine fellow at the Connecticut Children's Medical Center and the University of Connecticut and an author of the study.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Almost 9 percent of park injuries required hospital admission, compared with 5.2 percent of injuries from home trampolines. Admission usually suggests that surgery was needed or that the patient was in serious pain, Kasmire says. Trampoline park injuries made up 11 percent of all 2014 ER visits for trampoline injuries where the location was known.\u003c/p>\n\u003cp>While sprains and fractures were the most common injuries at both homes and parks, those at parks were more likely to involve a dislocation. The indoor parks resulted in more lower-extremity injuries and fewer upper-extremity and head injuries than home trampolines.\u003c/p>\n\u003cp>That corresponds with what \u003ca href=\"https://www.texaschildrens.org/find-a-doctor/katherine-jennifer-leaming-van-zandt-md\" target=\"_blank\">Katherine Leaming-Van Zandt\u003c/a>, an emergency medicine physician at Texas Children's Hospital, has seen in her ER. \"I don't think parents realize how significant the injuries can be or how frequently they occur,\" she says, adding that parents may be lulled into complacency, thinking that supervision by park employees will keep their kids safe.\u003c/p>\n\u003cp>But it's not always enough. Bottoms, who lives in Owasso, Okla., says she fully understands that trampoline parks carry risks. \"Anybody can get hurt anywhere, doing anything,\" she says. But she says no one at the park helped her son or performed first aid after the injury. She had to set the fracture herself with the ice scraper from her car.\u003c/p>\n\u003cp>The IATP, which represents the trampoline park industry, said in a statement it welcomes studies like this one that \"provide a deeper understanding of safety issues.\" But it noted that with industry growth from 25 parks in 2010 to more than 350 in 2014, the increase in the number of injuries isn't surprising. The rate at which injuries occur, it said, is more meaningful than raw numbers. \"We believe that the positives of youth recreational sports far outweigh the negatives, and we are actively engaged at programs aimed at promoting the safety and well-being of jumpers who visit our member parks,\" it said.\u003c/p>\n\u003cp>It's important for kids to have fun and get exercise, says Kasmire. \"But there is no activity in which a kid is getting exercise that is risk-free.\" If your children go, \"you should be cautious,\" she says. Go at a less busy time. Supervise your kids yourself, and make sure there's just one jumper per trampoline. Don't allow flips. And if you have younger children, look for a park with a designated area that keeps them separate from bigger kids.\u003c/p>\n\u003cp>And make sure to be careful yourself, if you decide to take a bounce — 19 percent of trampoline park injuries were in adults.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/katherinehobson\">\u003cem>@katherinehobson\u003c/em>\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=As+Trampoline+Parks+Jump+In+Popularity%2C+So+Do+Injuries&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Heather Bottoms' two sons had been asking to go to a local indoor trampoline park for a while, so last September she took them. Her older son, then age 13, was jumping up and down when he bounced off the wall, fell and broke both the bones in one arm. The injury required surgery to insert two pins into his arm.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I don't think parents realize how significant the injuries can be or how frequently they occur.' \u003ccite> Katherine Leaming-Van Zandt, emergency room physician \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>The number of trampoline-park injuries like this has soared, according to research published Monday in the journal \u003cem>Pediatrics\u003c/em>. Using data from a \u003ca href=\"http://www.cpsc.gov/en/Research--Statistics/NEISS-Injury-Data/\" target=\"_blank\">government injury surveillance system\u003c/a>, the study authors estimate that the number of ER visits from injuries incurred at an indoor park — typically a series of connected trampolines in a big room surrounded by padded or trampoline walls — rose from fewer than 600 in 2010 to 6,932 in 2014.\u003c/p>\n\u003cp>The International Association of Trampoline Parks notes, however, that there were an estimated 50 million North American visits in the past year to the parks, which are becoming increasingly popular.\u003c/p>\n\u003cp>Despite that, most injuries still occur on home trampolines, the use of which the \u003ca href=\"http://www.npr.org/sections/health-shots/2012/09/24/161679143/pediatricians-bounce-trampolines-from-homes-to-protect-kids\" target=\"_blank\">American Academy of Pediatrics \"strongly\" discourages\u003c/a>. And the overall number of annual ER visits for trampoline-related injuries held steady over the study period, averaging about 91,750.\u003c/p>\n\u003cp>\"Our concern is that there are more serious trampoline injuries [at parks] than on home trampolines,\" says \u003ca href=\"http://gme.uchc.edu/programs/pedsfellowships/pedem_currentfellows.html\" target=\"_blank\">Kathryn Kasmire\u003c/a>, a pediatric emergency medicine fellow at the Connecticut Children's Medical Center and the University of Connecticut and an author of the study.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Almost 9 percent of park injuries required hospital admission, compared with 5.2 percent of injuries from home trampolines. Admission usually suggests that surgery was needed or that the patient was in serious pain, Kasmire says. Trampoline park injuries made up 11 percent of all 2014 ER visits for trampoline injuries where the location was known.\u003c/p>\n\u003cp>While sprains and fractures were the most common injuries at both homes and parks, those at parks were more likely to involve a dislocation. The indoor parks resulted in more lower-extremity injuries and fewer upper-extremity and head injuries than home trampolines.\u003c/p>\n\u003cp>That corresponds with what \u003ca href=\"https://www.texaschildrens.org/find-a-doctor/katherine-jennifer-leaming-van-zandt-md\" target=\"_blank\">Katherine Leaming-Van Zandt\u003c/a>, an emergency medicine physician at Texas Children's Hospital, has seen in her ER. \"I don't think parents realize how significant the injuries can be or how frequently they occur,\" she says, adding that parents may be lulled into complacency, thinking that supervision by park employees will keep their kids safe.\u003c/p>\n\u003cp>But it's not always enough. Bottoms, who lives in Owasso, Okla., says she fully understands that trampoline parks carry risks. \"Anybody can get hurt anywhere, doing anything,\" she says. But she says no one at the park helped her son or performed first aid after the injury. She had to set the fracture herself with the ice scraper from her car.\u003c/p>\n\u003cp>The IATP, which represents the trampoline park industry, said in a statement it welcomes studies like this one that \"provide a deeper understanding of safety issues.\" But it noted that with industry growth from 25 parks in 2010 to more than 350 in 2014, the increase in the number of injuries isn't surprising. The rate at which injuries occur, it said, is more meaningful than raw numbers. \"We believe that the positives of youth recreational sports far outweigh the negatives, and we are actively engaged at programs aimed at promoting the safety and well-being of jumpers who visit our member parks,\" it said.\u003c/p>\n\u003cp>It's important for kids to have fun and get exercise, says Kasmire. \"But there is no activity in which a kid is getting exercise that is risk-free.\" If your children go, \"you should be cautious,\" she says. Go at a less busy time. Supervise your kids yourself, and make sure there's just one jumper per trampoline. Don't allow flips. And if you have younger children, look for a park with a designated area that keeps them separate from bigger kids.\u003c/p>\n\u003cp>And make sure to be careful yourself, if you decide to take a bounce — 19 percent of trampoline park injuries were in adults.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/katherinehobson\">\u003cem>@katherinehobson\u003c/em>\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=As+Trampoline+Parks+Jump+In+Popularity%2C+So+Do+Injuries&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>For a group of mental health professionals in California, watching the Syrian refugee crisis unfold on television was not an option.\u003c/p>\n\u003cp>“We were very, very concerned that there (was) a lot of need, and little available for professional services -- particularly mental health services,” says psychiatrist Dr. Saad Shakir.\u003c/p>\n\u003caside class=\"pullquote alignright\">Seeing all the devastation going on, I want to have an impact in a positive way. \u003ccite> Dr. Saad Shakir, Alalusi Foundation \u003c/cite>\u003c/aside>\n\u003cp>Shakir yearned to do more, and he zeroed in on Jordan. Amman, the country’s capital, is on the front lines of the Syrian refugee crisis, with nearly 1.5 million refugees now living in the country. Many are suffering deeply, but there aren’t nearly enough mental health professionals to serve them. A study from the \u003ca href=\"http://www.who.int/mental_health/evidence/mh_aims_report_jordan_jan_2011_en.pdf\" target=\"_blank\">World Health Organization\u003c/a> says fewer than 100 psychiatrists live in Jordan.\u003c/p>\n\u003cp>In the face of overwhelming need came a creative response from the Alalusi Foundation, a Hayward-based nonprofit focusing on refugee relief and humanitarian projects around the world. The foundation developed the Care Program for Refugees -- or CPR -- to train professionals who work with refugees to provide mental health care.\u003c/p>\n\u003cp>“Being a physician, I'm a humanitarian,” says Shakir. “So seeing all the devastation going on, it's like I want to have an impact in a positive way. We decided the best way we can help is by training the individuals here who provide care for refugees.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Earlier this summer, the group traveled to Amman to hold a weeklong training for Middle Eastern professionals who work with refugees.\u003c/p>\n\u003cp>Shakir and his colleagues prepared intensive trainings on a range of subjects including post-traumatic stress disorder, therapeutic interventions, ethics, and self-care for therapists.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/276000214\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Saadia Hameed is a school psychologist from Sunnyvale who first heard about CPR after a meeting of the Bay Area Muslim Mental Health Professionals. The group was looking for someone with a background working with children, and she jumped at the chance to get involved.\u003c/p>\n\u003cp>“It’s really important for someone who does want to help to look within themselves to see what skills they have to offer,” says Hameed, while on a break from leading a workshop for 30 people on caring for children who have experienced trauma. The room buzzes with energy, and the discussion alternates between English and Arabic.\u003c/p>\n\u003cp>The workshop is intended for medical professionals, as well as social workers, volunteers, and educators. One of the attendees, Nisreen Katbi is a displaced refugee herself. Now she runs a residential rehabilitation center in Amman called\u003ca href=\"http://souriyat-across-borders.org/\" target=\"_blank\"> Souriyat Across Borders\u003c/a> that cares for Syrian refugees who were injured in the war.\u003c/p>\n\u003cp>“We found ourselves, all of a sudden, in the middle of this crisis,\" she says. \"Those people around us need help, they need help very quickly.\" Because of limited resources, people like Katbi sometimes find themselves given large responsibilities. She is grateful for today’s training.\u003c/p>\n\u003cp>“It’s a critical situation when they came from a war zone,” Katbi says. “So I have to be qualified to deal with them.”\u003c/p>\n\u003cp>The problem is vast. Care Program for Refugees hopes to expand its efforts by holding more trainings and offering webinars to reach other people who work with refugees. And Hameed, the school psychologist, says working with professionals like Katbi has in turn inspired her to dig deeper into treating trauma.\u003c/p>\n\u003cp>“One thing I feel is very motivated,\" she says. \"I want to learn more about how to support children who’ve not just faced trauma but war trauma, and torture and grief and loss.\"\u003c/p>\n\u003cp>Hameed plans to return to Amman for next spring’s training.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Luisa Conlon and Hanna Miller contributed to this story.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For a group of mental health professionals in California, watching the Syrian refugee crisis unfold on television was not an option.\u003c/p>\n\u003cp>“We were very, very concerned that there (was) a lot of need, and little available for professional services -- particularly mental health services,” says psychiatrist Dr. Saad Shakir.\u003c/p>\n\u003caside class=\"pullquote alignright\">Seeing all the devastation going on, I want to have an impact in a positive way. \u003ccite> Dr. Saad Shakir, Alalusi Foundation \u003c/cite>\u003c/aside>\n\u003cp>Shakir yearned to do more, and he zeroed in on Jordan. Amman, the country’s capital, is on the front lines of the Syrian refugee crisis, with nearly 1.5 million refugees now living in the country. Many are suffering deeply, but there aren’t nearly enough mental health professionals to serve them. A study from the \u003ca href=\"http://www.who.int/mental_health/evidence/mh_aims_report_jordan_jan_2011_en.pdf\" target=\"_blank\">World Health Organization\u003c/a> says fewer than 100 psychiatrists live in Jordan.\u003c/p>\n\u003cp>In the face of overwhelming need came a creative response from the Alalusi Foundation, a Hayward-based nonprofit focusing on refugee relief and humanitarian projects around the world. The foundation developed the Care Program for Refugees -- or CPR -- to train professionals who work with refugees to provide mental health care.\u003c/p>\n\u003cp>“Being a physician, I'm a humanitarian,” says Shakir. “So seeing all the devastation going on, it's like I want to have an impact in a positive way. We decided the best way we can help is by training the individuals here who provide care for refugees.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Earlier this summer, the group traveled to Amman to hold a weeklong training for Middle Eastern professionals who work with refugees.\u003c/p>\n\u003cp>Shakir and his colleagues prepared intensive trainings on a range of subjects including post-traumatic stress disorder, therapeutic interventions, ethics, and self-care for therapists.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/276000214&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/276000214'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Saadia Hameed is a school psychologist from Sunnyvale who first heard about CPR after a meeting of the Bay Area Muslim Mental Health Professionals. The group was looking for someone with a background working with children, and she jumped at the chance to get involved.\u003c/p>\n\u003cp>“It’s really important for someone who does want to help to look within themselves to see what skills they have to offer,” says Hameed, while on a break from leading a workshop for 30 people on caring for children who have experienced trauma. The room buzzes with energy, and the discussion alternates between English and Arabic.\u003c/p>\n\u003cp>The workshop is intended for medical professionals, as well as social workers, volunteers, and educators. One of the attendees, Nisreen Katbi is a displaced refugee herself. Now she runs a residential rehabilitation center in Amman called\u003ca href=\"http://souriyat-across-borders.org/\" target=\"_blank\"> Souriyat Across Borders\u003c/a> that cares for Syrian refugees who were injured in the war.\u003c/p>\n\u003cp>“We found ourselves, all of a sudden, in the middle of this crisis,\" she says. \"Those people around us need help, they need help very quickly.\" Because of limited resources, people like Katbi sometimes find themselves given large responsibilities. She is grateful for today’s training.\u003c/p>\n\u003cp>“It’s a critical situation when they came from a war zone,” Katbi says. “So I have to be qualified to deal with them.”\u003c/p>\n\u003cp>The problem is vast. Care Program for Refugees hopes to expand its efforts by holding more trainings and offering webinars to reach other people who work with refugees. And Hameed, the school psychologist, says working with professionals like Katbi has in turn inspired her to dig deeper into treating trauma.\u003c/p>\n\u003cp>“One thing I feel is very motivated,\" she says. \"I want to learn more about how to support children who’ve not just faced trauma but war trauma, and torture and grief and loss.\"\u003c/p>\n\u003cp>Hameed plans to return to Amman for next spring’s training.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Luisa Conlon and Hanna Miller contributed to this story.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Florida likely has the first cases of Zika transmitted by mosquitoes on the U.S. mainland, the state's governor said Friday.\u003c/p>\n\u003cp>No mosquitoes in the state have tested positive for Zika, but one woman and three men in Miami-Dade and Broward counties likely contracted the virus through mosquito bites, Gov. Rick Scott said during a news conference in Orlando.\u003c/p>\n\u003cp>More than 1,650 Zika infections have been reported in the U.S., but the four patients in Florida would be the first not linked to travel outside the U.S. mainland.\u003c/p>\n\u003cp>\"This is not just a Florida issue. It's a national issue — we just happen to be at the forefront,\" Scott said.\u003c/p>\n\u003cp>Health officials believe the infections occurred in a small area just north of downtown Miami, in the popular Wynwood arts district, Scott said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It's the only part of the state currently being tested for potential local transmissions of Zika, Scott said. Women in the area who are pregnant or thinking about becoming pregnant are urged to contact their doctors and the county health department for Zika prevention kits.\u003c/p>\n\u003cp>Federal health officials have not recommended that pregnant women avoid travel to South Florida.\u003c/p>\n\u003cp>\"There are a series of factors we'll have to look at. The number of cases, the relationship in geography of those cases, how closely linked they are in time, as well as a series of other factors that we will use to determine what recommendations we issue in terms of travel guidance,\" U.S. Surgeon General Dr. Vivek Murthy said Thursday.\u003c/p>\n\u003cp>Zika primarily spreads through bites from tropical mosquitoes, but it also can be spread through sex. In most people, the virus causes only mild illness, but infection during pregnancy can lead to severe brain-related birth defects for the fetus. There is no vaccine.\u003c/p>\n\u003cp>Since February, over 380 Zika cases related to travel have been confirmed in Florida, including 151 cases in Miami-Dade and Broward counties. Since 2015 in California, \u003ca href=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf\" target=\"_blank\">98 people \u003c/a>have been confirmed to be infected with Zika virus. All cases are associated with travel.\u003c/p>\n\u003cp>The tropical mosquito that spreads Zika and other viruses is found in the southern U.S. While health officials have predicted that mosquitoes in the continental U.S. would begin spreading Zika this summer, they also have said they expect only isolated clusters of infections and not widespread outbreaks.\u003c/p>\n\u003cp>[contextly_sidebar id=\"otl96TyzT7kgPI9mM6XBL4cTvDAfTVU4\"]Florida should be able to contain the virus to an isolated area because its neighborhoods have better sanitation and living conditions than countries where Zika outbreaks have been widespread, said Adam Putnam, Florida's commissioner for agriculture and consumer services.\u003c/p>\n\u003cp>The U.S. Food and Drug Administration has told blood centers in Miami-Dade and Broward counties to suspend collections until they can screen each unit of blood for the Zika virus with authorized tests. Neighboring counties have been urged to implement the same precautions, and visitors to South Florida in the last month are encouraged to defer donations as well.\u003c/p>\n\u003cp>The FDA previously advised U.S. blood banks to refuse donations from people who recently traveled to areas outside the country that have Zika outbreaks.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Florida's main supplier of blood, OneBlood, said it was working as quickly as possible to comply with the FDA's recommendation and would start testing all its collections for Zika on Friday.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Florida likely has the first cases of Zika transmitted by mosquitoes on the U.S. mainland, the state's governor said Friday.\u003c/p>\n\u003cp>No mosquitoes in the state have tested positive for Zika, but one woman and three men in Miami-Dade and Broward counties likely contracted the virus through mosquito bites, Gov. Rick Scott said during a news conference in Orlando.\u003c/p>\n\u003cp>More than 1,650 Zika infections have been reported in the U.S., but the four patients in Florida would be the first not linked to travel outside the U.S. mainland.\u003c/p>\n\u003cp>\"This is not just a Florida issue. It's a national issue — we just happen to be at the forefront,\" Scott said.\u003c/p>\n\u003cp>Health officials believe the infections occurred in a small area just north of downtown Miami, in the popular Wynwood arts district, Scott said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It's the only part of the state currently being tested for potential local transmissions of Zika, Scott said. Women in the area who are pregnant or thinking about becoming pregnant are urged to contact their doctors and the county health department for Zika prevention kits.\u003c/p>\n\u003cp>Federal health officials have not recommended that pregnant women avoid travel to South Florida.\u003c/p>\n\u003cp>\"There are a series of factors we'll have to look at. The number of cases, the relationship in geography of those cases, how closely linked they are in time, as well as a series of other factors that we will use to determine what recommendations we issue in terms of travel guidance,\" U.S. Surgeon General Dr. Vivek Murthy said Thursday.\u003c/p>\n\u003cp>Zika primarily spreads through bites from tropical mosquitoes, but it also can be spread through sex. In most people, the virus causes only mild illness, but infection during pregnancy can lead to severe brain-related birth defects for the fetus. There is no vaccine.\u003c/p>\n\u003cp>Since February, over 380 Zika cases related to travel have been confirmed in Florida, including 151 cases in Miami-Dade and Broward counties. Since 2015 in California, \u003ca href=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf\" target=\"_blank\">98 people \u003c/a>have been confirmed to be infected with Zika virus. All cases are associated with travel.\u003c/p>\n\u003cp>The tropical mosquito that spreads Zika and other viruses is found in the southern U.S. While health officials have predicted that mosquitoes in the continental U.S. would begin spreading Zika this summer, they also have said they expect only isolated clusters of infections and not widespread outbreaks.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Florida should be able to contain the virus to an isolated area because its neighborhoods have better sanitation and living conditions than countries where Zika outbreaks have been widespread, said Adam Putnam, Florida's commissioner for agriculture and consumer services.\u003c/p>\n\u003cp>The U.S. Food and Drug Administration has told blood centers in Miami-Dade and Broward counties to suspend collections until they can screen each unit of blood for the Zika virus with authorized tests. Neighboring counties have been urged to implement the same precautions, and visitors to South Florida in the last month are encouraged to defer donations as well.\u003c/p>\n\u003cp>The FDA previously advised U.S. blood banks to refuse donations from people who recently traveled to areas outside the country that have Zika outbreaks.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Florida's main supplier of blood, OneBlood, said it was working as quickly as possible to comply with the FDA's recommendation and would start testing all its collections for Zika on Friday.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The number of people at Brian and Laura Smart’s San Jose home has been steadily growing since February.\u003c/p>\n\u003cp>By June, it reached six adults: Brian's parents, Laura's mother and an au pair. They're all part of a makeshift medical team aimed at keeping Noah, Brian and Laura's one-year-old son, alive.\u003c/p>\n\u003cp>Last July, Noah was born with \u003ca href=\"http://www.pted.org/?id=shones1\" target=\"_blank\">Shone’s Complex,\u003c/a> a rare congenital heart disease. In February, he suffered a stroke during a surgical procedure, which further disabled him. Noah is now dependent on a ventilator and a gastric tube, and he takes nine medications every day.\u003c/p>\n\u003cp>“We had this little boy who was rolling over and playing with us and now we have this body that vomits and cries, and it’s torture.” Brian says.\u003c/p>\n\u003cfigure id=\"attachment_218054\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-218054 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/NoahSmart-400x250.jpg\" alt=\"Noah Smart was born in July 2015 with a severe congenital heart disease. \" width=\"400\" height=\"250\">\u003cfigcaption class=\"wp-caption-text\">Noah Smart was born in July 2015 with a severe congenital heart disease. \u003ccite>(Jordan Katz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“What Noah was up until then, Noah is not anymore,” says \u003ca href=\"http://www.stanfordchildrens.org/en/doctor/default?id=meera-sukumaran\" target=\"_blank\">Dr. Meera Sukumaran\u003c/a>. She specializes in pediatric neurodevelopmental disabilities at Stanford, where she treats Noah. After Noah suffered the stroke, he started having seizures and muscles spasms, Sukumaran says. “He would cry out, be very distressed. ... He was having a harder time digesting his milk, so he was throwing up 10 to 20 times a day.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Noah has a feeding pump, a suction machine, and needs oxygen, his father says. These needs are highly complex, and while some members of Noah's makeshift support system have medical skills -- Brian's mother is a retired registered nurse, the au pair has a nursing license from the Philippines -- everyone agrees this care system is not sustainable.\u003c/p>\n\u003cp>\"Ideally, we would want a nurse 24 hours a day,” Brian says, although he also says they’d take even 8-hour support. But trying to access that level of care has been a months-long odyssey.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Brian and Laura are both employed full time and have health insurance with United Healthcare through Laura's job at Apple. Despite the insurance, they estimate they're paying $5,000 a month, out-of-pocket, for hired care and copays.\u003c/span>\u003c/p>\n\u003cp>The Smarts applied to get an in-home nurse covered by United Healthcare and were denied. The insurance company claimed the care Noah needed was custodial, meaning it was the same as the care that comes with having any baby. They appealed, and were denied again, even though a home nurse would help them avoid emergency room visits that would quickly cost the insurer more than a home nurse.\u003c/p>\n\u003cfigure id=\"attachment_215866\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-215866\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/SyringesCU-400x267.jpg\" alt=\"Part of the 15 doses of medication Noah Smart will need each day. \" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Part of the 15 doses of medication Noah Smart will need each day. \u003ccite>(Jordan Katz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Smarts next turned to Medi-Cal, the state's health insurance generally for people who are low income. Severely disabled children can be deemed eligible for the program, even if their parents’ income exceeds usual limits. This was a waiver the Smarts sought for Noah.\u003c/p>\n\u003cp>But getting a waiver is just the first hurdle and no guarantee Noah will actually be able to get the nursing care he needs. The problem is home health agencies that provide the care have trouble attracting nurses to meet the pressing demand by families, and they blame low Medi-Cal reimbursement rates.\u003c/p>\n\u003cp>“On paper, there are all these pediatric home health agencies,\" says Sherri Sager, chief government and community relations officer of Lucile Packard Children's Hospital at Stanford. “To meet the demand for pediatric home health nurses, the supply is nowhere near what we need.\"\u003c/p>\n\u003cp>At Maxim Healthcare Services, a home health agency that connects families with nurses, Kris Frank says he is finding it harder and harder to recruit and retain registered nurses, because the rates they offer are so low compared to what nurses can earn at hospitals or other skilled nursing facilities.\u003c/p>\n\u003cp>Currently, the average hourly rate for a registered nurse working in the Bay Area is around $65 an hour, according to the \u003ca href=\"http://www.bls.gov/oes/current/oes_41884.htm\" target=\"_blank\">Bureau of Labor Statistics\u003c/a>. The reimbursement rate Maxim says it receives for a registered nurse caring for a Medi-Cal patient is $40.16 an hour.\u003c/p>\n\u003cp>Though Frank says Maxim pays all its nurses the same rate whether the agency is reimbursed by Medi-Cal or another insurer, the net effect of a lower Medi-Cal reimbursement rates to the home health agency is a lower rate overall.\u003c/p>\n\u003cp>“We blend the rates,” Frank explains. \"but costs go up, and we just can’t continue to pay enough for us to fill all the approved shifts.\"\u003c/p>\n\u003cp>Barbara Crane, Maxim's director of clinical services, first came to the agency as a home health nurse after she and her husband moved to the Bay Area from New York. When she arrived, she says she was “taken aback” by the difference in wages.\u003c/p>\n\u003cp>“It was less than half of what I had been making ten years ago in New York,” Crane says. “Caring in the home, where you don’t have other doctors or other nurses around to support your assessment and your decisions, is a bit of a daunting task.\"\u003c/p>\n\u003cp>\"I know this is a different state, but the rates for nursing to be done in the home are just so sub-standard,” she says.\u003c/p>\n\u003cp>Now her job is to convince nurses to work in home health.\u003c/p>\n\u003cp>\"I am in the predicament of trying to get nurses to come here and get them to understand how important home health is, even though it’s not financially rewarding,” Crane says.\u003c/p>\n\u003cp>What’s more, Frank says, the nurses that agencies like Maxim need to recruit are highly-skilled, almost to the level of a hospital neo-natal intensive care unit. “But we’re bringing them in-home,\" he says, \"and some nurses don’t want to work in the home.\" Then when he tells them the rate, he says, they balk. \"They think, ‘Well, heck. I could be making more working as a waitress, or a waiter—a lot more.’”\u003c/p>\n\u003cp>Maxim has been working with Sen. Mike McGuire, D-Healdsburg, to pass legislation that addresses the issue. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1401\" target=\"_blank\">Senate Bill 1401\u003c/a>, first introduced in March, would establish a three-year pilot program in three regions around California— including the Bay Area. Under the pilot, Medi-Cal reimbursement rates for registered nurses and licensed vocational nurses would be increased 20 percent.\u003c/p>\n\u003cp>In a statement, McGuire pointed out that in-home nursing is cost-effective. “It costs 10 times more each day to care for a child in a hospital,\" he said, \"than it does to care for that child at home.”\u003c/p>\n\u003cp>Tony Cava, spokesman for the Department of Health Care Services which oversees Medi-Cal, said that the agency was \"not aware of any significant access issues\" with home health care for Medi-Cal recipients.\u003c/p>\n\u003cp>If a family is unable to find a home health agency -- or HHA -- to provide prescribed nursing service, Cava said that \"DHCS nurses [would] provide assistance to the family by referring them to other Medi-Cal-approved HHAs, individual nurse providers, and pediatric day health care centers.”\u003c/p>\n\u003cp>But implementing SB 1401 would cost more than $20 million to implement, according to \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201520160SB1401\" target=\"_blank\">an analysis \u003c/a>presented to the Senate Committee on Appropriations. The bill was ultimately held in the committee earlier this year and cannot be re-introduced until next January.\u003c/p>\n\u003cp>Meanwhile, home health agencies struggle to fill the hours that patients need. “We should be filling 100 percent,\" Frank says, but even when nurses call in sick, \"we have no backup nurses.\"\u003c/p>\n\u003cp>As for the Smarts—after months of phone calls and paperwork, Noah is on track to get Medi-Cal coverage. What's unclear is whether that coverage will make a difference, given the shortage of in-home pediatric nurses.\u003c/p>\n\u003cp>Brian Smart knew that even with coverage, Noah's name might linger on a wait list for care for a year—or more. Still, he decided it was worth a shot.\u003c/p>\n\u003cp>\"I filled out the paperwork as a just-in-case,” Brian says. Even the program coordinator told him it would be a \"long shot\" that he would get an in-home nurse.\u003c/p>\n\u003cp>\"Even if it’s a one-in-a-million chance, at least it’s a chance.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>For now, the Smarts will have to keep waiting.\u003c/p>\n\n",
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"excerpt": "They were denied coverage with private insurance. Their son qualifies for Medi-Cal, but there simply aren't enough nurses. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The number of people at Brian and Laura Smart’s San Jose home has been steadily growing since February.\u003c/p>\n\u003cp>By June, it reached six adults: Brian's parents, Laura's mother and an au pair. They're all part of a makeshift medical team aimed at keeping Noah, Brian and Laura's one-year-old son, alive.\u003c/p>\n\u003cp>Last July, Noah was born with \u003ca href=\"http://www.pted.org/?id=shones1\" target=\"_blank\">Shone’s Complex,\u003c/a> a rare congenital heart disease. In February, he suffered a stroke during a surgical procedure, which further disabled him. Noah is now dependent on a ventilator and a gastric tube, and he takes nine medications every day.\u003c/p>\n\u003cp>“We had this little boy who was rolling over and playing with us and now we have this body that vomits and cries, and it’s torture.” Brian says.\u003c/p>\n\u003cfigure id=\"attachment_218054\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-218054 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/NoahSmart-400x250.jpg\" alt=\"Noah Smart was born in July 2015 with a severe congenital heart disease. \" width=\"400\" height=\"250\">\u003cfigcaption class=\"wp-caption-text\">Noah Smart was born in July 2015 with a severe congenital heart disease. \u003ccite>(Jordan Katz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“What Noah was up until then, Noah is not anymore,” says \u003ca href=\"http://www.stanfordchildrens.org/en/doctor/default?id=meera-sukumaran\" target=\"_blank\">Dr. Meera Sukumaran\u003c/a>. She specializes in pediatric neurodevelopmental disabilities at Stanford, where she treats Noah. After Noah suffered the stroke, he started having seizures and muscles spasms, Sukumaran says. “He would cry out, be very distressed. ... He was having a harder time digesting his milk, so he was throwing up 10 to 20 times a day.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Noah has a feeding pump, a suction machine, and needs oxygen, his father says. These needs are highly complex, and while some members of Noah's makeshift support system have medical skills -- Brian's mother is a retired registered nurse, the au pair has a nursing license from the Philippines -- everyone agrees this care system is not sustainable.\u003c/p>\n\u003cp>\"Ideally, we would want a nurse 24 hours a day,” Brian says, although he also says they’d take even 8-hour support. But trying to access that level of care has been a months-long odyssey.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Brian and Laura are both employed full time and have health insurance with United Healthcare through Laura's job at Apple. Despite the insurance, they estimate they're paying $5,000 a month, out-of-pocket, for hired care and copays.\u003c/span>\u003c/p>\n\u003cp>The Smarts applied to get an in-home nurse covered by United Healthcare and were denied. The insurance company claimed the care Noah needed was custodial, meaning it was the same as the care that comes with having any baby. They appealed, and were denied again, even though a home nurse would help them avoid emergency room visits that would quickly cost the insurer more than a home nurse.\u003c/p>\n\u003cfigure id=\"attachment_215866\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-215866\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/SyringesCU-400x267.jpg\" alt=\"Part of the 15 doses of medication Noah Smart will need each day. \" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Part of the 15 doses of medication Noah Smart will need each day. \u003ccite>(Jordan Katz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Smarts next turned to Medi-Cal, the state's health insurance generally for people who are low income. Severely disabled children can be deemed eligible for the program, even if their parents’ income exceeds usual limits. This was a waiver the Smarts sought for Noah.\u003c/p>\n\u003cp>But getting a waiver is just the first hurdle and no guarantee Noah will actually be able to get the nursing care he needs. The problem is home health agencies that provide the care have trouble attracting nurses to meet the pressing demand by families, and they blame low Medi-Cal reimbursement rates.\u003c/p>\n\u003cp>“On paper, there are all these pediatric home health agencies,\" says Sherri Sager, chief government and community relations officer of Lucile Packard Children's Hospital at Stanford. “To meet the demand for pediatric home health nurses, the supply is nowhere near what we need.\"\u003c/p>\n\u003cp>At Maxim Healthcare Services, a home health agency that connects families with nurses, Kris Frank says he is finding it harder and harder to recruit and retain registered nurses, because the rates they offer are so low compared to what nurses can earn at hospitals or other skilled nursing facilities.\u003c/p>\n\u003cp>Currently, the average hourly rate for a registered nurse working in the Bay Area is around $65 an hour, according to the \u003ca href=\"http://www.bls.gov/oes/current/oes_41884.htm\" target=\"_blank\">Bureau of Labor Statistics\u003c/a>. The reimbursement rate Maxim says it receives for a registered nurse caring for a Medi-Cal patient is $40.16 an hour.\u003c/p>\n\u003cp>Though Frank says Maxim pays all its nurses the same rate whether the agency is reimbursed by Medi-Cal or another insurer, the net effect of a lower Medi-Cal reimbursement rates to the home health agency is a lower rate overall.\u003c/p>\n\u003cp>“We blend the rates,” Frank explains. \"but costs go up, and we just can’t continue to pay enough for us to fill all the approved shifts.\"\u003c/p>\n\u003cp>Barbara Crane, Maxim's director of clinical services, first came to the agency as a home health nurse after she and her husband moved to the Bay Area from New York. When she arrived, she says she was “taken aback” by the difference in wages.\u003c/p>\n\u003cp>“It was less than half of what I had been making ten years ago in New York,” Crane says. “Caring in the home, where you don’t have other doctors or other nurses around to support your assessment and your decisions, is a bit of a daunting task.\"\u003c/p>\n\u003cp>\"I know this is a different state, but the rates for nursing to be done in the home are just so sub-standard,” she says.\u003c/p>\n\u003cp>Now her job is to convince nurses to work in home health.\u003c/p>\n\u003cp>\"I am in the predicament of trying to get nurses to come here and get them to understand how important home health is, even though it’s not financially rewarding,” Crane says.\u003c/p>\n\u003cp>What’s more, Frank says, the nurses that agencies like Maxim need to recruit are highly-skilled, almost to the level of a hospital neo-natal intensive care unit. “But we’re bringing them in-home,\" he says, \"and some nurses don’t want to work in the home.\" Then when he tells them the rate, he says, they balk. \"They think, ‘Well, heck. I could be making more working as a waitress, or a waiter—a lot more.’”\u003c/p>\n\u003cp>Maxim has been working with Sen. Mike McGuire, D-Healdsburg, to pass legislation that addresses the issue. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1401\" target=\"_blank\">Senate Bill 1401\u003c/a>, first introduced in March, would establish a three-year pilot program in three regions around California— including the Bay Area. Under the pilot, Medi-Cal reimbursement rates for registered nurses and licensed vocational nurses would be increased 20 percent.\u003c/p>\n\u003cp>In a statement, McGuire pointed out that in-home nursing is cost-effective. “It costs 10 times more each day to care for a child in a hospital,\" he said, \"than it does to care for that child at home.”\u003c/p>\n\u003cp>Tony Cava, spokesman for the Department of Health Care Services which oversees Medi-Cal, said that the agency was \"not aware of any significant access issues\" with home health care for Medi-Cal recipients.\u003c/p>\n\u003cp>If a family is unable to find a home health agency -- or HHA -- to provide prescribed nursing service, Cava said that \"DHCS nurses [would] provide assistance to the family by referring them to other Medi-Cal-approved HHAs, individual nurse providers, and pediatric day health care centers.”\u003c/p>\n\u003cp>But implementing SB 1401 would cost more than $20 million to implement, according to \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201520160SB1401\" target=\"_blank\">an analysis \u003c/a>presented to the Senate Committee on Appropriations. The bill was ultimately held in the committee earlier this year and cannot be re-introduced until next January.\u003c/p>\n\u003cp>Meanwhile, home health agencies struggle to fill the hours that patients need. “We should be filling 100 percent,\" Frank says, but even when nurses call in sick, \"we have no backup nurses.\"\u003c/p>\n\u003cp>As for the Smarts—after months of phone calls and paperwork, Noah is on track to get Medi-Cal coverage. What's unclear is whether that coverage will make a difference, given the shortage of in-home pediatric nurses.\u003c/p>\n\u003cp>Brian Smart knew that even with coverage, Noah's name might linger on a wait list for care for a year—or more. Still, he decided it was worth a shot.\u003c/p>\n\u003cp>\"I filled out the paperwork as a just-in-case,” Brian says. Even the program coordinator told him it would be a \"long shot\" that he would get an in-home nurse.\u003c/p>\n\u003cp>\"Even if it’s a one-in-a-million chance, at least it’s a chance.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For now, the Smarts will have to keep waiting.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "More Addiction Training at Stanford Med School as Opioid Epidemic Surges",
"title": "More Addiction Training at Stanford Med School as Opioid Epidemic Surges",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Jonathan Goodman can recall most of the lectures he's attended at the Stanford University School of Medicine. He can recite detailed instructions given more than a year ago about how to conduct a physical.\u003c/p>\n\u003caside class=\"pullquote alignright\">Stanford's medical school may offer an example of what change in teaching about addiction can look like.\u003c/aside>\n\u003cp>But at the end of his second year, the 27-year-old M.D.-Ph.D. student could not remember any class dedicated to addiction medicine. Then he recalled skipping class months earlier. Reviewing his syllabus, he realized he had missed the sole lecture dedicated to that topic.\u003c/p>\n\u003cp>\"I wasn't tested on it,\" Goodman says, with a note of surprise.\u003c/p>\n\u003cp>Americans are \u003ca href=\"http://www.npr.org/sections/health-shots/2016/06/01/479440834/in-opioid-crisis-it-s-important-to-know-which-drugs-caused-a-death\" target=\"_blank\">overdosing on opioids\u003c/a> such as heroin and prescribed painkillers at epidemic rates, and the nation's doctors appear to be inadequately prepared to help.\u003c/p>\n\u003cp>The problem begins in medical school.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A \u003ca href=\"http://www.centeronaddiction.org/addiction-research/reports/addiction-medicine\" target=\"_blank\">report\u003c/a> in 2012 by The National Center on Addiction and Substance Abuse revealed that medical schools devoted little time to teaching addiction medicine — only a few hours over the course of four years. Since then, the number of Americans overdosing from prescribed opioids has surpassed \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">14,000 per year\u003c/a>, quadrupling from 1999 to 2014.\u003c/p>\n\u003cp>But Stanford's medical school may offer an example of what faculty-driven change in teaching about addiction can look like.\u003c/p>\n\u003cp>The school began retooling its curriculum after the director of its addiction medicine fellowship, \u003ca href=\"https://med.stanford.edu/profiles/anna-lembke\" target=\"_blank\">Dr. Anna Lembke\u003c/a>, expressed concern about its meager offerings in that field.\u003c/p>\n\u003cp>Lectures on addiction will no longer be folded into the psychiatry series as a side note, but instead will be presented as a separate unit relevant to future doctors in any subspecialty, Lembke says. And that training will continue when the students leave the classrooms for clinical rotations.\u003c/p>\n\u003cp>\"We're at the very bottom of a very long uphill road,\" says Lembke, who gave the lecture Goodman missed.\u003c/p>\n\u003cp>Medical faculties have traditionally eschewed teaching the subject, in part because many physicians viewed addiction as a personal vice rather than a disease. And, even now, some doctors who specialize in addiction treatment are skeptical that the best care for the problem comes out of a medical model.\u003c/p>\n\u003cp>For example, \u003ca href=\"https://www.youtube.com/watch?v=0Ueb-7ZxltQ\" target=\"_blank\">Dr. Joe Gerstein\u003c/a>, a retired internist and clinical assistant professor at Harvard Medical School, is founding president of \u003ca href=\"http://www.smartrecovery.org/intro/\" target=\"_blank\">SMART Recovery\u003c/a>, an international program that emphasizes cognitive behavioral therapy and positive thinking to help people beat their drug habit.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"Clearly, if you've got an addiction, you've been making a lot of bad choices,\" says Gerstein. Framing substance abuse strictly as a disease ignores the fact that some people are able to quit their use of a drug with willpower, he says.\u003c/p>\n\u003cp>Still, those who believe in the value of medical treatment for addiction say it can no longer be an afterthought in medical education. Because the current opioid epidemic is largely linked to prescribed opioid painkillers, many doctors are being forced to grapple with addicted patients in their practices. In March, the American Board of Medical Specialties \u003ca href=\"http://www.abms.org/news-events/abms-officially-recognizes-addiction-medicine-as-a-subspecialty/\">officially recognized\u003c/a> addiction medicine as a subspecialty.\u003c/p>\n\u003cp>In a March \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20RecoveryReachMAT.pdf\" target=\"_blank\">report\u003c/a>, the California Health Care Foundation cited inadequate medical school training as one of the challenges in treating patients addicted to opioids.\u003c/p>\n\u003cp>The White House has also been pressuring medical schools to improve instruction on opioid addiction by issuing pledges for schools to sign, promising to change their curricula. But as recently as April, Lembke hadn't yet heard of any concrete plans to change Stanford's curriculum.\u003c/p>\n\u003cp>In late spring, however, she was asked to meet with the dean of the medical school about bolstering education in addiction medicine. Working with fellow faculty members, Lembke is now expanding addiction medicine beyond the lone talk she gives on opioids each year to a series of lectures that recommend and teach alternative treatments for pain, like acupuncture or massage.\u003c/p>\n\u003cp>Lembke will also seek an endorsement of her fellowship program by the Accreditation Council of Graduate Medical Education. Accreditation can help programs get additional funding.\u003c/p>\n\u003cp>One of Lembke's Stanford colleagues, \u003ca href=\"https://med.stanford.edu/profiles/jordan-newmark\" target=\"_blank\">Dr. Jordan Newmark\u003c/a>, who directs education in medical school's pain division, is seeking to increase medical students' training on opioids in their third and fourth years. His plans for clinical training sessions include having actors portray patients with opioid addictions.\u003c/p>\n\u003cp>The next hurdle is to recruit doctors to specialize in addiction medicine, says \u003ca href=\"http://www.centeronaddiction.org/about/staff-biographies\" target=\"_blank\">Emily Feinstein\u003c/a>, director of health law and policy at the National Center on Addiction and Substance Abuse.\u003c/p>\n\u003cp>Among the challenges in getting young doctors interested in the field, Feinstein says, are low insurance reimbursement rates and having to deal with patients who can be difficult behaviorally because of their drug use.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It's best to reach doctors at the start of their careers, Lembke says — before they've established a practice and get set in their ways.\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=As+Opioid+Epidemic+Surges%2C+Medical+Schools+Must+Change+To+Keep+Pace&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Most medical schools offer little teaching about opioid addiction. Stanford University's medical school is trying to change that.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Jonathan Goodman can recall most of the lectures he's attended at the Stanford University School of Medicine. He can recite detailed instructions given more than a year ago about how to conduct a physical.\u003c/p>\n\u003caside class=\"pullquote alignright\">Stanford's medical school may offer an example of what change in teaching about addiction can look like.\u003c/aside>\n\u003cp>But at the end of his second year, the 27-year-old M.D.-Ph.D. student could not remember any class dedicated to addiction medicine. Then he recalled skipping class months earlier. Reviewing his syllabus, he realized he had missed the sole lecture dedicated to that topic.\u003c/p>\n\u003cp>\"I wasn't tested on it,\" Goodman says, with a note of surprise.\u003c/p>\n\u003cp>Americans are \u003ca href=\"http://www.npr.org/sections/health-shots/2016/06/01/479440834/in-opioid-crisis-it-s-important-to-know-which-drugs-caused-a-death\" target=\"_blank\">overdosing on opioids\u003c/a> such as heroin and prescribed painkillers at epidemic rates, and the nation's doctors appear to be inadequately prepared to help.\u003c/p>\n\u003cp>The problem begins in medical school.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A \u003ca href=\"http://www.centeronaddiction.org/addiction-research/reports/addiction-medicine\" target=\"_blank\">report\u003c/a> in 2012 by The National Center on Addiction and Substance Abuse revealed that medical schools devoted little time to teaching addiction medicine — only a few hours over the course of four years. Since then, the number of Americans overdosing from prescribed opioids has surpassed \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">14,000 per year\u003c/a>, quadrupling from 1999 to 2014.\u003c/p>\n\u003cp>But Stanford's medical school may offer an example of what faculty-driven change in teaching about addiction can look like.\u003c/p>\n\u003cp>The school began retooling its curriculum after the director of its addiction medicine fellowship, \u003ca href=\"https://med.stanford.edu/profiles/anna-lembke\" target=\"_blank\">Dr. Anna Lembke\u003c/a>, expressed concern about its meager offerings in that field.\u003c/p>\n\u003cp>Lectures on addiction will no longer be folded into the psychiatry series as a side note, but instead will be presented as a separate unit relevant to future doctors in any subspecialty, Lembke says. And that training will continue when the students leave the classrooms for clinical rotations.\u003c/p>\n\u003cp>\"We're at the very bottom of a very long uphill road,\" says Lembke, who gave the lecture Goodman missed.\u003c/p>\n\u003cp>Medical faculties have traditionally eschewed teaching the subject, in part because many physicians viewed addiction as a personal vice rather than a disease. And, even now, some doctors who specialize in addiction treatment are skeptical that the best care for the problem comes out of a medical model.\u003c/p>\n\u003cp>For example, \u003ca href=\"https://www.youtube.com/watch?v=0Ueb-7ZxltQ\" target=\"_blank\">Dr. Joe Gerstein\u003c/a>, a retired internist and clinical assistant professor at Harvard Medical School, is founding president of \u003ca href=\"http://www.smartrecovery.org/intro/\" target=\"_blank\">SMART Recovery\u003c/a>, an international program that emphasizes cognitive behavioral therapy and positive thinking to help people beat their drug habit.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"Clearly, if you've got an addiction, you've been making a lot of bad choices,\" says Gerstein. Framing substance abuse strictly as a disease ignores the fact that some people are able to quit their use of a drug with willpower, he says.\u003c/p>\n\u003cp>Still, those who believe in the value of medical treatment for addiction say it can no longer be an afterthought in medical education. Because the current opioid epidemic is largely linked to prescribed opioid painkillers, many doctors are being forced to grapple with addicted patients in their practices. In March, the American Board of Medical Specialties \u003ca href=\"http://www.abms.org/news-events/abms-officially-recognizes-addiction-medicine-as-a-subspecialty/\">officially recognized\u003c/a> addiction medicine as a subspecialty.\u003c/p>\n\u003cp>In a March \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20RecoveryReachMAT.pdf\" target=\"_blank\">report\u003c/a>, the California Health Care Foundation cited inadequate medical school training as one of the challenges in treating patients addicted to opioids.\u003c/p>\n\u003cp>The White House has also been pressuring medical schools to improve instruction on opioid addiction by issuing pledges for schools to sign, promising to change their curricula. But as recently as April, Lembke hadn't yet heard of any concrete plans to change Stanford's curriculum.\u003c/p>\n\u003cp>In late spring, however, she was asked to meet with the dean of the medical school about bolstering education in addiction medicine. Working with fellow faculty members, Lembke is now expanding addiction medicine beyond the lone talk she gives on opioids each year to a series of lectures that recommend and teach alternative treatments for pain, like acupuncture or massage.\u003c/p>\n\u003cp>Lembke will also seek an endorsement of her fellowship program by the Accreditation Council of Graduate Medical Education. Accreditation can help programs get additional funding.\u003c/p>\n\u003cp>One of Lembke's Stanford colleagues, \u003ca href=\"https://med.stanford.edu/profiles/jordan-newmark\" target=\"_blank\">Dr. Jordan Newmark\u003c/a>, who directs education in medical school's pain division, is seeking to increase medical students' training on opioids in their third and fourth years. His plans for clinical training sessions include having actors portray patients with opioid addictions.\u003c/p>\n\u003cp>The next hurdle is to recruit doctors to specialize in addiction medicine, says \u003ca href=\"http://www.centeronaddiction.org/about/staff-biographies\" target=\"_blank\">Emily Feinstein\u003c/a>, director of health law and policy at the National Center on Addiction and Substance Abuse.\u003c/p>\n\u003cp>Among the challenges in getting young doctors interested in the field, Feinstein says, are low insurance reimbursement rates and having to deal with patients who can be difficult behaviorally because of their drug use.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It's best to reach doctors at the start of their careers, Lembke says — before they've established a practice and get set in their ways.\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=As+Opioid+Epidemic+Surges%2C+Medical+Schools+Must+Change+To+Keep+Pace&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Hair products aren't at the top of most people's health worry list, but the Food and Drug Administration is investigating a surprisingly high number of reports of problems after people used a particular cleansing conditioner.\u003c/p>\n\u003cp>As of July 7, the FDA had received 127 complaints of \"hair loss, hair breakage, balding, itching, and rash\" after people used Wen by Chaz Dean cleansing conditioner products — more reports than the agency has ever received for a cosmetic hair product.\u003c/p>\n\u003cp>\"This kind of report is very rare,\" says \u003ca href=\"https://mydoctor.kaiserpermanente.org/ncal/provider/pmirmirani\">Paradi Mirmirani\u003c/a>, a dermatologist in Vallejo, Calif. \"For the most part, shampoo products out there are all very safe.\" The agency's \u003ca href=\"http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm511890.htm\">safety alert \u003c/a>says it has not determined a possible cause for the problems reported.\u003c/p>\n\u003cp>Late last year, mediation began for a \u003ca href=\"http://ww2.kqed.org/wp-content/uploads/gunthy_renker_wen_complaint.pdf\">class-action lawsuit\u003c/a> in California against Guthy-Renker, the company that markets and manufactures Wen.\u003c/p>\n\u003cp>The FDA doesn't approve cosmetics before they go on the market, though it does set upper limits for \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/23/387766821/there-s-bacteria-in-your-soap-and-everywhere-else\">bacteria in cosmetics\u003c/a> and hygiene products. Instead, says Linda Katz, director of the FDA's Office of Cosmetics and Colors, the agency monitors consumer complaints for many factors to decide whether to investigate a product.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In this case, the sheer number of complaints played a role in the decision. The agency says it is investigating more than 21,000 complaints reported to Chaz Dean Inc. and Guthy-Renker. (Gianna Cesa, a PR representative for Chaz Dean, says the company did not receive this number of complaints.)\u003c/p>\n\u003cp>Katz says she can't discuss any working hypotheses associated with the investigation, though she did say investigators have no reason to believe the product was contaminated with something foreign, like microbes. For now, the FDA is still gathering information. Officials will look at the product's quality testing and whether there have been any changes to how the product is made.\u003c/p>\n\u003cp>In an email, a spokesman for Chaz Dean said the company stands behind its products and that \"the brand has consistently cooperated with the FDA and will continue to do so.\"\u003c/p>\n\u003cp>Dermatologists say hair care products can cause these sorts of symptoms. One common reason is allergy.\u003c/p>\n\u003cp>\"There are thousands of ingredients that are in personal hair products,\" says \u003ca href=\"https://www.pennmedicine.org/providers/profile/bruce-brod\">Bruce Brod\u003c/a>, a clinical professor of dermatology at the University of Pennsylvania. \"While most people in the population won't react to them, there's a small subpopulation that will.\"\u003c/p>\n\u003cp>Common allergy triggers include surfactants, the ingredients in shampoos and conditioners that make them sudsy, as well as preservatives that increase shelf life and chemicals used to create fragrances.\u003c/p>\n\u003cp>These allergic reactions can occur regardless of whether a product is \"all natural,\" says Mirmirani. \"Lots of plants give people a reaction as well,\" she says, citing poison oak as an example. And because allergic reactions can take a while to occur, people may not immediately realize a hair product is causing issues.\u003c/p>\n\u003cp>But there are also causes of scalp problems that have nothing to do with cosmetics, says \u003ca href=\"http://www.oldmetairiedermatology.com/index.php/AboutUs/MeetDrRogers\">Nicole Rogers\u003c/a>, an assistant clinical professor of dermatology at Tulane Medical School. For example, she says, male-pattern or female-pattern baldness are both common causes of hair loss. Or a patient could suffer from alopecia areata, a disease in which the immune system attacks hair follicles. She says she believes it's unlikely the consumers' complaints are tied to Wen.\u003c/p>\n\u003cp>Stress, changes in diet and pregnancy can cause hair loss as well, says \u003ca href=\"https://www.mskcc.org/cancer-care/doctors/anthony-rossi\">Anthony Rossi\u003c/a>, a dermatologist who serves as a consultant to Chaz Dean's PR firm.\u003c/p>\n\u003cp>That said, all the doctors told Shots that people with scalp problems should visit a dermatologist and discuss hair products, along with other possible factors. Doctors can do allergy tests on patients to analyze as many as 55 potential allergy triggers. It's important, says Brod, to look at all potential causes of symptoms, rather than looking at Internet chat rooms alone.\u003c/p>\n\u003cp>\"Often, there's a suggestive herd effect,\" he says. \"If somebody says, 'I'm using something and it itches my scalp,' the person next to him will say, 'You know what? Me too.' \"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Katz of the FDA also urges people to visit doctors in addition to \u003ca href=\"http://www.fda.gov/Cosmetics/ComplianceEnforcement/AdverseEventReporting/default.htm\">reporting complaints\u003c/a> to the FDA. And if someone decides to switch from Wen to a different conditioner, Mirmirani says, \"There's plenty more out there.\"\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=Problems+After+Using+Hair+Conditioner+Prompt+An+FDA+Warning&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Hair products aren't at the top of most people's health worry list, but the Food and Drug Administration is investigating a surprisingly high number of reports of problems after people used a particular cleansing conditioner.\u003c/p>\n\u003cp>As of July 7, the FDA had received 127 complaints of \"hair loss, hair breakage, balding, itching, and rash\" after people used Wen by Chaz Dean cleansing conditioner products — more reports than the agency has ever received for a cosmetic hair product.\u003c/p>\n\u003cp>\"This kind of report is very rare,\" says \u003ca href=\"https://mydoctor.kaiserpermanente.org/ncal/provider/pmirmirani\">Paradi Mirmirani\u003c/a>, a dermatologist in Vallejo, Calif. \"For the most part, shampoo products out there are all very safe.\" The agency's \u003ca href=\"http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm511890.htm\">safety alert \u003c/a>says it has not determined a possible cause for the problems reported.\u003c/p>\n\u003cp>Late last year, mediation began for a \u003ca href=\"http://ww2.kqed.org/wp-content/uploads/gunthy_renker_wen_complaint.pdf\">class-action lawsuit\u003c/a> in California against Guthy-Renker, the company that markets and manufactures Wen.\u003c/p>\n\u003cp>The FDA doesn't approve cosmetics before they go on the market, though it does set upper limits for \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/23/387766821/there-s-bacteria-in-your-soap-and-everywhere-else\">bacteria in cosmetics\u003c/a> and hygiene products. Instead, says Linda Katz, director of the FDA's Office of Cosmetics and Colors, the agency monitors consumer complaints for many factors to decide whether to investigate a product.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In this case, the sheer number of complaints played a role in the decision. The agency says it is investigating more than 21,000 complaints reported to Chaz Dean Inc. and Guthy-Renker. (Gianna Cesa, a PR representative for Chaz Dean, says the company did not receive this number of complaints.)\u003c/p>\n\u003cp>Katz says she can't discuss any working hypotheses associated with the investigation, though she did say investigators have no reason to believe the product was contaminated with something foreign, like microbes. For now, the FDA is still gathering information. Officials will look at the product's quality testing and whether there have been any changes to how the product is made.\u003c/p>\n\u003cp>In an email, a spokesman for Chaz Dean said the company stands behind its products and that \"the brand has consistently cooperated with the FDA and will continue to do so.\"\u003c/p>\n\u003cp>Dermatologists say hair care products can cause these sorts of symptoms. One common reason is allergy.\u003c/p>\n\u003cp>\"There are thousands of ingredients that are in personal hair products,\" says \u003ca href=\"https://www.pennmedicine.org/providers/profile/bruce-brod\">Bruce Brod\u003c/a>, a clinical professor of dermatology at the University of Pennsylvania. \"While most people in the population won't react to them, there's a small subpopulation that will.\"\u003c/p>\n\u003cp>Common allergy triggers include surfactants, the ingredients in shampoos and conditioners that make them sudsy, as well as preservatives that increase shelf life and chemicals used to create fragrances.\u003c/p>\n\u003cp>These allergic reactions can occur regardless of whether a product is \"all natural,\" says Mirmirani. \"Lots of plants give people a reaction as well,\" she says, citing poison oak as an example. And because allergic reactions can take a while to occur, people may not immediately realize a hair product is causing issues.\u003c/p>\n\u003cp>But there are also causes of scalp problems that have nothing to do with cosmetics, says \u003ca href=\"http://www.oldmetairiedermatology.com/index.php/AboutUs/MeetDrRogers\">Nicole Rogers\u003c/a>, an assistant clinical professor of dermatology at Tulane Medical School. For example, she says, male-pattern or female-pattern baldness are both common causes of hair loss. Or a patient could suffer from alopecia areata, a disease in which the immune system attacks hair follicles. She says she believes it's unlikely the consumers' complaints are tied to Wen.\u003c/p>\n\u003cp>Stress, changes in diet and pregnancy can cause hair loss as well, says \u003ca href=\"https://www.mskcc.org/cancer-care/doctors/anthony-rossi\">Anthony Rossi\u003c/a>, a dermatologist who serves as a consultant to Chaz Dean's PR firm.\u003c/p>\n\u003cp>That said, all the doctors told Shots that people with scalp problems should visit a dermatologist and discuss hair products, along with other possible factors. Doctors can do allergy tests on patients to analyze as many as 55 potential allergy triggers. It's important, says Brod, to look at all potential causes of symptoms, rather than looking at Internet chat rooms alone.\u003c/p>\n\u003cp>\"Often, there's a suggestive herd effect,\" he says. \"If somebody says, 'I'm using something and it itches my scalp,' the person next to him will say, 'You know what? Me too.' \"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Katz of the FDA also urges people to visit doctors in addition to \u003ca href=\"http://www.fda.gov/Cosmetics/ComplianceEnforcement/AdverseEventReporting/default.htm\">reporting complaints\u003c/a> to the FDA. And if someone decides to switch from Wen to a different conditioner, Mirmirani says, \"There's plenty more out there.\"\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=Problems+After+Using+Hair+Conditioner+Prompt+An+FDA+Warning&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"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": "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.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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"tagline": "True-life supernatural stories",
"info": "",
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