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"disqusTitle": "5 Things to Remember When Choosing a Nursing Home",
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"content": "\u003cfigure id=\"attachment_14929\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/Screen-Shot-2013-09-10-at-4.34.21-PM-e1378856102443.png\">\u003cimg class=\"size-large wp-image-14929\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/Screen-Shot-2013-09-10-at-4.34.21-PM-640x492.png\" alt=\"(Keith Brofsky/Thinkstock)\" width=\"640\" height=\"492\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Keith Brofsky/Thinkstock)\u003c/figcaption>\u003c/figure>\n\u003cp>KQED and the\u003ca href=\"http://cironline.org/reports/quick-dismissal-caregiver-abuse-cases-puts-calif-patients-risk-5158\" target=\"_blank\"> Center for Investigative Reporting\u003c/a> have teamed up to tell a decidedly sobering story of abuse by caregivers in California nursing homes. If you're wondering \u003ca href=\"http://cironline.org/reports/quick-dismissal-caregiver-abuse-cases-puts-calif-patients-risk-5158\" target=\"_blank\">who's protecting the elderly\u003c/a>, perhaps the most haunting quote is this one from Brian Woods, former director of the state Department of Public Health's office in West Covina (Los Angeles County):\u003c/p>\n\u003cp>“I would tell anybody: Do not count on the government taking care of you,\" Woods said.\u003c/p>\n\u003cp>I'm not sure whether to feel disheartened or furious. But what the KQED and CIR reports speak to are the need for patients (if possible) and certainly their families and loved ones to be very engaged when selecting a nursing home in the first place.\u003c/p>\n\u003cp>When you are looking for a nursing home, there are \"time-tested methods for identifying and evaluating nursing homes,\" according to California Advocates for Nursing Home Reform, a leading statewide advocate for long-term care for the last 30 years. I talked to Pat McGinnis, CANHR co-founder and executive director.\u003c/p>\n\u003cp>\u003cstrong>1) Visit in person:\u003c/strong> It sounds pretty basic, but this was one of the first things McGinnis said. \"People will look to the (Medicare) five-star approval,\" she said, in reference to Medicare's \u003ca href=\"http://www.medicare.gov/nursinghomecompare/search.html?AspxAutoDetectCookieSupport=1\" target=\"_blank\">Nursing Home Compare\u003c/a> website, \"but we've got five-star facilities that are terrible and two-star facilities that are good.\" Websites are a starting point, but you must go take a look -- and be sure to visit more than one facility. Then, trust your gut. If you get a bad feeling right off the bat, pay attention to that feeling.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>2)\u003c/strong> \u003cstrong>Schedule your visit at lunchtime\u003c/strong>: McGinnis said lunchtime is the busiest time of day. While facilities may publish their staffing ratios, that's a meaningless number to the average consumer. But you can look for other signs, during this busy time of day. \"If you see people waiting to get their call light answered,\" that can mean the facility is understaffed. \"If they don't have enough people during lunchtime, they won't have enough at night.\" This is also a good time to pay attention to how the staff treats patients. Are they condescending or nasty? Do they talk about the patients as if the patients were not right there? And while you're there during lunch, take a look at the food. McGinniss acknowledged that people at larger institutions -- from colleges to nursing homes -- will complain about the food, but still there's a range. Try it. Will any special dietary needs be met? As you narrow your choices to one or two places, visit on the weekends, too.\u003c/p>\n\u003cp>\u003cstrong>3) Visit your loved one often\u003c/strong>: \"The more visitors the patient has, the better the care is going to be,\" McGinniss said. In addition, an elderly or otherwise frail patient is unlikely to be her own best advocate. It is the regular visitor who will notice that any one of a number of things are not quite right: The walker is too far away from the bed (which could mean a fall if the patient has to struggle to get to it); there's no water on the nightstand; the patient isn't being turned enough, which can lead to bedsores and from there, the possibility of sepsis, a potentially life-threatening infection. It is the regular visitor who will notice these things and can effect change.\u003c/p>\n\u003cp>\u003cstrong>4) Is there a family council? \u003c/strong>This is just what it sounds like: a group of family members who care about the residents, although McGinniss cautioned about making sure this is not simply an \"activity-based\" group. It should be about addressing problems or issues at the facility. \"They can be powerful tools,\" McGinniss said. She recommends asking about the council, who the president is, and when they meet. In addition, family councils are \"a way to share burdens with each other.\"\u003c/p>\n\u003cp>\u003cstrong>5) Look for a \"dual-eligible\" facility\u003c/strong>: Many people think Medicare covers nursing home care for as long as someone needs it. It does not. Medicare only covers 100 days in a nursing home. Unless your loved one is very wealthy, you need to consider finances right up-front. Nursing home cost is \"just extraordinary\" McGinniss said, \"$7,000 to $8,000 a month.\" Consider how quickly your loved one might go through any savings and become eligible for Medi-Cal, which is the major payer of nursing home care. If the nursing home does not accept Medi-Cal it can evict your loved one, should your family become unable to pay. So look for a nursing home that accepts both Medicare (for those first 100 days) and Medi-Cal (in case your loved one runs out of money).\u003c/p>\n\u003cp>Finally, even though KQED's and CIR's investigation has revealed that the state is not doing its job in investigating abuses, if you feel something wrong is happening, document it. \"Document as much as possible,\" McGinniss said. \"The nursing home and staff are supposed to report suspected abuse.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>CANHR has multilingual resources on its website, including a \u003ca href=\"http://canhr.org/factsheets/nh_fs/html/fs_evalchecklist.htm\" target=\"_blank\">nursing home evaluation checklist \u003c/a>and a\u003ca href=\"http://www.nursinghomeguide.org/NHG/nhg_txt_home.lasso\" target=\"_blank\"> nursing home guide\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14929\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/Screen-Shot-2013-09-10-at-4.34.21-PM-e1378856102443.png\">\u003cimg class=\"size-large wp-image-14929\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/Screen-Shot-2013-09-10-at-4.34.21-PM-640x492.png\" alt=\"(Keith Brofsky/Thinkstock)\" width=\"640\" height=\"492\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Keith Brofsky/Thinkstock)\u003c/figcaption>\u003c/figure>\n\u003cp>KQED and the\u003ca href=\"http://cironline.org/reports/quick-dismissal-caregiver-abuse-cases-puts-calif-patients-risk-5158\" target=\"_blank\"> Center for Investigative Reporting\u003c/a> have teamed up to tell a decidedly sobering story of abuse by caregivers in California nursing homes. If you're wondering \u003ca href=\"http://cironline.org/reports/quick-dismissal-caregiver-abuse-cases-puts-calif-patients-risk-5158\" target=\"_blank\">who's protecting the elderly\u003c/a>, perhaps the most haunting quote is this one from Brian Woods, former director of the state Department of Public Health's office in West Covina (Los Angeles County):\u003c/p>\n\u003cp>“I would tell anybody: Do not count on the government taking care of you,\" Woods said.\u003c/p>\n\u003cp>I'm not sure whether to feel disheartened or furious. But what the KQED and CIR reports speak to are the need for patients (if possible) and certainly their families and loved ones to be very engaged when selecting a nursing home in the first place.\u003c/p>\n\u003cp>When you are looking for a nursing home, there are \"time-tested methods for identifying and evaluating nursing homes,\" according to California Advocates for Nursing Home Reform, a leading statewide advocate for long-term care for the last 30 years. I talked to Pat McGinnis, CANHR co-founder and executive director.\u003c/p>\n\u003cp>\u003cstrong>1) Visit in person:\u003c/strong> It sounds pretty basic, but this was one of the first things McGinnis said. \"People will look to the (Medicare) five-star approval,\" she said, in reference to Medicare's \u003ca href=\"http://www.medicare.gov/nursinghomecompare/search.html?AspxAutoDetectCookieSupport=1\" target=\"_blank\">Nursing Home Compare\u003c/a> website, \"but we've got five-star facilities that are terrible and two-star facilities that are good.\" Websites are a starting point, but you must go take a look -- and be sure to visit more than one facility. Then, trust your gut. If you get a bad feeling right off the bat, pay attention to that feeling.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>2)\u003c/strong> \u003cstrong>Schedule your visit at lunchtime\u003c/strong>: McGinnis said lunchtime is the busiest time of day. While facilities may publish their staffing ratios, that's a meaningless number to the average consumer. But you can look for other signs, during this busy time of day. \"If you see people waiting to get their call light answered,\" that can mean the facility is understaffed. \"If they don't have enough people during lunchtime, they won't have enough at night.\" This is also a good time to pay attention to how the staff treats patients. Are they condescending or nasty? Do they talk about the patients as if the patients were not right there? And while you're there during lunch, take a look at the food. McGinniss acknowledged that people at larger institutions -- from colleges to nursing homes -- will complain about the food, but still there's a range. Try it. Will any special dietary needs be met? As you narrow your choices to one or two places, visit on the weekends, too.\u003c/p>\n\u003cp>\u003cstrong>3) Visit your loved one often\u003c/strong>: \"The more visitors the patient has, the better the care is going to be,\" McGinniss said. In addition, an elderly or otherwise frail patient is unlikely to be her own best advocate. It is the regular visitor who will notice that any one of a number of things are not quite right: The walker is too far away from the bed (which could mean a fall if the patient has to struggle to get to it); there's no water on the nightstand; the patient isn't being turned enough, which can lead to bedsores and from there, the possibility of sepsis, a potentially life-threatening infection. It is the regular visitor who will notice these things and can effect change.\u003c/p>\n\u003cp>\u003cstrong>4) Is there a family council? \u003c/strong>This is just what it sounds like: a group of family members who care about the residents, although McGinniss cautioned about making sure this is not simply an \"activity-based\" group. It should be about addressing problems or issues at the facility. \"They can be powerful tools,\" McGinniss said. She recommends asking about the council, who the president is, and when they meet. In addition, family councils are \"a way to share burdens with each other.\"\u003c/p>\n\u003cp>\u003cstrong>5) Look for a \"dual-eligible\" facility\u003c/strong>: Many people think Medicare covers nursing home care for as long as someone needs it. It does not. Medicare only covers 100 days in a nursing home. Unless your loved one is very wealthy, you need to consider finances right up-front. Nursing home cost is \"just extraordinary\" McGinniss said, \"$7,000 to $8,000 a month.\" Consider how quickly your loved one might go through any savings and become eligible for Medi-Cal, which is the major payer of nursing home care. If the nursing home does not accept Medi-Cal it can evict your loved one, should your family become unable to pay. So look for a nursing home that accepts both Medicare (for those first 100 days) and Medi-Cal (in case your loved one runs out of money).\u003c/p>\n\u003cp>Finally, even though KQED's and CIR's investigation has revealed that the state is not doing its job in investigating abuses, if you feel something wrong is happening, document it. \"Document as much as possible,\" McGinniss said. \"The nursing home and staff are supposed to report suspected abuse.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>CANHR has multilingual resources on its website, including a \u003ca href=\"http://canhr.org/factsheets/nh_fs/html/fs_evalchecklist.htm\" target=\"_blank\">nursing home evaluation checklist \u003c/a>and a\u003ca href=\"http://www.nursinghomeguide.org/NHG/nhg_txt_home.lasso\" target=\"_blank\"> nursing home guide\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Foster Kids, Children in Orphanages at Higher Risk for Fetal Alcohol Syndrome",
"title": "Foster Kids, Children in Orphanages at Higher Risk for Fetal Alcohol Syndrome",
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"content": "\u003cfigure id=\"attachment_14863\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126221153-e1378752078714.jpg\">\u003cimg class=\"size-large wp-image-14863\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126221153-640x480.jpg\" alt=\"Experts say no amount of alcohol is known to be safe during pregnancy. (Getty Images)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Experts say no amount of alcohol is known to be safe during pregnancy. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>Children who grow up in foster care or are adopted from orphanages are more at risk for fetal alcohol syndrome because there is a higher probability that their mothers consumed alcohol during pregnancy. An \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/09/04/peds.2013-0066.abstract\" target=\"_blank\">international study\u003c/a> published Monday strongly recommends that infants and adolescents in these child welfare settings be tested for the disorder.\u003c/p>\n\u003cp>\"It is imperative that screening be implemented in these at-risk populations,\" reported the authors of the study, \"Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Setting.\" The researchers conducted a meta-analysis, where they pooled data from past studies.\u003c/p>\n\u003cp>Fetal alcohol syndrome can cause a \u003ca href=\"http://www.mayoclinic.com/health/fetal-alcohol-syndrome/DS00184\" target=\"_blank\">cascade of problems\u003c/a>, including physical deformities, developmental delay, learning disorders and behavior problems.\u003c/p>\n\u003cp>Svetlana Popova of the University of Toronto said she and three other researchers collected international data from peer-reviewed journals, government reports and books. They found that 6 percent of children who live in foster homes or similar care settings have fetal alcohol syndrome. This rate is approximately nine to 60 times higher than that in the general population internationally and up to 30 times higher than the prevalence of the disorder in the general population in the U.S., which is between 0.2 and 0.7 percent, Popova said in an interview.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Our research team has been studying the disorder for years,\" Popova said. \"We hope the results of this study will attract attention to the needs of children in care affected by prenatal alcohol exposure.\"\u003c/p>\n\u003cp>Though fetal alcohol syndrome is preventable, it is difficult to diagnose because health care providers must understand how often and how much alcohol the mother drank during pregnancy, and at which stages, according to experts who study the disorder. Even more challenging is that alcohol affects children differently — problems range from facial deformities to brain damage that can manifest itself in cognitive impairments, difficulty learning, and inability to cope in social settings.\u003c/p>\n\u003cp>Tom Donaldson, president of the National Organization on Fetal Alcohol Syndrome, said screening for the disorder would have huge benefits both to the person who has it and to society.\u003c/p>\n\u003cp>\"Screening would be very important in many systems of care because when you screen, you can then diagnose, and then you can develop a care plan and get somebody on a path of reaching their full potential,\" Donaldson said.\u003c/p>\n\u003cp>But he cautioned that information needed to identify the disorder is often hard to come by.\u003c/p>\n\u003cp>\"You need the alcohol usage history from the mother,\" he said. And when so many affected children \"are in foster care or adoptive care — they're not with their biological parents — that can sometimes can be hard to obtain,\" he said.\u003c/p>\n\u003cp>Monday was also International Fetal Alcohol Syndrome Awareness Day, established in 1999 in an attempt to draw international attention to the importance of abstaining from drinking alcohol during pregnancy, said experts in the field.\u003c/p>\n\u003cp>The awareness day \"is an important reminder that prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States,\" said the National Institutes of Health in \u003ca href=\"http://www.nih.gov/news/health/sep2013/niaaa-06.htm\" target=\"_blank\">a release\u003c/a>. \"Almost 40 years have passed since we recognized that drinking during pregnancy can result in a wide range of disabilities for children, of which Fetal Alcohol Syndrome is the most severe.\"\u003c/p>\n\u003cp>Sarah Mattson, an expert in fetal alcohol syndrome at San Diego State University, said the disorder has remained a severe public health problem since its initial identification in 1973.\u003c/p>\n\u003cp>\"Mixed messages in the media and a general lack of information about the disorder in the general population are at least part of the reason that it is so prevalent,\" Mattson said.\u003c/p>\n\u003cp>Advocates say the leading recommendation of the study in the journal \"Pediatrics\" — early detection, especially in foster care settings -- can lead to wider public awareness and improved health for those affected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Screening can lead to better coordination between agencies, for example, between schools, between health care agencies and in the actual foster homes,\" said Mike Odeh, of Children Now, an advocacy group. \"We know by definition, children in the welfare system are by definition more vulnerable, so it's no surprise that there is higher prevalence of the disorder in those areas. We need to focus on early identification, but also look at how our systems are set up to coordinate their care.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14863\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126221153-e1378752078714.jpg\">\u003cimg class=\"size-large wp-image-14863\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126221153-640x480.jpg\" alt=\"Experts say no amount of alcohol is known to be safe during pregnancy. (Getty Images)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Experts say no amount of alcohol is known to be safe during pregnancy. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>Children who grow up in foster care or are adopted from orphanages are more at risk for fetal alcohol syndrome because there is a higher probability that their mothers consumed alcohol during pregnancy. An \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/09/04/peds.2013-0066.abstract\" target=\"_blank\">international study\u003c/a> published Monday strongly recommends that infants and adolescents in these child welfare settings be tested for the disorder.\u003c/p>\n\u003cp>\"It is imperative that screening be implemented in these at-risk populations,\" reported the authors of the study, \"Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Setting.\" The researchers conducted a meta-analysis, where they pooled data from past studies.\u003c/p>\n\u003cp>Fetal alcohol syndrome can cause a \u003ca href=\"http://www.mayoclinic.com/health/fetal-alcohol-syndrome/DS00184\" target=\"_blank\">cascade of problems\u003c/a>, including physical deformities, developmental delay, learning disorders and behavior problems.\u003c/p>\n\u003cp>Svetlana Popova of the University of Toronto said she and three other researchers collected international data from peer-reviewed journals, government reports and books. They found that 6 percent of children who live in foster homes or similar care settings have fetal alcohol syndrome. This rate is approximately nine to 60 times higher than that in the general population internationally and up to 30 times higher than the prevalence of the disorder in the general population in the U.S., which is between 0.2 and 0.7 percent, Popova said in an interview.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Our research team has been studying the disorder for years,\" Popova said. \"We hope the results of this study will attract attention to the needs of children in care affected by prenatal alcohol exposure.\"\u003c/p>\n\u003cp>Though fetal alcohol syndrome is preventable, it is difficult to diagnose because health care providers must understand how often and how much alcohol the mother drank during pregnancy, and at which stages, according to experts who study the disorder. Even more challenging is that alcohol affects children differently — problems range from facial deformities to brain damage that can manifest itself in cognitive impairments, difficulty learning, and inability to cope in social settings.\u003c/p>\n\u003cp>Tom Donaldson, president of the National Organization on Fetal Alcohol Syndrome, said screening for the disorder would have huge benefits both to the person who has it and to society.\u003c/p>\n\u003cp>\"Screening would be very important in many systems of care because when you screen, you can then diagnose, and then you can develop a care plan and get somebody on a path of reaching their full potential,\" Donaldson said.\u003c/p>\n\u003cp>But he cautioned that information needed to identify the disorder is often hard to come by.\u003c/p>\n\u003cp>\"You need the alcohol usage history from the mother,\" he said. And when so many affected children \"are in foster care or adoptive care — they're not with their biological parents — that can sometimes can be hard to obtain,\" he said.\u003c/p>\n\u003cp>Monday was also International Fetal Alcohol Syndrome Awareness Day, established in 1999 in an attempt to draw international attention to the importance of abstaining from drinking alcohol during pregnancy, said experts in the field.\u003c/p>\n\u003cp>The awareness day \"is an important reminder that prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States,\" said the National Institutes of Health in \u003ca href=\"http://www.nih.gov/news/health/sep2013/niaaa-06.htm\" target=\"_blank\">a release\u003c/a>. \"Almost 40 years have passed since we recognized that drinking during pregnancy can result in a wide range of disabilities for children, of which Fetal Alcohol Syndrome is the most severe.\"\u003c/p>\n\u003cp>Sarah Mattson, an expert in fetal alcohol syndrome at San Diego State University, said the disorder has remained a severe public health problem since its initial identification in 1973.\u003c/p>\n\u003cp>\"Mixed messages in the media and a general lack of information about the disorder in the general population are at least part of the reason that it is so prevalent,\" Mattson said.\u003c/p>\n\u003cp>Advocates say the leading recommendation of the study in the journal \"Pediatrics\" — early detection, especially in foster care settings -- can lead to wider public awareness and improved health for those affected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Screening can lead to better coordination between agencies, for example, between schools, between health care agencies and in the actual foster homes,\" said Mike Odeh, of Children Now, an advocacy group. \"We know by definition, children in the welfare system are by definition more vulnerable, so it's no surprise that there is higher prevalence of the disorder in those areas. We need to focus on early identification, but also look at how our systems are set up to coordinate their care.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "More California Parents Opting Out of Vaccines; Look Up Your School Online",
"title": "More California Parents Opting Out of Vaccines; Look Up Your School Online",
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"content": "\u003cp>\u003cem>\u003cstrong>Editor's note: the story below is from 2013. To see more recent data, please see \u003ca title=\"Vaccine Opt-Out Rate Doubled in 7 Years\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/11/vaccine\" target=\"_blank\">this story published in early September, 2014.\u003c/a>\u003c/strong> \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Olivia Hubert-Allen and Lisa Aliferis\u003c/strong>\u003c/p>\n\u003cp>Despite the overwhelming medical evidence that childhood vaccinations are exceptionally effective at preventing disease, a growing number of parents are opting out of having their children vaccinated. While state law requires that children be fully vaccinated to enter kindergarten, California parents can get around this requirement simply by filing a personal belief exemption, or PBE, a signed statement saying that vaccines are counter to their beliefs.\u003c/p>\n\u003cp>PBE rates vary across the state, including by county (Marin has the highest \u003ca href=\"http://ww2.kqed.org/news/2013/08/21/marin-vaccinations/\" target=\"_blank\">personal belief exemption rate\u003c/a> in the Bay Area at 7.8 percent), and also by individual school. The California Department of Public Health \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20California%20Kindergarten%20Data.pdf\" target=\"_blank\">compiles vaccination rates\u003c/a> and PBE rates statewide. Below, we've made it easy for you to look up your own child's school and see what the PBE rate is. You can also look at the data by county, city or school district. (PBE data for some schools was not provided.)\u003c/p>\n\u003cp>The column to the far right -- \"%PBE\" -- shows the percentage of children at a kindergarten with a personal belief exemption on file. Ideally, that number should be zero, as it is at many schools statewide. Look up your child's school in the search box:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ciframe src=\"http://www.kqed.org/news/health/vaccinations/pmerates.jsp\" width=\"640\" height=\"485\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c!--more-->James Watt, chief of the communicable disease control division with the California Department of Public Health, called high personal belief rates \"a concern,\" especially \"because in some schools you really do have situations where you fall below a herd immunity threshold, and disease transmission is even more possible.\"\u003c/p>\n\u003cp>\"Herd immunity\" means that there's such a high vaccination rate that those who cannot be vaccinated, such as newborn infants or people with compromised immune systems, are protected.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/23/5-things-you-should-know-about-vaccines/\" target=\"_blank\">Five Things You Should Know About Vaccines\u003c/a>]\u003c/p>\n\u003cp>Schools are ripe places for disease transmission if kids aren't vaccinated. Kids don't have good \"cough etiquette,\" Watt noted, plus \"kids in schools have a lot of contact with each other.\" He stressed that the best thing parents can do is have their own children vaccinated. \"The vast majority of children who are vaccinated are protected.\"\u003c/p>\n\u003cp>A more worrisome issue, he said, is for children who cannot be vaccinated for a medical reason. In that case, parents may want to weigh a school's PBE rate and consider what that means for their own child.\u003c/p>\n\u003cp>\"It's one piece of information that parents can use as they think about schools and their own children and what their risks may be,\" Watt said. \"Different children have different needs.\"\u003c/p>\n\u003cp>In January, a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/08/23/new-requirement-for-vaccine-exemption-passed-by-senate/\" target=\"_blank\">new state law goes into effect\u003c/a> requiring parents who want to opt out of vaccines to talk with a health care provider first about the pros and cons of both vaccines and communicable illnesses. Washington state passed a similar law in 2011, and their opt-out rate has since dropped by almost 40 percent.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20CA%20Kindergarten%20Immunization%20Assessment.pdf\" target=\"_blank\">On a countywide basis\u003c/a>, the highest PBE rates are found in a collection of Northern California counties. Alpine, Calaveras, Del Norte, Humboldt, Mariposa, Siskiyou and Tuolomne counties all have PBE rates between 10.5 and 12.5 percent. Trinity County's rate is 15.93 and Nevada County's rate is 22.44, but both these counties have only a few hundred students in school, so it would take just a few children with PBEs to create the high percentage rate.\u003c/p>\n\u003cp>By contrast, San Francisco County's PBE rate is 1.33 percent, and Los Angeles County's rate is 1.88 percent.\u003c/p>\n\u003cp>\u003cstrong>Our methodology\u003c/strong>\u003c/p>\n\u003cp>The state conducts a \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20CA%20Kindergarten%20Immunization%20Assessment.pdf\" target=\"_blank\">kindergarten assessment\u003c/a> of vaccination rates each fall. The data shown above are from the 2012-2013 school year and reflect a survey of more than 500,000 children at 8,220 public and private kindergartens in California. The assessment is done at the school level and reported to local health departments and to the state.\u003c/p>\n\u003cp>The state then compiles \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20California%20Kindergarten%20Data.pdf\" target=\"_blank\">a report of the immunization status\u003c/a> of all kindergarteners, a table with 26 columns of information. More than 90 percent of kindergarteners in the state start school fully immunized. But some children have \"conditional\" status, meaning they are lacking some vaccines but parents intend to get them. Officials told us they do not want to deny entrance to school because the child is not fully up-to-date, but is expected to be soon. Some parents are opposed to vaccines, so they have a \"personal belief exemption\" on file.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To make it easier for readers to look up the PBE rate at their own school, we simplified the state's table. We did not alter the data in any individual column. Instead, we selected six of the 26 columns that we thought readers would find most interesting. In addition, we made the data sortable by county, city, school district and PBE rate. The state publishes a PDF of its data, which is not sortable. We asked the state for its Excel spreadsheet so that we could post this sortable version.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>\u003cstrong>Editor's note: the story below is from 2013. To see more recent data, please see \u003ca title=\"Vaccine Opt-Out Rate Doubled in 7 Years\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/11/vaccine\" target=\"_blank\">this story published in early September, 2014.\u003c/a>\u003c/strong> \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Olivia Hubert-Allen and Lisa Aliferis\u003c/strong>\u003c/p>\n\u003cp>Despite the overwhelming medical evidence that childhood vaccinations are exceptionally effective at preventing disease, a growing number of parents are opting out of having their children vaccinated. While state law requires that children be fully vaccinated to enter kindergarten, California parents can get around this requirement simply by filing a personal belief exemption, or PBE, a signed statement saying that vaccines are counter to their beliefs.\u003c/p>\n\u003cp>PBE rates vary across the state, including by county (Marin has the highest \u003ca href=\"http://ww2.kqed.org/news/2013/08/21/marin-vaccinations/\" target=\"_blank\">personal belief exemption rate\u003c/a> in the Bay Area at 7.8 percent), and also by individual school. The California Department of Public Health \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20California%20Kindergarten%20Data.pdf\" target=\"_blank\">compiles vaccination rates\u003c/a> and PBE rates statewide. Below, we've made it easy for you to look up your own child's school and see what the PBE rate is. You can also look at the data by county, city or school district. (PBE data for some schools was not provided.)\u003c/p>\n\u003cp>The column to the far right -- \"%PBE\" -- shows the percentage of children at a kindergarten with a personal belief exemption on file. Ideally, that number should be zero, as it is at many schools statewide. Look up your child's school in the search box:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ciframe src=\"http://www.kqed.org/news/health/vaccinations/pmerates.jsp\" width=\"640\" height=\"485\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c!--more-->James Watt, chief of the communicable disease control division with the California Department of Public Health, called high personal belief rates \"a concern,\" especially \"because in some schools you really do have situations where you fall below a herd immunity threshold, and disease transmission is even more possible.\"\u003c/p>\n\u003cp>\"Herd immunity\" means that there's such a high vaccination rate that those who cannot be vaccinated, such as newborn infants or people with compromised immune systems, are protected.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/23/5-things-you-should-know-about-vaccines/\" target=\"_blank\">Five Things You Should Know About Vaccines\u003c/a>]\u003c/p>\n\u003cp>Schools are ripe places for disease transmission if kids aren't vaccinated. Kids don't have good \"cough etiquette,\" Watt noted, plus \"kids in schools have a lot of contact with each other.\" He stressed that the best thing parents can do is have their own children vaccinated. \"The vast majority of children who are vaccinated are protected.\"\u003c/p>\n\u003cp>A more worrisome issue, he said, is for children who cannot be vaccinated for a medical reason. In that case, parents may want to weigh a school's PBE rate and consider what that means for their own child.\u003c/p>\n\u003cp>\"It's one piece of information that parents can use as they think about schools and their own children and what their risks may be,\" Watt said. \"Different children have different needs.\"\u003c/p>\n\u003cp>In January, a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/08/23/new-requirement-for-vaccine-exemption-passed-by-senate/\" target=\"_blank\">new state law goes into effect\u003c/a> requiring parents who want to opt out of vaccines to talk with a health care provider first about the pros and cons of both vaccines and communicable illnesses. Washington state passed a similar law in 2011, and their opt-out rate has since dropped by almost 40 percent.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20CA%20Kindergarten%20Immunization%20Assessment.pdf\" target=\"_blank\">On a countywide basis\u003c/a>, the highest PBE rates are found in a collection of Northern California counties. Alpine, Calaveras, Del Norte, Humboldt, Mariposa, Siskiyou and Tuolomne counties all have PBE rates between 10.5 and 12.5 percent. Trinity County's rate is 15.93 and Nevada County's rate is 22.44, but both these counties have only a few hundred students in school, so it would take just a few children with PBEs to create the high percentage rate.\u003c/p>\n\u003cp>By contrast, San Francisco County's PBE rate is 1.33 percent, and Los Angeles County's rate is 1.88 percent.\u003c/p>\n\u003cp>\u003cstrong>Our methodology\u003c/strong>\u003c/p>\n\u003cp>The state conducts a \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20CA%20Kindergarten%20Immunization%20Assessment.pdf\" target=\"_blank\">kindergarten assessment\u003c/a> of vaccination rates each fall. The data shown above are from the 2012-2013 school year and reflect a survey of more than 500,000 children at 8,220 public and private kindergartens in California. The assessment is done at the school level and reported to local health departments and to the state.\u003c/p>\n\u003cp>The state then compiles \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20California%20Kindergarten%20Data.pdf\" target=\"_blank\">a report of the immunization status\u003c/a> of all kindergarteners, a table with 26 columns of information. More than 90 percent of kindergarteners in the state start school fully immunized. But some children have \"conditional\" status, meaning they are lacking some vaccines but parents intend to get them. Officials told us they do not want to deny entrance to school because the child is not fully up-to-date, but is expected to be soon. Some parents are opposed to vaccines, so they have a \"personal belief exemption\" on file.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To make it easier for readers to look up the PBE rate at their own school, we simplified the state's table. We did not alter the data in any individual column. Instead, we selected six of the 26 columns that we thought readers would find most interesting. In addition, we made the data sortable by county, city, school district and PBE rate. The state publishes a PDF of its data, which is not sortable. We asked the state for its Excel spreadsheet so that we could post this sortable version.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Battery Recycler to Test Soil for Dangerous Metals; Neighbors Skeptical",
"title": "Battery Recycler to Test Soil for Dangerous Metals; Neighbors Skeptical",
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"content": "\u003cfigure id=\"attachment_14724\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/Exide3.jpg\">\u003cimg class=\"size-large wp-image-14724 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/Exide3-640x478.jpg\" alt=\"Regulators say arsenic leaking from the Exide Technologies plant in Vernon endangered as many as 110,000 people living nearby. (Photo/Chris Richards)\" width=\"640\" height=\"478\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Regulators say arsenic leaking from the Exide Technologies plant in Vernon endangered as many as 110,000 people living nearby. Results of tests for lead and other toxins should be available in December. (Photo/Chris Richard)\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cp>\u003cstrong>By Chris Richard\u003c/strong>\u003c/p>\n\u003cp>State-ordered testing of soil for lead and other toxins around a battery recycling plant in Vernon, just east of downtown Los Angeles, is underway. The plant, Exide Technologies, already has been accused of endangering the lives of 110,000 people who live nearby.\u003c/p>\n\u003cp>But neighborhood residents and community leaders say they’re skeptical that the test results will force Exide’s factory to close before it can do any more harm.\u003c/p>\n\u003cp>“I think it’s great that they’re testing, and I’d say that it’s long overdue,” said Monsignor John Moretta of Resurrection Catholic Church in Boyle Heights, a neighborhood about a mile from the plant. He says that members of his congregation have long been worried about emissions from the plant.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“But this is all pretty superficial. It doesn’t get to the real question, which is, at what point do you wait for them to go into more violations before you shut them down?”\u003c/p>\n\u003cp>California \u003ca href=\"http://www.dtsc.ca.gov/LawsRegsPolicies/RCRA.cfm\" target=\"_blank\">regulation\u003c/a> ensures the safe treatment, storage and disposal of hazardous waste, and requires that factories such as battery recyclers satisfy rigorous environmental reviews before obtaining a permit. But Exide has never met that standard.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Long history of citations\u003c/strong>\u003c/p>\n\u003cp>The plant has a long history of air pollution write-ups, including allegations that it allowed lead dust to contaminate the surrounding neighborhood, regulators say. Still, state officials allowed the factory, which melts tens of thousands of batteries a day, to operate on “interim status” for some 30 years.\u003c/p>\n\u003cp>In April, the state Department of Toxic Substances Control took action and ordered Exide to suspend operations. Regulators said arsenic emissions from the plant endangered as many as 110,000 who live in Boyle Heights and other nearby neighborhoods. The South Coast Air Quality Management District estimated cancer risk from the airborne arsenic at up to 15 times state standards.\u003c/p>\n\u003cp>The Department of Toxic Substances Control also found that contaminants had seeped into the ground from corroded pipes at up to 63 times the levels allowed under state law.\u003c/p>\n\u003cp>But Exide appealed the suspension. In court filings, Exide said it has reduced its arsenic emissions by 70 percent since 2010. Company attorneys argued that regulators were bowing to public outrage and acting arbitrarily. In mid-June, Los Angeles County Judge Luis Lavin ordered the plant reopened.\u003c/p>\n\u003cp>Lavin said that keeping the factory closed wouldn’t improve neighborhood health conditions immediately and would cause irreparable harm to the company. He affirmed that ruling two weeks later, pending an administrative law hearing.\u003c/p>\n\u003cp>That hearing was to resume Tuesday, but DTSC requested a postponement because Exide agreed to address the leaking pipes and airborne emissions identified in the agency’s suspension order.\u003c/p>\n\u003cp>“We are obligated to articulate, and have discussed with (Exide) ... what actions would have to occur at the facility in order to correct the unacceptable conditions,” agency spokesman Russ Edmondson wrote in an email Tuesday.\u003c/p>\n\u003cp>“If and when Exide demonstrates that it can satisfy these requirements, DTSC will have achieved its goal in ensuring that the facility operates safely and would consider lifting the suspension.”\u003c/p>\n\u003cp>He said the faulty pipes are now out of service and Exide has installed a temporary drainage system. A permanent drainage system is in the planning stage.\u003c/p>\n\u003cp>Neighborhood resident Cristal Rivera said she has lost confidence that state regulators will protect her, her husband or their 8-month-old son, Julian.\u003c/p>\n\u003cp>“The things they want Exide to do are good, but they don’t seem to have much power,” she said.\u003c/p>\n\u003cp>\u003cstrong>Factory operated despite damaged system to filter toxic emissions\u003c/strong>\u003c/p>\n\u003cp>On July 7, just five days after Judge Lavin’s ruling to reopen the plant, Exide reported that heat had damaged air filtration devices in one of two “baghouses” that are supposed to scrub out toxic emissions. Even though its air filtration system was compromised, the factory continued to operate, South Coast Air Quality Management District spokesman Sam Atwood said.\u003c/p>\n\u003cp>He said Exide temporarily shut down portions of the factory that vented to the baghouses but resumed operations the next day, triggering a citation from the Air Quality Management District on July 9. After that, the company closed down operations until the filtration system was repaired, a district report shows.\u003c/p>\n\u003cp>The district had ordered additional remediation measures and set a deadline of Sept. 1 for Exide to report what new steps it was taking to safeguard the public from its toxic emissions.\u003c/p>\n\u003cp>But in an interview last week, Atwood said no such report had been received.\u003c/p>\n\u003cp>“I think their response is going to be, ‘Our plan is what we’ve already done,’ ” Atwood said.\u003c/p>\n\u003cp>The company has installed an automatic door between a storage bin for dismantled batteries and blast furnaces where it melts them, he said. Formerly, the furnaces could freely vent gases into the air through the entrance to the storage bin. Now the automatic gate keeps that passageway closed part of the time.\u003c/p>\n\u003cp>“Then the question becomes, ‘Where’s the proof that this has accomplished the risk reduction?’ ” Atwood said.\u003c/p>\n\u003cp>Exide spokeswoman Susan Jaramillo did not respond to repeated requests for comment.\u003c/p>\n\u003cp>Rivera, the young mother, said she can’t afford to wait. She said she and her husband have decided to sell their house and move to a safer area.\u003c/p>\n\u003cp>“There will be gases that stay in that room with the furnace,” she said. “When they open that gate, they’re going to come out.”\u003c/p>\n\u003cp>In the neighboring community of Bell, City Councilman Nestor Enrique Valencia, a founder of the health activist group Our Salud, said he’s skeptical of government efforts. He admits that’s partly due to his experience of government in his own city, which was shaken by a political corruption scandal in 2010 and 2011. (Valencia was not implicated in the scandal and won his council seat in 2011.)\u003c/p>\n\u003cp>“After all that, I’m not going to sit there and listen to a bunch of bureaucrats. I’m just very leery, if not skeptical, of (state agencies’) work,” he said. “I know they’re trying, but I don’t see them being very successful in closing this plant down.”\u003c/p>\n\u003cp>Valencia said a private lab has tested the blood-lead levels of some 15 people living in the area, and additional testing is scheduled. He has asked local school officials for permission to meet with parents on campus and urge them to have their children tested.\u003c/p>\n\u003cp>David Campbell, a spokesman for unionized plant workers, said federally mandated blood tests among employees did not find elevated lead levels. He said he supports additional soil testing and blood testing for the wider community.\u003c/p>\n\u003cp>Edmondson said dust testing is beginning within 500 feet of the Exide plant, progressing in 1,500-foot concentric circles. Samples are drawn from stormwater curb boxes and open drainage channels, the Los Angeles River channel, sidewalks, and the roofs and grounds of neighboring facilities.\u003c/p>\n\u003cp>Test results will be available in early December, Edmondson said. If they show contamination, the department will conduct additional testing in a broader area, he said.\u003c/p>\n\u003cp>Meanwhile, at the Resurrection Catholic School, which is affiliated with Moretta’s parish, principal Angelica Figueroa said faculty members have been encouraging children to participate in public meetings and other political processes that can influence regulators to increase their oversight of companies like Exide.\u003c/p>\n\u003cp>The school is about a mile and a half from Exide.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“These companies would not go to the Westside or Pasadena or any other more affluent area,” she said. “Why? Because people there will step up and voice their concerns. Well, I want our students to know that they have that same right.”\u003c/p>\n\n",
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"excerpt": "State-ordered testing of the soil for lead and other toxins around a battery recycling plant in Vernon is underway. Exide Technologies has already been accused of endangering the lives of 110,000 people who live nearby.\r\n\r\nBut neighborhood residents and community leaders say they’re skeptical that the test results will force Exide’s factory to close before it can do any more harm.",
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"description": "State-ordered testing of the soil for lead and other toxins around a battery recycling plant in Vernon is underway. Exide Technologies has already been accused of endangering the lives of 110,000 people who live nearby.\r\n\r\nBut neighborhood residents and community leaders say they’re skeptical that the test results will force Exide’s factory to close before it can do any more harm.",
"title": "Battery Recycler to Test Soil for Dangerous Metals; Neighbors Skeptical | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14724\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/Exide3.jpg\">\u003cimg class=\"size-large wp-image-14724 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/Exide3-640x478.jpg\" alt=\"Regulators say arsenic leaking from the Exide Technologies plant in Vernon endangered as many as 110,000 people living nearby. (Photo/Chris Richards)\" width=\"640\" height=\"478\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Regulators say arsenic leaking from the Exide Technologies plant in Vernon endangered as many as 110,000 people living nearby. Results of tests for lead and other toxins should be available in December. (Photo/Chris Richard)\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cp>\u003cstrong>By Chris Richard\u003c/strong>\u003c/p>\n\u003cp>State-ordered testing of soil for lead and other toxins around a battery recycling plant in Vernon, just east of downtown Los Angeles, is underway. The plant, Exide Technologies, already has been accused of endangering the lives of 110,000 people who live nearby.\u003c/p>\n\u003cp>But neighborhood residents and community leaders say they’re skeptical that the test results will force Exide’s factory to close before it can do any more harm.\u003c/p>\n\u003cp>“I think it’s great that they’re testing, and I’d say that it’s long overdue,” said Monsignor John Moretta of Resurrection Catholic Church in Boyle Heights, a neighborhood about a mile from the plant. He says that members of his congregation have long been worried about emissions from the plant.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“But this is all pretty superficial. It doesn’t get to the real question, which is, at what point do you wait for them to go into more violations before you shut them down?”\u003c/p>\n\u003cp>California \u003ca href=\"http://www.dtsc.ca.gov/LawsRegsPolicies/RCRA.cfm\" target=\"_blank\">regulation\u003c/a> ensures the safe treatment, storage and disposal of hazardous waste, and requires that factories such as battery recyclers satisfy rigorous environmental reviews before obtaining a permit. But Exide has never met that standard.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Long history of citations\u003c/strong>\u003c/p>\n\u003cp>The plant has a long history of air pollution write-ups, including allegations that it allowed lead dust to contaminate the surrounding neighborhood, regulators say. Still, state officials allowed the factory, which melts tens of thousands of batteries a day, to operate on “interim status” for some 30 years.\u003c/p>\n\u003cp>In April, the state Department of Toxic Substances Control took action and ordered Exide to suspend operations. Regulators said arsenic emissions from the plant endangered as many as 110,000 who live in Boyle Heights and other nearby neighborhoods. The South Coast Air Quality Management District estimated cancer risk from the airborne arsenic at up to 15 times state standards.\u003c/p>\n\u003cp>The Department of Toxic Substances Control also found that contaminants had seeped into the ground from corroded pipes at up to 63 times the levels allowed under state law.\u003c/p>\n\u003cp>But Exide appealed the suspension. In court filings, Exide said it has reduced its arsenic emissions by 70 percent since 2010. Company attorneys argued that regulators were bowing to public outrage and acting arbitrarily. In mid-June, Los Angeles County Judge Luis Lavin ordered the plant reopened.\u003c/p>\n\u003cp>Lavin said that keeping the factory closed wouldn’t improve neighborhood health conditions immediately and would cause irreparable harm to the company. He affirmed that ruling two weeks later, pending an administrative law hearing.\u003c/p>\n\u003cp>That hearing was to resume Tuesday, but DTSC requested a postponement because Exide agreed to address the leaking pipes and airborne emissions identified in the agency’s suspension order.\u003c/p>\n\u003cp>“We are obligated to articulate, and have discussed with (Exide) ... what actions would have to occur at the facility in order to correct the unacceptable conditions,” agency spokesman Russ Edmondson wrote in an email Tuesday.\u003c/p>\n\u003cp>“If and when Exide demonstrates that it can satisfy these requirements, DTSC will have achieved its goal in ensuring that the facility operates safely and would consider lifting the suspension.”\u003c/p>\n\u003cp>He said the faulty pipes are now out of service and Exide has installed a temporary drainage system. A permanent drainage system is in the planning stage.\u003c/p>\n\u003cp>Neighborhood resident Cristal Rivera said she has lost confidence that state regulators will protect her, her husband or their 8-month-old son, Julian.\u003c/p>\n\u003cp>“The things they want Exide to do are good, but they don’t seem to have much power,” she said.\u003c/p>\n\u003cp>\u003cstrong>Factory operated despite damaged system to filter toxic emissions\u003c/strong>\u003c/p>\n\u003cp>On July 7, just five days after Judge Lavin’s ruling to reopen the plant, Exide reported that heat had damaged air filtration devices in one of two “baghouses” that are supposed to scrub out toxic emissions. Even though its air filtration system was compromised, the factory continued to operate, South Coast Air Quality Management District spokesman Sam Atwood said.\u003c/p>\n\u003cp>He said Exide temporarily shut down portions of the factory that vented to the baghouses but resumed operations the next day, triggering a citation from the Air Quality Management District on July 9. After that, the company closed down operations until the filtration system was repaired, a district report shows.\u003c/p>\n\u003cp>The district had ordered additional remediation measures and set a deadline of Sept. 1 for Exide to report what new steps it was taking to safeguard the public from its toxic emissions.\u003c/p>\n\u003cp>But in an interview last week, Atwood said no such report had been received.\u003c/p>\n\u003cp>“I think their response is going to be, ‘Our plan is what we’ve already done,’ ” Atwood said.\u003c/p>\n\u003cp>The company has installed an automatic door between a storage bin for dismantled batteries and blast furnaces where it melts them, he said. Formerly, the furnaces could freely vent gases into the air through the entrance to the storage bin. Now the automatic gate keeps that passageway closed part of the time.\u003c/p>\n\u003cp>“Then the question becomes, ‘Where’s the proof that this has accomplished the risk reduction?’ ” Atwood said.\u003c/p>\n\u003cp>Exide spokeswoman Susan Jaramillo did not respond to repeated requests for comment.\u003c/p>\n\u003cp>Rivera, the young mother, said she can’t afford to wait. She said she and her husband have decided to sell their house and move to a safer area.\u003c/p>\n\u003cp>“There will be gases that stay in that room with the furnace,” she said. “When they open that gate, they’re going to come out.”\u003c/p>\n\u003cp>In the neighboring community of Bell, City Councilman Nestor Enrique Valencia, a founder of the health activist group Our Salud, said he’s skeptical of government efforts. He admits that’s partly due to his experience of government in his own city, which was shaken by a political corruption scandal in 2010 and 2011. (Valencia was not implicated in the scandal and won his council seat in 2011.)\u003c/p>\n\u003cp>“After all that, I’m not going to sit there and listen to a bunch of bureaucrats. I’m just very leery, if not skeptical, of (state agencies’) work,” he said. “I know they’re trying, but I don’t see them being very successful in closing this plant down.”\u003c/p>\n\u003cp>Valencia said a private lab has tested the blood-lead levels of some 15 people living in the area, and additional testing is scheduled. He has asked local school officials for permission to meet with parents on campus and urge them to have their children tested.\u003c/p>\n\u003cp>David Campbell, a spokesman for unionized plant workers, said federally mandated blood tests among employees did not find elevated lead levels. He said he supports additional soil testing and blood testing for the wider community.\u003c/p>\n\u003cp>Edmondson said dust testing is beginning within 500 feet of the Exide plant, progressing in 1,500-foot concentric circles. Samples are drawn from stormwater curb boxes and open drainage channels, the Los Angeles River channel, sidewalks, and the roofs and grounds of neighboring facilities.\u003c/p>\n\u003cp>Test results will be available in early December, Edmondson said. If they show contamination, the department will conduct additional testing in a broader area, he said.\u003c/p>\n\u003cp>Meanwhile, at the Resurrection Catholic School, which is affiliated with Moretta’s parish, principal Angelica Figueroa said faculty members have been encouraging children to participate in public meetings and other political processes that can influence regulators to increase their oversight of companies like Exide.\u003c/p>\n\u003cp>The school is about a mile and a half from Exide.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“These companies would not go to the Westside or Pasadena or any other more affluent area,” she said. “Why? Because people there will step up and voice their concerns. Well, I want our students to know that they have that same right.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Money May Be Motivating Doctors To Do More C-Sections",
"title": "Money May Be Motivating Doctors To Do More C-Sections",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_14679\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-e1377898062785.jpg\">\u003cimg class=\"size-large wp-image-14679\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"http://www.npr.org/people/137765146/shankar-vedantam\" target=\"_blank\">By Shankar Vedantam\u003c/a>,\u003ca href=\"http://www.npr.org/blogs/health/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections\" target=\"_blank\"> NPR\u003c/a>\u003c/p>\n\u003cp>Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.\u003c/p>\n\u003cp>About \u003ca href=\"http://www.npr.org/blogs/health/2010/08/31/129552505/cesarean-sections-stay-popular\">1 in 3\u003c/a> babies born today is delivered via C-section, compared to 1 in 5 babies delivered via the surgical procedure in 1996. During the same time period, the annual medical costs of childbirth in the U.S. have grown by $3 billion annually. There are \u003ca href=\"http://www.npr.org/blogs/health/2010/09/13/129826908/C-sections-and-the-profit-motive\">significant variations\u003c/a> in the rate of cesarean deliveries in different parts of the country — in Louisiana, for example, the C-section rate is nearly twice as high as in Alaska.\u003c/p>\n\u003cp>Obstetricians in many medical settings are paid more for C-sections. In a new working \u003ca href=\"http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2295856\">paper\u003c/a> published by the National Bureau of Economic Research, health care economists \u003ca href=\"http://mitsloan.mit.edu/faculty/detail.php?in_spseqno=50047\">Erin Johnson\u003c/a> and \u003ca href=\"http://www.cifar.ca/m-marit-rehavi\">M. Marit Rehavi\u003c/a> calculated that doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more.\u003c!--more-->\u003c/p>\n\u003cp>Johnson and Rehavi decided to explore the reasons for the increased number of surgical childbirth procedures via an unusual tack: They hypothesized that obstetricians would be less likely to be swayed by financial incentives when patients themselves had significant medical expertise and knowledge. By contrast, the researchers figured, such incentives might play a larger role in medical decision-making when patients knew very little.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In some ways, this is analogous to what happens when people take their cars to mechanics. People who are knowledgeable about cars are likely to push back against unnecessary repairs, whereas those who don't know much about cars are less likely to take issue with the mechanic's advice.\u003c/p>\n\u003cp>In childbirth, Johnson and Rehavi figured, this meant that obstetricians would perform fewer C-sections when their patients were themselves doctors.\u003c/p>\n\u003cp>\"The idea is that physicians have medical knowledge,\" Johnson says. \"If the obstetrician is deviating from the best treatment because of their own financial incentive, the patient [who is a] doctor would be able to push back against the obstetrician. But that might not be the case for nondoctors because they simply do not have the medical knowledge to know whether or not this C-section is the appropriate [method of delivery] for them.\"\u003c/p>\n\u003cp>The researchers tracked large numbers of births in California and Texas via databases that checked to see whether the mothers were themselves doctors.\u003c/p>\n\u003cp>\"We found that doctors are about 10 percent less likely to get C-sections,\" Johnson says. \"So obstetricians appear to be treating their physician patients differently than [they treat] their nonphysician patients.\"\u003c/p>\n\u003cp>Johnson says she thinks it unlikely that the doctors are conscious of the role financial incentives seem to be playing in their decisions. Rather, she says, a variety of analyses by economists suggests that incentives affect behavior in many different ways — often subtly.\u003c/p>\n\u003cp>Indeed, Johnson and Rehavi found that there was no disparity in the C-section rate between physician mothers and nonphysician mothers when the surgical procedures were scheduled in advance. Scheduled C-section decisions tend to be less subjective — a variety of medical conditions, such as a baby being in the breech position, call for a C-section.\u003c/p>\n\u003cp>Rather, she says, the disparity came about in what are known as unscheduled C-sections, when labor is attempted but does not go well. Patient and obstetrician then find themselves in a gray zone, where a judgment has to be made about whether to terminate labor and deliver the baby surgically.\u003c/p>\n\u003cp>Johnson and Rehavi also analyzed disparities in medical settings where doctors were paid a flat salary. In these cases, Johnson and Rehavi found there was a disincentive to perform the surgical procedures, which typically involve more time. In these settings, more of the mothers who were physicians received C-sections than mothers who were not physicians. Presumably, Johnson says, this means that some nonphysician mothers who needed C-sections did not get them in these settings.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Johnson suggests that one solution to the disparities lies in better patient knowledge and empowerment.\u003c/p>\n\n",
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"excerpt": "Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.\r\n\r\nAbout 1 in 3 babies born today is delivered via C-section, compared to 1 in 5 babies delivered via the surgical procedure in 1996. During the same time period, the annual medical costs of childbirth in the U.S. have grown by $3 billion annually. There are significant variations in the rate of cesarean deliveries in different parts of the country — in Louisiana, for example, the C-section rate is nearly twice as high as in Alaska.",
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"description": "Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.\r\n\r\nAbout 1 in 3 babies born today is delivered via C-section, compared to 1 in 5 babies delivered via the surgical procedure in 1996. During the same time period, the annual medical costs of childbirth in the U.S. have grown by $3 billion annually. There are significant variations in the rate of cesarean deliveries in different parts of the country — in Louisiana, for example, the C-section rate is nearly twice as high as in Alaska.",
"title": "Money May Be Motivating Doctors To Do More C-Sections | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14679\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-e1377898062785.jpg\">\u003cimg class=\"size-large wp-image-14679\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"http://www.npr.org/people/137765146/shankar-vedantam\" target=\"_blank\">By Shankar Vedantam\u003c/a>,\u003ca href=\"http://www.npr.org/blogs/health/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections\" target=\"_blank\"> NPR\u003c/a>\u003c/p>\n\u003cp>Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.\u003c/p>\n\u003cp>About \u003ca href=\"http://www.npr.org/blogs/health/2010/08/31/129552505/cesarean-sections-stay-popular\">1 in 3\u003c/a> babies born today is delivered via C-section, compared to 1 in 5 babies delivered via the surgical procedure in 1996. During the same time period, the annual medical costs of childbirth in the U.S. have grown by $3 billion annually. There are \u003ca href=\"http://www.npr.org/blogs/health/2010/09/13/129826908/C-sections-and-the-profit-motive\">significant variations\u003c/a> in the rate of cesarean deliveries in different parts of the country — in Louisiana, for example, the C-section rate is nearly twice as high as in Alaska.\u003c/p>\n\u003cp>Obstetricians in many medical settings are paid more for C-sections. In a new working \u003ca href=\"http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2295856\">paper\u003c/a> published by the National Bureau of Economic Research, health care economists \u003ca href=\"http://mitsloan.mit.edu/faculty/detail.php?in_spseqno=50047\">Erin Johnson\u003c/a> and \u003ca href=\"http://www.cifar.ca/m-marit-rehavi\">M. Marit Rehavi\u003c/a> calculated that doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more.\u003c!--more-->\u003c/p>\n\u003cp>Johnson and Rehavi decided to explore the reasons for the increased number of surgical childbirth procedures via an unusual tack: They hypothesized that obstetricians would be less likely to be swayed by financial incentives when patients themselves had significant medical expertise and knowledge. By contrast, the researchers figured, such incentives might play a larger role in medical decision-making when patients knew very little.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In some ways, this is analogous to what happens when people take their cars to mechanics. People who are knowledgeable about cars are likely to push back against unnecessary repairs, whereas those who don't know much about cars are less likely to take issue with the mechanic's advice.\u003c/p>\n\u003cp>In childbirth, Johnson and Rehavi figured, this meant that obstetricians would perform fewer C-sections when their patients were themselves doctors.\u003c/p>\n\u003cp>\"The idea is that physicians have medical knowledge,\" Johnson says. \"If the obstetrician is deviating from the best treatment because of their own financial incentive, the patient [who is a] doctor would be able to push back against the obstetrician. But that might not be the case for nondoctors because they simply do not have the medical knowledge to know whether or not this C-section is the appropriate [method of delivery] for them.\"\u003c/p>\n\u003cp>The researchers tracked large numbers of births in California and Texas via databases that checked to see whether the mothers were themselves doctors.\u003c/p>\n\u003cp>\"We found that doctors are about 10 percent less likely to get C-sections,\" Johnson says. \"So obstetricians appear to be treating their physician patients differently than [they treat] their nonphysician patients.\"\u003c/p>\n\u003cp>Johnson says she thinks it unlikely that the doctors are conscious of the role financial incentives seem to be playing in their decisions. Rather, she says, a variety of analyses by economists suggests that incentives affect behavior in many different ways — often subtly.\u003c/p>\n\u003cp>Indeed, Johnson and Rehavi found that there was no disparity in the C-section rate between physician mothers and nonphysician mothers when the surgical procedures were scheduled in advance. Scheduled C-section decisions tend to be less subjective — a variety of medical conditions, such as a baby being in the breech position, call for a C-section.\u003c/p>\n\u003cp>Rather, she says, the disparity came about in what are known as unscheduled C-sections, when labor is attempted but does not go well. Patient and obstetrician then find themselves in a gray zone, where a judgment has to be made about whether to terminate labor and deliver the baby surgically.\u003c/p>\n\u003cp>Johnson and Rehavi also analyzed disparities in medical settings where doctors were paid a flat salary. In these cases, Johnson and Rehavi found there was a disincentive to perform the surgical procedures, which typically involve more time. In these settings, more of the mothers who were physicians received C-sections than mothers who were not physicians. Presumably, Johnson says, this means that some nonphysician mothers who needed C-sections did not get them in these settings.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Johnson suggests that one solution to the disparities lies in better patient knowledge and empowerment.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Obamacare to Force Millions to Upgrade Insurance",
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"content": "\u003cfigure id=\"attachment_14506\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-14506\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/hall_photo2-640x480.jpg\" alt=\"Darren Hall will have to choose a new health insurance plan after Obamacare is fully implemented in January. His policy today doesn’t meet the standards outlined in the law. (Kelley Weiss/ CHCF Center for Health Reporting)\" width=\"640\" height=\"480\">\u003cfigcaption class=\"wp-caption-text\">Darren Hall will have to choose a new health insurance plan after Obamacare is fully implemented in January. His policy today doesn’t meet the standards outlined in the law. (Kelley Weiss/ CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Kelley Weiss\u003c/strong>, \u003ca href=\"http://centerforhealthreporting.org/article/obamacare-force-millions-upgrade-insurance1152\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cp>Despite promises by President Obama that people can keep the insurance they have once Obamacare is in full effect in January, millions of people nationally will have to upgrade their policies.\u003c/p>\n\u003cp>That’s because these people have “bare bones” plans that don’t meet the Affordable Care Act benefit standards.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\u003ca href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" target=\"_blank\">Learn more about Obamacare in KQED's guide, specifically for Californians\u003c/a>\u003c/aside>\n\u003cp>Darren Hall is one of those people. He runs a pool service company in Sacramento. Since he’s self-employed he doesn’t get health insurance through his job, but buys it on his own.\u003c/p>\n\u003cp>He says it’s worked out pretty well until this spring when his monthly premium spiked from $250 a month to $300 dollars overnight.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So he says he looked for a better deal and found another health insurance policy for half as much.\u003c/p>\n\u003cp>“As a small business you have your ups and downs and so every dollar does count,” Hall says. “Another $150, that’s half a truck payment right there.\"\u003c!--more-->\u003c/p>\n\u003cp>Hall got this new policy in April and it’s another high-deductible health plan. He pays for the first $1,500 of medical care out-of-pocket to meet his deductible. He doesn’t get coverage for certain benefits but that leaves him with a lower monthly premium.\u003c/p>\n\u003cp>Since he’s hardly needed any medical care in the last 14 years, Hall says it’s been just fine.\u003c/p>\n\u003cp>“The amount of times I’ve been to see a doctor I can probably count on one hand,” he says.\u003c/p>\n\u003cp>But Hall says now there’s a problem. He’s going to have to choose another insurance policy soon because his doesn’t meet the standards under the Affordable Care Act.\u003c/p>\n\u003cp>“Folks are going to have to buy more comprehensive policies, generally, in 2014,” says Micah Weinberg, a senior policy consultant with the Bay Area Council.\u003c/p>\n\u003cp>He says a small portion of people might be able to \u003ca href=\"https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/\" target=\"_blank\">keep their policy if they have a grandfathered plan\u003c/a>, meaning they had it on March 23, 2010. But he says Hall and millions of other people have individual health plans today that won’t cut it.\u003c/p>\n\u003cp>“Most of the policies sold in the individual market are much skinnier than the policies provided by employers,” he says.\u003c/p>\n\u003cp>Weinberg says the Affordable Care Act \u003ca href=\"https://www.healthcare.gov/what-does-marketplace-health-insurance-cover/\">requires all insurance policies to cover 10 benefits\u003c/a>, including things like hospitalizations, maternity care or prescription drugs. The idea, he says, is to protect people with a high deductible plan, like Darren Hall, from financial calamity.\u003c/p>\n\u003cp>“A lot of what the Affordable Care Act does is prevent moments of terror, panic, bankruptcy that we didn’t anticipate were even going to happen,” Weinberg says.\u003c/p>\n\u003cp>Obamacare will do this, he says, by making insurers pick up at least 60 percent of medical costs. And it caps out-of-pocket spending for individuals to around $6,400 per year.\u003c/p>\n\u003cp>People can also get help if they buy a plan on the newly formed health care marketplaces and qualify for a subsidy. But this won’t help everyone. Take, for example, the two million people in California who buy insurance on their own today. Only about a third will qualify for tax subsidies. Darren Hall makes too much money to qualify.\u003c/p>\n\u003cp>Sarah Aquino, of Integrated Benefits and Insurance Services Inc., says those who don’t qualify for a subsidy will likely see their premiums increase.\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/interactive/subsidy-calculator/\">To qualify for a tax subsidy\u003c/a> an individual has to make less than $46,000 a year, or 400 percent of the Federal Poverty Level.\u003c/p>\n\u003cp>But Aquino says most of her clients make more than that. Regardless, almost everyone has to have insurance or pay a fee come January. And Aquino says if that insurance is going to be more expensive, people will have a choice to make.\u003c/p>\n\u003cp>“The penalty for the individual mandate is $95 or one percent of your income,” she says. “So the question is will people who are healthy and don’t qualify for a subsidy come into the system?”\u003c/p>\n\u003cp>Aquino says the most important thing is for people to learn what their options are. And, she adds, it’s not a bad idea to start now.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced in collaboration with the \u003ca href=\"http://centerforhealthreporting.org/\">\u003cstrong>California HealthCare Foundation Center for Health Reporting\u003c/strong>\u003c/a>\u003cstrong>,\u003c/strong> a nonprofit news organization that focuses on California health issues. Based at the \u003ca href=\"http://annenberg.usc.edu/\">\u003cstrong>USC Annenberg School for Communication and Journalism\u003c/strong>\u003c/a>, the center is funded by the nonpartisan \u003cstrong>\u003ca href=\"http://www.chcf.org/\">California HealthCare Foundation.\u003c/a> \u003c/strong>The story first appeared on \u003ca href=\"http://www.npr.org/2013/08/23/214723180/obamacare-to-force-millions-to-upgrade-insurance\" target=\"_blank\">NPR\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Despite promises by President Obama that people can keep the insurance they have once Obamacare is in full effect in January, millions will have to upgrade their policies.\r\nThat’s because these people have “bare bones” plans that don’t meet the Affordable Care Act benefit standards.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14506\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-14506\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/hall_photo2-640x480.jpg\" alt=\"Darren Hall will have to choose a new health insurance plan after Obamacare is fully implemented in January. His policy today doesn’t meet the standards outlined in the law. (Kelley Weiss/ CHCF Center for Health Reporting)\" width=\"640\" height=\"480\">\u003cfigcaption class=\"wp-caption-text\">Darren Hall will have to choose a new health insurance plan after Obamacare is fully implemented in January. His policy today doesn’t meet the standards outlined in the law. (Kelley Weiss/ CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Kelley Weiss\u003c/strong>, \u003ca href=\"http://centerforhealthreporting.org/article/obamacare-force-millions-upgrade-insurance1152\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cp>Despite promises by President Obama that people can keep the insurance they have once Obamacare is in full effect in January, millions of people nationally will have to upgrade their policies.\u003c/p>\n\u003cp>That’s because these people have “bare bones” plans that don’t meet the Affordable Care Act benefit standards.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\u003ca href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" target=\"_blank\">Learn more about Obamacare in KQED's guide, specifically for Californians\u003c/a>\u003c/aside>\n\u003cp>Darren Hall is one of those people. He runs a pool service company in Sacramento. Since he’s self-employed he doesn’t get health insurance through his job, but buys it on his own.\u003c/p>\n\u003cp>He says it’s worked out pretty well until this spring when his monthly premium spiked from $250 a month to $300 dollars overnight.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So he says he looked for a better deal and found another health insurance policy for half as much.\u003c/p>\n\u003cp>“As a small business you have your ups and downs and so every dollar does count,” Hall says. “Another $150, that’s half a truck payment right there.\"\u003c!--more-->\u003c/p>\n\u003cp>Hall got this new policy in April and it’s another high-deductible health plan. He pays for the first $1,500 of medical care out-of-pocket to meet his deductible. He doesn’t get coverage for certain benefits but that leaves him with a lower monthly premium.\u003c/p>\n\u003cp>Since he’s hardly needed any medical care in the last 14 years, Hall says it’s been just fine.\u003c/p>\n\u003cp>“The amount of times I’ve been to see a doctor I can probably count on one hand,” he says.\u003c/p>\n\u003cp>But Hall says now there’s a problem. He’s going to have to choose another insurance policy soon because his doesn’t meet the standards under the Affordable Care Act.\u003c/p>\n\u003cp>“Folks are going to have to buy more comprehensive policies, generally, in 2014,” says Micah Weinberg, a senior policy consultant with the Bay Area Council.\u003c/p>\n\u003cp>He says a small portion of people might be able to \u003ca href=\"https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/\" target=\"_blank\">keep their policy if they have a grandfathered plan\u003c/a>, meaning they had it on March 23, 2010. But he says Hall and millions of other people have individual health plans today that won’t cut it.\u003c/p>\n\u003cp>“Most of the policies sold in the individual market are much skinnier than the policies provided by employers,” he says.\u003c/p>\n\u003cp>Weinberg says the Affordable Care Act \u003ca href=\"https://www.healthcare.gov/what-does-marketplace-health-insurance-cover/\">requires all insurance policies to cover 10 benefits\u003c/a>, including things like hospitalizations, maternity care or prescription drugs. The idea, he says, is to protect people with a high deductible plan, like Darren Hall, from financial calamity.\u003c/p>\n\u003cp>“A lot of what the Affordable Care Act does is prevent moments of terror, panic, bankruptcy that we didn’t anticipate were even going to happen,” Weinberg says.\u003c/p>\n\u003cp>Obamacare will do this, he says, by making insurers pick up at least 60 percent of medical costs. And it caps out-of-pocket spending for individuals to around $6,400 per year.\u003c/p>\n\u003cp>People can also get help if they buy a plan on the newly formed health care marketplaces and qualify for a subsidy. But this won’t help everyone. Take, for example, the two million people in California who buy insurance on their own today. Only about a third will qualify for tax subsidies. Darren Hall makes too much money to qualify.\u003c/p>\n\u003cp>Sarah Aquino, of Integrated Benefits and Insurance Services Inc., says those who don’t qualify for a subsidy will likely see their premiums increase.\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/interactive/subsidy-calculator/\">To qualify for a tax subsidy\u003c/a> an individual has to make less than $46,000 a year, or 400 percent of the Federal Poverty Level.\u003c/p>\n\u003cp>But Aquino says most of her clients make more than that. Regardless, almost everyone has to have insurance or pay a fee come January. And Aquino says if that insurance is going to be more expensive, people will have a choice to make.\u003c/p>\n\u003cp>“The penalty for the individual mandate is $95 or one percent of your income,” she says. “So the question is will people who are healthy and don’t qualify for a subsidy come into the system?”\u003c/p>\n\u003cp>Aquino says the most important thing is for people to learn what their options are. And, she adds, it’s not a bad idea to start now.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced in collaboration with the \u003ca href=\"http://centerforhealthreporting.org/\">\u003cstrong>California HealthCare Foundation Center for Health Reporting\u003c/strong>\u003c/a>\u003cstrong>,\u003c/strong> a nonprofit news organization that focuses on California health issues. Based at the \u003ca href=\"http://annenberg.usc.edu/\">\u003cstrong>USC Annenberg School for Communication and Journalism\u003c/strong>\u003c/a>, the center is funded by the nonpartisan \u003cstrong>\u003ca href=\"http://www.chcf.org/\">California HealthCare Foundation.\u003c/a> \u003c/strong>The story first appeared on \u003ca href=\"http://www.npr.org/2013/08/23/214723180/obamacare-to-force-millions-to-upgrade-insurance\" target=\"_blank\">NPR\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "5 Things You Should Know About Vaccines",
"title": "5 Things You Should Know About Vaccines",
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"content": "\u003cfigure id=\"attachment_14496\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-14496\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/polio_weve_been_here_before02_slide-a9b12bba3e1cd9b0185395ee73be9a628224dd30-s6-c30-1-640x425.jpg\" alt=\"Young girl with partial paralysis, caused by polio. (Courtesy Boston Children's Hospital)\" width=\"640\" height=\"425\">\u003cfigcaption class=\"wp-caption-text\">Young girl with partial paralysis, caused by polio. (Courtesy Boston Children's Hospital)\u003c/figcaption>\u003c/figure>\n\u003cp>Take a hard look at the picture. These are images we don't see in this country at all anymore. But until the polio vaccine came along in 1955, children and adults paralyzed from polio were fairly commonplace. (FDR, anyone?) Today, vaccines are now a victim of their own success. Because they've so successfully wiped out devastating childhood illnesses, people seem not to fear those illnesses anymore. Now we have parents who decide\u003cem> not\u003c/em> to have their children vaccinated.\u003c/p>\n\u003cp>As KQED News has \u003ca href=\"http://ww2.kqed.org/news/2013/08/21/marin-vaccinations/\" target=\"_blank\">reported\u003c/a> this week, the number of parents in Marin County opting out of vaccines for their children is climbing. Last year, 7.8 percent of Marin parents opted out, 1 percentage point higher than the previous year. At present, California has one of the most lenient laws in the country to allow parents to decline vaccinating their kids: the \"personal belief exemption.\" It's a short statement that says vaccinations are against a parent's beliefs. (A new law amends this exemption somewhat; more on that below.)\u003c/p>\n\u003cp>On Thursday,\u003ca href=\"http://www.kqed.org/a/forum/R201308220900\" target=\"_blank\"> KQED's Forum\u003c/a> took up the question of vaccines, and it was clear that many people remain confused on some key points.\u003c/p>\n\u003cp>\u003cstrong>1. What is\u003ca href=\"http://www.vaccines.gov/basics/protection\" target=\"_blank\"> herd immunity\u003c/a>?\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>This simply means that enough people are vaccinated against a contagious illness that most of the community is protected -- including those who cannot be vaccinated, such as newborn infants and people with compromised immune systems. And there are a lot of people with compromised immune systems, including pregnant women, people being treated for cancer, HIV/AIDS patients and more. The percentage of people who need to be vaccinated to create herd immunity for many childhood illnesses is high -- 90 percent, according to the federal government's \u003ca href=\"http://www.healthypeople.gov/2020/about/default.aspx\" target=\"_blank\">Healthy People 2020 goals\u003c/a>. The National Network for Immunization Information \u003ca href=\"http://www.immunizationinfo.org/issues/general/community-immunity\" target=\"_blank\">draws a striking contrast \u003c/a>between two outbreaks of measles. In 2003, an infected Japanese tourist arrived in the Marshall Islands, where vaccination rates were below 75 percent (i.e., below a herd immunity level). An epidemic ensued with more than 700 cases, 56 hospitalizations and three deaths. In the same year, there were two separate introductions of measles in Mexico. But vaccination rates were above 95 percent there. Only 41 people contracted measles as a result. Vaccination matters.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>2. Does state law require kids to be vaccinated? And can I find out how many kids are not vaccinated at my child's school?\u003c/strong>\u003c/p>\n\u003cp>The short answer is \"yes\" to both questions. \u003ca href=\"http://www.leginfo.ca.gov/cgi-bin/displaycode?section=hsc&group=120001-121000&file=120325-120380\" target=\"_blank\">State law\u003c/a> requires that children at all public and private schools be fully immunized before they start kindergarten. The California Department of Public Health sets the list of vaccines, but essentially follows national guidelines from the federal government and the American Academy of Pediatrics. A very small number of children cannot be vaccinated for medical reasons, and they are eligible for a \"personal medical exemption.\" But in California, the bigger problem has been the personal belief exemption, or PBE. This is the last school year that parents will be able to avoid vaccination for their children simply by signing a piece of paper saying they are opposed to vaccines. Starting in January, when \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/08/23/new-requirement-for-vaccine-exemption-passed-by-senate/\" target=\"_blank\">a new state law \u003c/a>goes into effect, parents will also need to provide a signed form from a health care provider who will have explained the benefits and risks of vaccines as well as the risks of communicable diseases. While it's plausible this law won't make a difference to the dedicated anti-vaccine crowd, it may well make a difference to people who have found conflicting or inaccurate information on the Internet or other sources (or parents who find it easier to drop off a signed statement instead of vaccinating their kids). The state of Washington passed a similar law in 2011 and their opt-out rate has dropped by almost 40 percent. Here in California, the state compiles data on vaccination rates for public and private schools statewide, and\u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20California%20Kindergarten%20Data.pdf\" target=\"_blank\"> you can look up \u003c/a>your own child's school.\u003c/p>\n\u003cp>\u003cstrong>3. I disagree with the vaccination schedule and have developed my own. Is this a problem?\u003c/strong>\u003c/p>\n\u003cp>The CDC's Advisory Committee on Immunization Practices reviews the \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/su6201a2.htm\" target=\"_blank\">vaccine schedule\u003c/a> every year. What many people don't know is that there is some flexibility built into the schedule. For example, the third dose of the hepatitis B vaccine can be given between 6 and 18 months of age. The third dose of polio can be given between 4 and 18 months. If you adjust the schedule on your own, you are putting your child at risk of developing a serious illness that could have been avoided. \u003ca href=\"http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-child-immun-color-office.pdf\" target=\"_blank\">CDC information\u003c/a> allays concerns about vaccines overloading a child's immune system:\u003c/p>\n\u003cblockquote>\u003cp>Every day, a healthy baby’s immune system successfully fights off millions of antigens—the parts of germs that cause the body’s immune system to go to work. ...\u003c/p>\n\u003cp>Vaccines contain only a tiny fraction of the antigens that babies encounter every day in their environment, even if they receive several vaccines on one day.\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong>4. If your child is vaccinated, why do you care if mine is not?\u003c/strong>\u003c/p>\n\u003cp>While vaccines are highly effective, they are not 100 percent effective. This goes back to herd immunity described above. In order to protect the entire community, we need for as many people to be vaccinated as possible. Again, it's not just about protecting children. People who deny vaccinations to their children put pregnant women, cancer patients, AIDS patients and even healthy people at risk of disease. Here's just one example about one of the \"newer\" vaccines, against Haemophilus Influenzae type b, also known as Hib. Before 1985 -- before the vaccine -- Hib caused serious infections in children, including 12,000 cases of meningitis and 7,500 cases of pneumonia. \u003ca href=\"http://www.immunizationinfo.org/parents/why-immunize#footnote7_9lc0rab\" target=\"_blank\">Compare that with 2002\u003c/a>, when there were just 34 cases of Hib disease.\u003c/p>\n\u003cp>\u003cstrong>5. What about the link to autism? Or other problems from vaccines?\u003c/strong>\u003c/p>\n\u003cp>The public confusion about a connection between vaccines and autism stems primarily from one major study. In 1998, the Lancet published a study from British researchers which implicated the measles, mumps and rubella vaccine as increasing the risk of autism. There's just one problem: One of the researchers on that study, Dr. Andrew Wakefield, was investigated. Britain's General Medical Council \u003ca href=\"http://www.sciencebasedmedicine.org/andrew-wakefield-the-panel-is-satisfied-that-your-conduct-was-irresponsible-and-dishonest/\" target=\"_blank\">concluded\u003c/a> his \"conduct was irresponsible and dishonest,\" and the study was later \u003ca href=\"http://www.nytimes.com/2010/02/03/health/research/03lancet.html?_r=0\" target=\"_blank\">retracted\u003c/a>. But Wakefield's damage is hard to undo. The concern continues to circulate.\u003c/p>\n\u003cp>As for other side effects of vaccines, yes, they exist. Like everything else in life, vaccines, too, come with risks of adverse effects. The risks are small, but not zero. The CDC and the FDA \u003ca href=\"http://vaers.hhs.gov/index\" target=\"_blank\">co-sponsor a reporting system \u003c/a>to track vaccine side effects.\u003c/p>\n\u003cp>Now, back to polio for a minute. If you really want to feel the fear of life before the polio vaccine, watch this excellent segment from RLTV's documentary \u003ca href=\"http://www.rl.tv/video/polio-revisited/\" target=\"_blank\">Polio Revisited\u003c/a>. It will break your heart.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003cem>This post has been updated to clarify the role of the Lancet study in the public confusion around vaccines and autism.\u003c/em>\u003c/em>\u003c/p>\n\n",
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"excerpt": "Take a hard look at the picture. These are images we don't see in this country at all any more. But until the polio vaccine came along, children and adults paralyzed from polio were fairly commonplace. (FDR, anyone?) Today, vaccines are now a victim of their own success. Because they've so successfully wiped out devastating childhood illnesses, people seem not to fear those illnesses any more. Now we have parents who decide not to have their children vaccinated. ",
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"description": "Take a hard look at the picture. These are images we don't see in this country at all any more. But until the polio vaccine came along, children and adults paralyzed from polio were fairly commonplace. (FDR, anyone?) Today, vaccines are now a victim of their own success. Because they've so successfully wiped out devastating childhood illnesses, people seem not to fear those illnesses any more. Now we have parents who decide not to have their children vaccinated. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14496\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-14496\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/polio_weve_been_here_before02_slide-a9b12bba3e1cd9b0185395ee73be9a628224dd30-s6-c30-1-640x425.jpg\" alt=\"Young girl with partial paralysis, caused by polio. (Courtesy Boston Children's Hospital)\" width=\"640\" height=\"425\">\u003cfigcaption class=\"wp-caption-text\">Young girl with partial paralysis, caused by polio. (Courtesy Boston Children's Hospital)\u003c/figcaption>\u003c/figure>\n\u003cp>Take a hard look at the picture. These are images we don't see in this country at all anymore. But until the polio vaccine came along in 1955, children and adults paralyzed from polio were fairly commonplace. (FDR, anyone?) Today, vaccines are now a victim of their own success. Because they've so successfully wiped out devastating childhood illnesses, people seem not to fear those illnesses anymore. Now we have parents who decide\u003cem> not\u003c/em> to have their children vaccinated.\u003c/p>\n\u003cp>As KQED News has \u003ca href=\"http://ww2.kqed.org/news/2013/08/21/marin-vaccinations/\" target=\"_blank\">reported\u003c/a> this week, the number of parents in Marin County opting out of vaccines for their children is climbing. Last year, 7.8 percent of Marin parents opted out, 1 percentage point higher than the previous year. At present, California has one of the most lenient laws in the country to allow parents to decline vaccinating their kids: the \"personal belief exemption.\" It's a short statement that says vaccinations are against a parent's beliefs. (A new law amends this exemption somewhat; more on that below.)\u003c/p>\n\u003cp>On Thursday,\u003ca href=\"http://www.kqed.org/a/forum/R201308220900\" target=\"_blank\"> KQED's Forum\u003c/a> took up the question of vaccines, and it was clear that many people remain confused on some key points.\u003c/p>\n\u003cp>\u003cstrong>1. What is\u003ca href=\"http://www.vaccines.gov/basics/protection\" target=\"_blank\"> herd immunity\u003c/a>?\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>This simply means that enough people are vaccinated against a contagious illness that most of the community is protected -- including those who cannot be vaccinated, such as newborn infants and people with compromised immune systems. And there are a lot of people with compromised immune systems, including pregnant women, people being treated for cancer, HIV/AIDS patients and more. The percentage of people who need to be vaccinated to create herd immunity for many childhood illnesses is high -- 90 percent, according to the federal government's \u003ca href=\"http://www.healthypeople.gov/2020/about/default.aspx\" target=\"_blank\">Healthy People 2020 goals\u003c/a>. The National Network for Immunization Information \u003ca href=\"http://www.immunizationinfo.org/issues/general/community-immunity\" target=\"_blank\">draws a striking contrast \u003c/a>between two outbreaks of measles. In 2003, an infected Japanese tourist arrived in the Marshall Islands, where vaccination rates were below 75 percent (i.e., below a herd immunity level). An epidemic ensued with more than 700 cases, 56 hospitalizations and three deaths. In the same year, there were two separate introductions of measles in Mexico. But vaccination rates were above 95 percent there. Only 41 people contracted measles as a result. Vaccination matters.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>2. Does state law require kids to be vaccinated? And can I find out how many kids are not vaccinated at my child's school?\u003c/strong>\u003c/p>\n\u003cp>The short answer is \"yes\" to both questions. \u003ca href=\"http://www.leginfo.ca.gov/cgi-bin/displaycode?section=hsc&group=120001-121000&file=120325-120380\" target=\"_blank\">State law\u003c/a> requires that children at all public and private schools be fully immunized before they start kindergarten. The California Department of Public Health sets the list of vaccines, but essentially follows national guidelines from the federal government and the American Academy of Pediatrics. A very small number of children cannot be vaccinated for medical reasons, and they are eligible for a \"personal medical exemption.\" But in California, the bigger problem has been the personal belief exemption, or PBE. This is the last school year that parents will be able to avoid vaccination for their children simply by signing a piece of paper saying they are opposed to vaccines. Starting in January, when \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/08/23/new-requirement-for-vaccine-exemption-passed-by-senate/\" target=\"_blank\">a new state law \u003c/a>goes into effect, parents will also need to provide a signed form from a health care provider who will have explained the benefits and risks of vaccines as well as the risks of communicable diseases. While it's plausible this law won't make a difference to the dedicated anti-vaccine crowd, it may well make a difference to people who have found conflicting or inaccurate information on the Internet or other sources (or parents who find it easier to drop off a signed statement instead of vaccinating their kids). The state of Washington passed a similar law in 2011 and their opt-out rate has dropped by almost 40 percent. Here in California, the state compiles data on vaccination rates for public and private schools statewide, and\u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20California%20Kindergarten%20Data.pdf\" target=\"_blank\"> you can look up \u003c/a>your own child's school.\u003c/p>\n\u003cp>\u003cstrong>3. I disagree with the vaccination schedule and have developed my own. Is this a problem?\u003c/strong>\u003c/p>\n\u003cp>The CDC's Advisory Committee on Immunization Practices reviews the \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/su6201a2.htm\" target=\"_blank\">vaccine schedule\u003c/a> every year. What many people don't know is that there is some flexibility built into the schedule. For example, the third dose of the hepatitis B vaccine can be given between 6 and 18 months of age. The third dose of polio can be given between 4 and 18 months. If you adjust the schedule on your own, you are putting your child at risk of developing a serious illness that could have been avoided. \u003ca href=\"http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-child-immun-color-office.pdf\" target=\"_blank\">CDC information\u003c/a> allays concerns about vaccines overloading a child's immune system:\u003c/p>\n\u003cblockquote>\u003cp>Every day, a healthy baby’s immune system successfully fights off millions of antigens—the parts of germs that cause the body’s immune system to go to work. ...\u003c/p>\n\u003cp>Vaccines contain only a tiny fraction of the antigens that babies encounter every day in their environment, even if they receive several vaccines on one day.\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong>4. If your child is vaccinated, why do you care if mine is not?\u003c/strong>\u003c/p>\n\u003cp>While vaccines are highly effective, they are not 100 percent effective. This goes back to herd immunity described above. In order to protect the entire community, we need for as many people to be vaccinated as possible. Again, it's not just about protecting children. People who deny vaccinations to their children put pregnant women, cancer patients, AIDS patients and even healthy people at risk of disease. Here's just one example about one of the \"newer\" vaccines, against Haemophilus Influenzae type b, also known as Hib. Before 1985 -- before the vaccine -- Hib caused serious infections in children, including 12,000 cases of meningitis and 7,500 cases of pneumonia. \u003ca href=\"http://www.immunizationinfo.org/parents/why-immunize#footnote7_9lc0rab\" target=\"_blank\">Compare that with 2002\u003c/a>, when there were just 34 cases of Hib disease.\u003c/p>\n\u003cp>\u003cstrong>5. What about the link to autism? Or other problems from vaccines?\u003c/strong>\u003c/p>\n\u003cp>The public confusion about a connection between vaccines and autism stems primarily from one major study. In 1998, the Lancet published a study from British researchers which implicated the measles, mumps and rubella vaccine as increasing the risk of autism. There's just one problem: One of the researchers on that study, Dr. Andrew Wakefield, was investigated. Britain's General Medical Council \u003ca href=\"http://www.sciencebasedmedicine.org/andrew-wakefield-the-panel-is-satisfied-that-your-conduct-was-irresponsible-and-dishonest/\" target=\"_blank\">concluded\u003c/a> his \"conduct was irresponsible and dishonest,\" and the study was later \u003ca href=\"http://www.nytimes.com/2010/02/03/health/research/03lancet.html?_r=0\" target=\"_blank\">retracted\u003c/a>. But Wakefield's damage is hard to undo. The concern continues to circulate.\u003c/p>\n\u003cp>As for other side effects of vaccines, yes, they exist. Like everything else in life, vaccines, too, come with risks of adverse effects. The risks are small, but not zero. The CDC and the FDA \u003ca href=\"http://vaers.hhs.gov/index\" target=\"_blank\">co-sponsor a reporting system \u003c/a>to track vaccine side effects.\u003c/p>\n\u003cp>Now, back to polio for a minute. If you really want to feel the fear of life before the polio vaccine, watch this excellent segment from RLTV's documentary \u003ca href=\"http://www.rl.tv/video/polio-revisited/\" target=\"_blank\">Polio Revisited\u003c/a>. It will break your heart.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cem>This post has been updated to clarify the role of the Lancet study in the public confusion around vaccines and autism.\u003c/em>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In San Francisco, Seniors Are Singing for Science",
"title": "In San Francisco, Seniors Are Singing for Science",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_14405\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-14405 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/Martha-640x480.jpg\" alt=\"Martha Rodriguez-Salazar of the Community Music Center leads the senior choir. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003cfigcaption class=\"wp-caption-text\">Martha Rodriguez-Salazar leads the senior choir. (Lisa Aliferis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update: 5/22/14\u003c/strong> -- Community Music Choirs is a finalist for \u003ca href=\"https://impactchallenge.withgoogle.com/bayarea2014\" target=\"_blank\">Google's Bay Area Impact Challenge\u003c/a>. CMC has already been awarded $250,000 to continue rehearsals for the 12 choirs established in this study, detailed below. It will be awarded additional funds if it is \u003ca href=\"https://impactchallenge.withgoogle.com/bayarea2014\" target=\"_blank\">voted a finalist\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>In an auditorium tucked behind San Francisco's Mission Neighborhood Center, a new choir is rehearsing a collection of familiar Spanish songs. The 20 members of the choir didn't need to audition; no singing experience required here. Instead, they needed just one thing: to be age 60 or older.\u003c/p>\n\u003cp>They're part of an innovative\u003ca href=\"http://communityofvoices.org/home/\" target=\"_blank\"> study\u003c/a> spearheaded at UCSF and funded by the National Institutes of Health. Over the next four years, researchers will launch a dozen community choirs to see if singing in a choir can have an effect on healthy aging. It's a joint project of UCSF, the San Francisco Department of Aging and the San Francisco Community Music Center.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Researchers are interested in the quantifiable health benefits of singing in a choir. Right now, there are almost no hard data.\u003c/aside>\n\u003cp>As the choir rehearses \"Besame Mucho,\" 82-year-old Francisco Sanchez stands in the back row. Sanchez has suffered from depression and fights what he calls \"negative thinking.\" So when he saw a flyer in his apartment advertising the choir, he thought he'd give it a try.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Everyone, they are so kind, so nice, so I feel like I am in home,\" says Sanchez in accented English. He's originally from Guatemala, and has lived in the U.S. permanently since 1977.\u003c/p>\n\u003cp>Sanchez says he looks forward to Friday rehearsals. And after just a few weeks of participating, he's feeling better.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\"The worse thing that happen to a person, especially older person, is depression,\" he says. \"And you feel important or something useful, depression is gone.\"\u003c/p>\n\u003cp>Right about now you might be wondering: Do we really need a study to show singing in a choir has health benefits? It's a question Julene Johnson fields frequently. Johnson, a cognitive neuroscientist at the UC San Francisco Institute for Health & Aging, is interested in the quantifiable health benefits of singing in a choir. Right now, there are almost no hard data. While the team will look at the somewhat predictable psychosocial benefits that Sanchez is already experiencing, they're interested in physical mobility and cognition, too.\u003c/p>\n\u003cp>\"So those three areas will be the primary things we focus on looking at. Will there be change after singing in a choir?\" Johnson explains.\u003c/p>\n\u003cp>Besides improvement in his mood, Sanchez has noticed some other changes.\u003c/p>\n\u003cp>\"It's helped me with my breathing,\" he says, adding that he's had pneumonia five times. \"I know breathing is important. Here I am practicing.\"\u003c/p>\n\u003cp>Johnson and her team will launch a dozen choirs -- in English and Spanish -- in San Francisco over the next four years. They're recruiting a diverse group.\u003c/p>\n\u003cp>\"It's very important to be able to design studies that are relevant to individuals of color. As you might imagine, singing in a choir comes from almost any culture,\" Johnson says. She's also excited about conducting a study outside the confines of the ivory tower of UCSF. \"I think there's lots of opportunities to do research studies in the community and involve community participants in particular that are more diverse and represent the communities in which we live,\" she says.\u003c/p>\n\u003cp>They're also working to reach vulnerable seniors, people who might not get out too much. Bilingual choir director Martha Rodriguez-Salazar says some singers are quite timid at the beginning.\u003c/p>\n\u003cp>\"They're very afraid of singing or afraid of making mistakes,\" she says, \"or thinking that they're too old to do anything.\"\u003c/p>\n\u003cp>But the more she teaches them, Rodriguez-Salazar explains, how to stand in front of an audience or sing while holding up a binder of music, \"that really empowers them, gives them knowledge.\" Choir members rehearse for 90 minutes once a week. On a recent Friday, members were seated for the first half of rehearsal, but they stood for the second half.\u003c/p>\n\u003cp>Johnson is measuring health and well-being before participants begin in a choir, \"then look over time to see how those ratings of health and well-being might change over time with the choir.\" And all of this can build strength, Johnson says. People who have stronger lower-body strength may fall less, saving them from injury. And avoiding injury could save money.\u003c/p>\n\u003cp>It's this kind of data that could make a difference to senior centers relying on government funds, needing to prove their programs have make a difference. \"These days when they're cutting programs at senior centers left and right,\" Johnson says, \"those senior centers need additional evidence\" that they have cost-effective programs.\u003c/p>\n\u003cp>Francisco Sanchez says he's sold already. \"Breathing, discipline ... a lot of things, music is the best for all that.\"\u003c/p>\n\u003cp>Community of Voices is\u003ca href=\"http://communityofvoices.org/home/join-the-study/\" target=\"_blank\"> enrolling now \u003c/a>for choirs in San Francisco's Bayview and Western Addition neighborhoods.\u003c/p>\n\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=http%3A%2F%2Fapi.soundcloud.com%2Ftracks%2F106721251\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\n",
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"excerpt": "In an auditorium tucked behind San Francisco's Mission Neighborhood center, a new choir is rehearsing a collection of familiar Spanish songs. The 20 members of the choir didn't need to audition, no singing experience required here. Instead they needed just one thing: to be age 60 or older.\r\n\r\nThey're part of an innovative study spearheaded at UCSF and funded by the National Institutes of Health. Over the next 4 years, researchers will launch a dozen community choirs to see if singing in a choir can have an effect on healthy aging. It's a joint project of UCSF, the San Francisco Department of Aging and the San Francisco Community Music Center.",
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"title": "In San Francisco, Seniors Are Singing for Science | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14405\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-14405 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/Martha-640x480.jpg\" alt=\"Martha Rodriguez-Salazar of the Community Music Center leads the senior choir. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003cfigcaption class=\"wp-caption-text\">Martha Rodriguez-Salazar leads the senior choir. (Lisa Aliferis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update: 5/22/14\u003c/strong> -- Community Music Choirs is a finalist for \u003ca href=\"https://impactchallenge.withgoogle.com/bayarea2014\" target=\"_blank\">Google's Bay Area Impact Challenge\u003c/a>. CMC has already been awarded $250,000 to continue rehearsals for the 12 choirs established in this study, detailed below. It will be awarded additional funds if it is \u003ca href=\"https://impactchallenge.withgoogle.com/bayarea2014\" target=\"_blank\">voted a finalist\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>In an auditorium tucked behind San Francisco's Mission Neighborhood Center, a new choir is rehearsing a collection of familiar Spanish songs. The 20 members of the choir didn't need to audition; no singing experience required here. Instead, they needed just one thing: to be age 60 or older.\u003c/p>\n\u003cp>They're part of an innovative\u003ca href=\"http://communityofvoices.org/home/\" target=\"_blank\"> study\u003c/a> spearheaded at UCSF and funded by the National Institutes of Health. Over the next four years, researchers will launch a dozen community choirs to see if singing in a choir can have an effect on healthy aging. It's a joint project of UCSF, the San Francisco Department of Aging and the San Francisco Community Music Center.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Researchers are interested in the quantifiable health benefits of singing in a choir. Right now, there are almost no hard data.\u003c/aside>\n\u003cp>As the choir rehearses \"Besame Mucho,\" 82-year-old Francisco Sanchez stands in the back row. Sanchez has suffered from depression and fights what he calls \"negative thinking.\" So when he saw a flyer in his apartment advertising the choir, he thought he'd give it a try.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Everyone, they are so kind, so nice, so I feel like I am in home,\" says Sanchez in accented English. He's originally from Guatemala, and has lived in the U.S. permanently since 1977.\u003c/p>\n\u003cp>Sanchez says he looks forward to Friday rehearsals. And after just a few weeks of participating, he's feeling better.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\"The worse thing that happen to a person, especially older person, is depression,\" he says. \"And you feel important or something useful, depression is gone.\"\u003c/p>\n\u003cp>Right about now you might be wondering: Do we really need a study to show singing in a choir has health benefits? It's a question Julene Johnson fields frequently. Johnson, a cognitive neuroscientist at the UC San Francisco Institute for Health & Aging, is interested in the quantifiable health benefits of singing in a choir. Right now, there are almost no hard data. While the team will look at the somewhat predictable psychosocial benefits that Sanchez is already experiencing, they're interested in physical mobility and cognition, too.\u003c/p>\n\u003cp>\"So those three areas will be the primary things we focus on looking at. Will there be change after singing in a choir?\" Johnson explains.\u003c/p>\n\u003cp>Besides improvement in his mood, Sanchez has noticed some other changes.\u003c/p>\n\u003cp>\"It's helped me with my breathing,\" he says, adding that he's had pneumonia five times. \"I know breathing is important. Here I am practicing.\"\u003c/p>\n\u003cp>Johnson and her team will launch a dozen choirs -- in English and Spanish -- in San Francisco over the next four years. They're recruiting a diverse group.\u003c/p>\n\u003cp>\"It's very important to be able to design studies that are relevant to individuals of color. As you might imagine, singing in a choir comes from almost any culture,\" Johnson says. She's also excited about conducting a study outside the confines of the ivory tower of UCSF. \"I think there's lots of opportunities to do research studies in the community and involve community participants in particular that are more diverse and represent the communities in which we live,\" she says.\u003c/p>\n\u003cp>They're also working to reach vulnerable seniors, people who might not get out too much. Bilingual choir director Martha Rodriguez-Salazar says some singers are quite timid at the beginning.\u003c/p>\n\u003cp>\"They're very afraid of singing or afraid of making mistakes,\" she says, \"or thinking that they're too old to do anything.\"\u003c/p>\n\u003cp>But the more she teaches them, Rodriguez-Salazar explains, how to stand in front of an audience or sing while holding up a binder of music, \"that really empowers them, gives them knowledge.\" Choir members rehearse for 90 minutes once a week. On a recent Friday, members were seated for the first half of rehearsal, but they stood for the second half.\u003c/p>\n\u003cp>Johnson is measuring health and well-being before participants begin in a choir, \"then look over time to see how those ratings of health and well-being might change over time with the choir.\" And all of this can build strength, Johnson says. People who have stronger lower-body strength may fall less, saving them from injury. And avoiding injury could save money.\u003c/p>\n\u003cp>It's this kind of data that could make a difference to senior centers relying on government funds, needing to prove their programs have make a difference. \"These days when they're cutting programs at senior centers left and right,\" Johnson says, \"those senior centers need additional evidence\" that they have cost-effective programs.\u003c/p>\n\u003cp>Francisco Sanchez says he's sold already. \"Breathing, discipline ... a lot of things, music is the best for all that.\"\u003c/p>\n\u003cp>Community of Voices is\u003ca href=\"http://communityofvoices.org/home/join-the-study/\" target=\"_blank\"> enrolling now \u003c/a>for choirs in San Francisco's Bayview and Western Addition neighborhoods.\u003c/p>\n\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=http%3A%2F%2Fapi.soundcloud.com%2Ftracks%2F106721251\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "5 Ways to Save Teen Athletes' Lives",
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"content": "\u003cfigure id=\"attachment_14376\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/11368371@N00/5787777369/in/photolist-9PrSyZ-9Psb4K-9Pvr37-9Ps5Tn-9PrXv4-9Pvgtj-9PuPt9-9Pvspo-9Ps2vZ-9PrPen-9PuN3j-9PrWfT-9PrS9x-9PuQfb-9PuNLw-9Pvqp1-9PvsRW-9PvnRE-9PvuDs-9PuSAb-9Pvmzo-9PsEXB-9Pv49E-9PsdxF-9PuSkh-9PvvxU-9Pvk7s-9Pvoi7-9PrMUr-9PsBqV-9Psfmr-9PvtNJ-9PuXA9-9PrNyx-9Pvp9f-9PsAcZ-9PvvUf-9PuPYo-9PrMiD-9PsExP-9PrTZR-9PvpWs-9Pvqyw-9PrM5e-9PuFT7-bWeJ31-8PHZ4D-8PHZyD-8PHXNz-8PM2oj-8PMaEh\">\u003cimg class=\"size-full wp-image-14376 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/5787777369_35a609b41f_z.jpg\" alt=\"(bedlamonbalticavenue/Flickr)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/08/5787777369_35a609b41f_z.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/08/5787777369_35a609b41f_z-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/08/5787777369_35a609b41f_z-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">With high school sports starting up as summer winds down, new guidelines are designed to keep student athletes safe. (bedlamonbalticavenue/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Deborah Franklin,\u003c/strong> \u003ca href=\"http://www.npr.org/blogs/health/2013/08/14/212067372/a-safety-checklist-to-save-teen-athletes-lives\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>For all the benefits of exercise and teamwork to the heart and head, high school athletes still lead the nation in athletics-related deaths. And it doesn't have to be that way, sports medicine specialists say.\u003c/p>\n\u003cp>Many student deaths from head and neck injuries, heat stroke, sudden heart trouble and exertion-related sickle cell crises can be prevented, according to a scrum of leading sports doctors, athletic trainers, research physiologists and high school administrators who have endorsed a detailed set of \u003ca href=\"http://www.nata.org/sites/default/files/preventing-sudden-death.pdf\" target=\"_blank\">guidelines\u003c/a> for keeping high school athletes safe.\u003c/p>\n\u003caside class=\"pullquote alignright\">Give student athletes several days to acclimatize at the start of every season.\u003c/aside>\n\u003cp>\"The idea was to create something that schools could almost use as a checklist,\" says Douglas Casa, who helped shape the consensus guidelines published in the August issue of the \u003cem>Journal of Athletic Training\u003c/em>. Casa, who led a similar effort to produce conditioning \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396308/\">guidelines for college athletes\u003c/a> in 2012, is a sports physiologist at the University of Connecticut in Storrs.\u003c/p>\n\u003cp>Some of the key recommendations for high schools follow.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>1. Have a \u003ca href=\"http://www.nata.org/node/645\">certified athletic trainer\u003c/a> available during games and practices.\u003c/strong> Roughly a third of public high schools and many private ones don't do that, Casa tells Shots, and it's a problem during emergencies. \"It's unbelievable,\" he says, \"that some of the same schools that insist on having a school nurse on hand to handle emergencies from 8 to 2 don't have a medical professional onsite to make key decisions after school when students are exerting themselves in the heat or under other extreme conditions.\"\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>2. Have an \u003ca href=\"http://www.redcross.org/prepare/location/workplace/easy-as-aed\">AED\u003c/a> (automated external defibrillator) within easy reach\u003c/strong> during practices and games to jump-start a heart that suddenly fails. \"Cardiac problems are becoming much more survivable, but the AED has to be out on the field with the athletic trainer and on the kid's chest within a minute after the heart stops to save a life,\" says. Running inside the school to pull the device from the hallway case isn't fast enough, he says.\u003c/p>\n\u003cp>\u003cstrong>3. Have water freely available at all times, and give student athletes a tightly structured, several-day acclimatization period at the start of every season\u003c/strong> — especially in summer — with shorter, less intense practices that will help their bodies adjust to the big shifts in heat and exertion of a full game or regular practice.\u003c/p>\n\u003cp>\u003cstrong>4. Cool the victim of a heat stroke immediately, even before transport to the hospital.\u003c/strong>\"You've got to get their body temperature down to under 104 degrees within 30 minutes of collapse if you want to save somebody's life,\" Casa says. The guidelines recommend\u003ca href=\"http://ksi.uconn.edu/ksi/assets/File/CWI%20cooling%20guidelines.pdf\">immersion in ice cold water\u003c/a>. \"Every high school has ice and water, and the tank costs $150,\" Casa says. \"It's worth it.\"\u003c/p>\n\u003cp>\u003cstrong>5. Recommend that all players, especially any \"performing intense physical activity,\" check with their doctor to see if they carry the sickle cell trait.\u003c/strong> All newborns in the U.S. these days are screened for the sickle cell gene, so the player's pediatrician may have the results on file. (Note that people with sickle cell disease inherit two copies of the gene responsible for the illness; those with one copy of the gene are said to have the sickle cell trait — a condition that is usually benign. Rarely, though, according to the American Society of Hematology, \"extreme conditions such as severe dehydration and high-intensity physical activity,\" can prompt serious health issues, including sudden death.) Casa's guidelines stop short of suggesting mandatory screening of all athletes for \u003ca href=\"http://www.cdc.gov/ncbddd/sicklecell/traits.html\" target=\"_blank\">the trait\u003c/a>. The NCAA requires college athletes who want to play at the Division I or Division II level to have the test or sign a written release. As Shots \u003ca href=\"http://www.npr.org/blogs/health/2012/01/26/145923225/blood-doctors-call-foul-on-ncaas-screening-for-sickle-cell\" target=\"_blank\">described in a post\u003c/a> last year, the NCAA's mandatory testing of athletes for the sickle cell trait is controversial.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Casa says it's important to alert anyone overseeing athletic activity that shortness of breath, muscle pain or cramping, low back pain and difficulty recovering from exercise could be signaling the rare but serious \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/3627196\">exertional sickling crisis\u003c/a> (particularly at high altitudes, or during heat waves, or during the sport season's first days of heavy exertion). High schools that carefully follow the rules regarding hydration and gradual acclimatization can greatly minimize the chances of the problem developing, Casa says. \"No one who has the sickle cell trait should be denied participation in any sport,\" he adds.\u003c/p>\n\n",
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"excerpt": "For all the benefits of exercise and teamwork to the heart and head, high school athletes still lead the nation in athletics-related deaths. And it doesn't have to be that way, sports medicine specialists say.\r\n\r\nMany student deaths from head and neck injuries, heat stroke, sudden heart trouble and exertion-related sickle cell crises can be prevented, according to a scrum of leading sports doctors, athletic trainers, research physiologists and high school administrators who have endorsed a detailed set of guidelines for keeping high school athletes safe.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14376\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/11368371@N00/5787777369/in/photolist-9PrSyZ-9Psb4K-9Pvr37-9Ps5Tn-9PrXv4-9Pvgtj-9PuPt9-9Pvspo-9Ps2vZ-9PrPen-9PuN3j-9PrWfT-9PrS9x-9PuQfb-9PuNLw-9Pvqp1-9PvsRW-9PvnRE-9PvuDs-9PuSAb-9Pvmzo-9PsEXB-9Pv49E-9PsdxF-9PuSkh-9PvvxU-9Pvk7s-9Pvoi7-9PrMUr-9PsBqV-9Psfmr-9PvtNJ-9PuXA9-9PrNyx-9Pvp9f-9PsAcZ-9PvvUf-9PuPYo-9PrMiD-9PsExP-9PrTZR-9PvpWs-9Pvqyw-9PrM5e-9PuFT7-bWeJ31-8PHZ4D-8PHZyD-8PHXNz-8PM2oj-8PMaEh\">\u003cimg class=\"size-full wp-image-14376 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/5787777369_35a609b41f_z.jpg\" alt=\"(bedlamonbalticavenue/Flickr)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/08/5787777369_35a609b41f_z.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/08/5787777369_35a609b41f_z-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/08/5787777369_35a609b41f_z-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">With high school sports starting up as summer winds down, new guidelines are designed to keep student athletes safe. (bedlamonbalticavenue/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Deborah Franklin,\u003c/strong> \u003ca href=\"http://www.npr.org/blogs/health/2013/08/14/212067372/a-safety-checklist-to-save-teen-athletes-lives\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>For all the benefits of exercise and teamwork to the heart and head, high school athletes still lead the nation in athletics-related deaths. And it doesn't have to be that way, sports medicine specialists say.\u003c/p>\n\u003cp>Many student deaths from head and neck injuries, heat stroke, sudden heart trouble and exertion-related sickle cell crises can be prevented, according to a scrum of leading sports doctors, athletic trainers, research physiologists and high school administrators who have endorsed a detailed set of \u003ca href=\"http://www.nata.org/sites/default/files/preventing-sudden-death.pdf\" target=\"_blank\">guidelines\u003c/a> for keeping high school athletes safe.\u003c/p>\n\u003caside class=\"pullquote alignright\">Give student athletes several days to acclimatize at the start of every season.\u003c/aside>\n\u003cp>\"The idea was to create something that schools could almost use as a checklist,\" says Douglas Casa, who helped shape the consensus guidelines published in the August issue of the \u003cem>Journal of Athletic Training\u003c/em>. Casa, who led a similar effort to produce conditioning \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396308/\">guidelines for college athletes\u003c/a> in 2012, is a sports physiologist at the University of Connecticut in Storrs.\u003c/p>\n\u003cp>Some of the key recommendations for high schools follow.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>1. Have a \u003ca href=\"http://www.nata.org/node/645\">certified athletic trainer\u003c/a> available during games and practices.\u003c/strong> Roughly a third of public high schools and many private ones don't do that, Casa tells Shots, and it's a problem during emergencies. \"It's unbelievable,\" he says, \"that some of the same schools that insist on having a school nurse on hand to handle emergencies from 8 to 2 don't have a medical professional onsite to make key decisions after school when students are exerting themselves in the heat or under other extreme conditions.\"\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>2. Have an \u003ca href=\"http://www.redcross.org/prepare/location/workplace/easy-as-aed\">AED\u003c/a> (automated external defibrillator) within easy reach\u003c/strong> during practices and games to jump-start a heart that suddenly fails. \"Cardiac problems are becoming much more survivable, but the AED has to be out on the field with the athletic trainer and on the kid's chest within a minute after the heart stops to save a life,\" says. Running inside the school to pull the device from the hallway case isn't fast enough, he says.\u003c/p>\n\u003cp>\u003cstrong>3. Have water freely available at all times, and give student athletes a tightly structured, several-day acclimatization period at the start of every season\u003c/strong> — especially in summer — with shorter, less intense practices that will help their bodies adjust to the big shifts in heat and exertion of a full game or regular practice.\u003c/p>\n\u003cp>\u003cstrong>4. Cool the victim of a heat stroke immediately, even before transport to the hospital.\u003c/strong>\"You've got to get their body temperature down to under 104 degrees within 30 minutes of collapse if you want to save somebody's life,\" Casa says. The guidelines recommend\u003ca href=\"http://ksi.uconn.edu/ksi/assets/File/CWI%20cooling%20guidelines.pdf\">immersion in ice cold water\u003c/a>. \"Every high school has ice and water, and the tank costs $150,\" Casa says. \"It's worth it.\"\u003c/p>\n\u003cp>\u003cstrong>5. Recommend that all players, especially any \"performing intense physical activity,\" check with their doctor to see if they carry the sickle cell trait.\u003c/strong> All newborns in the U.S. these days are screened for the sickle cell gene, so the player's pediatrician may have the results on file. (Note that people with sickle cell disease inherit two copies of the gene responsible for the illness; those with one copy of the gene are said to have the sickle cell trait — a condition that is usually benign. Rarely, though, according to the American Society of Hematology, \"extreme conditions such as severe dehydration and high-intensity physical activity,\" can prompt serious health issues, including sudden death.) Casa's guidelines stop short of suggesting mandatory screening of all athletes for \u003ca href=\"http://www.cdc.gov/ncbddd/sicklecell/traits.html\" target=\"_blank\">the trait\u003c/a>. The NCAA requires college athletes who want to play at the Division I or Division II level to have the test or sign a written release. As Shots \u003ca href=\"http://www.npr.org/blogs/health/2012/01/26/145923225/blood-doctors-call-foul-on-ncaas-screening-for-sickle-cell\" target=\"_blank\">described in a post\u003c/a> last year, the NCAA's mandatory testing of athletes for the sickle cell trait is controversial.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Casa says it's important to alert anyone overseeing athletic activity that shortness of breath, muscle pain or cramping, low back pain and difficulty recovering from exercise could be signaling the rare but serious \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/3627196\">exertional sickling crisis\u003c/a> (particularly at high altitudes, or during heat waves, or during the sport season's first days of heavy exertion). High schools that carefully follow the rules regarding hydration and gradual acclimatization can greatly minimize the chances of the problem developing, Casa says. \"No one who has the sickle cell trait should be denied participation in any sport,\" he adds.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why Sleep Deprivation Makes You Crave Junk Food",
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"content": "\u003cfigure id=\"attachment_14168\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-14168 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/croppedburger-640x498.jpg\" alt=\"People who are sleep deprived had changes in the brain that led them to crave high-calorie foods, study suggests. (Getty Images)\" width=\"640\" height=\"498\">\u003cfigcaption class=\"wp-caption-text\">People who are sleep deprived had changes in the brain that led them to crave high-calorie foods, study suggests. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Science has been pretty strong on connecting sleep deprivation to weight gain. Now a new study from UC Berkeley shows one reason might lie in the brain and how it is affected by sleep deprivation.\u003c/p>\n\u003cp>While \u003ca href=\"http://www.nature.com/ncomms/2013/130806/ncomms3259/full/ncomms3259.html\" target=\"_blank\">the study\u003c/a> was small -- 23 people -- it's certainly intriguing. The recruits were monitored for two individual nights, a week apart. On one night, they got a normal night's sleep (they slept 8.2 hours on average). On the other night, they were not allowed to sleep at all. After they had not slept, the study participants showed a much stronger preference for high-calorie foods, such as pizza and doughnuts, over more healthful choices like strawberries and carrots.\u003c/p>\n\u003cp>In addition, researchers, led by Matthew Walker, a UC Berkeley psychology professor, measured areas of the brain using functional magnetic resonance imaging. The preference for high-calorie foods among the sleep-deprived matched with greater activity in an area of the brain called the amygdala, which the authors say has been \"strongly implicated in governing the motivation to eat.\" At the same time, those who were sleep-deprived had \"significantly reduced activity\" in three areas of the brain that have to deal with decision-making.\u003c!--more-->\u003c/p>\n\u003cp>In other words, it's a double whammy: The sleep-deprived subjects wanted higher-calorie foods and had impaired rational decision-making to overcome those urges.\u003c/p>\n\u003cp>\"This combination of altered brain activity and decision-making may help explain why people who sleep less also tend to be overweight or obese,\" said Walker in a release.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In the study, published Tuesday in the journal Nature Communications, researchers measured the desire for junk food by showing participants pictures of foods and having them rank their desire for each of the 80 foods they were shown. The difference in total calories of foods wanted in the sleep-deprived state vs. the rested state was about 600 calories.\u003c/p>\n\u003cp>And if you're thinking those poor souls who had to stay up all night were probably hungrier, the researchers accounted for that, too. First, those who stayed up all night got a snack, intended to offset the amount of energy they would need to stay awake. In case you're curious, the snack consisted of: Goldfish crackers, Fig Newtons, Ritz peanut butter crackers and an apple.\u003c/p>\n\u003cp>Perhaps more importantly, the participants were asked to rate their hunger, and there was no difference between the two sessions, \"suggesting that the condition of sleep loss, rather than metabolic need or hunger, acts as a primary factor influencing the observed changes,\" the authors write.\u003c/p>\n\u003cp>Still, as they say in science, more research is needed. Walker and his colleagues point to areas for further investigation. First, instead of showing subjects pictures of food, study participants could be allowed to eat what they want to see if high-calorie food would \"normalize the observed brain responses under sleep deprivation,\" they write. In addition, the 23 subjects in this study were young, healthy and lean. \"An important future challenge will be to examine whether similar alterations caused by sleep deprivation are expressed across a broader age and body mass range.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "Science has been pretty strong on connecting sleep deprivation to weight gain. Now a new study from UC Berkeley shows one reason might lie in the brain and how it is affected by sleep deprivation.\r\n\r\nWhile the study was small -- 23 people -- it's certainly intriguing. The recruits were monitored for two individual nights, a week apart. On one night, they get a normal night's sleep (they slept 8.2 hours on average). ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14168\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-14168 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/croppedburger-640x498.jpg\" alt=\"People who are sleep deprived had changes in the brain that led them to crave high-calorie foods, study suggests. (Getty Images)\" width=\"640\" height=\"498\">\u003cfigcaption class=\"wp-caption-text\">People who are sleep deprived had changes in the brain that led them to crave high-calorie foods, study suggests. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Science has been pretty strong on connecting sleep deprivation to weight gain. Now a new study from UC Berkeley shows one reason might lie in the brain and how it is affected by sleep deprivation.\u003c/p>\n\u003cp>While \u003ca href=\"http://www.nature.com/ncomms/2013/130806/ncomms3259/full/ncomms3259.html\" target=\"_blank\">the study\u003c/a> was small -- 23 people -- it's certainly intriguing. The recruits were monitored for two individual nights, a week apart. On one night, they got a normal night's sleep (they slept 8.2 hours on average). On the other night, they were not allowed to sleep at all. After they had not slept, the study participants showed a much stronger preference for high-calorie foods, such as pizza and doughnuts, over more healthful choices like strawberries and carrots.\u003c/p>\n\u003cp>In addition, researchers, led by Matthew Walker, a UC Berkeley psychology professor, measured areas of the brain using functional magnetic resonance imaging. The preference for high-calorie foods among the sleep-deprived matched with greater activity in an area of the brain called the amygdala, which the authors say has been \"strongly implicated in governing the motivation to eat.\" At the same time, those who were sleep-deprived had \"significantly reduced activity\" in three areas of the brain that have to deal with decision-making.\u003c!--more-->\u003c/p>\n\u003cp>In other words, it's a double whammy: The sleep-deprived subjects wanted higher-calorie foods and had impaired rational decision-making to overcome those urges.\u003c/p>\n\u003cp>\"This combination of altered brain activity and decision-making may help explain why people who sleep less also tend to be overweight or obese,\" said Walker in a release.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In the study, published Tuesday in the journal Nature Communications, researchers measured the desire for junk food by showing participants pictures of foods and having them rank their desire for each of the 80 foods they were shown. The difference in total calories of foods wanted in the sleep-deprived state vs. the rested state was about 600 calories.\u003c/p>\n\u003cp>And if you're thinking those poor souls who had to stay up all night were probably hungrier, the researchers accounted for that, too. First, those who stayed up all night got a snack, intended to offset the amount of energy they would need to stay awake. In case you're curious, the snack consisted of: Goldfish crackers, Fig Newtons, Ritz peanut butter crackers and an apple.\u003c/p>\n\u003cp>Perhaps more importantly, the participants were asked to rate their hunger, and there was no difference between the two sessions, \"suggesting that the condition of sleep loss, rather than metabolic need or hunger, acts as a primary factor influencing the observed changes,\" the authors write.\u003c/p>\n\u003cp>Still, as they say in science, more research is needed. Walker and his colleagues point to areas for further investigation. First, instead of showing subjects pictures of food, study participants could be allowed to eat what they want to see if high-calorie food would \"normalize the observed brain responses under sleep deprivation,\" they write. In addition, the 23 subjects in this study were young, healthy and lean. \"An important future challenge will be to examine whether similar alterations caused by sleep deprivation are expressed across a broader age and body mass range.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Yes, Even Pre-Schoolers at Risk of Obesity from Sugary Drinks",
"title": "Yes, Even Pre-Schoolers at Risk of Obesity from Sugary Drinks",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_14140\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://www.flickr.com/photos/30974104@N00/1430326746/in/photolist-3boNiY-8pAmUN-5LJ7Ea-6sgAAa-57h9rt-y6Axn-bmg4i8\">\u003cimg class=\"size-large wp-image-14140 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/koolaid-620x496.jpg\" alt=\"The pre-schoolers weren’t necessarily drinking soda. Kool-Aid also is a sugar-sweetened beverage. (Dimmerswitch/Flickr)\" width=\"620\" height=\"496\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The pre-schoolers weren’t necessarily drinking soda. Kool-Aid also is a sugar-sweetened beverage. (Dimmerswitch/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Adults have been studied; \u003ca href=\"http://www.pediatricsdigest.mobi/content/117/3/673.full\" target=\"_blank\">teens\u003c/a> have been studied; other \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1203034\" target=\"_blank\">school-age children \u003c/a>have been studied. And the evidence shows pretty conclusively that sugar-sweetened beverages are linked to increased risk of obesity.\u003c/p>\n\u003cp>But one group has not been studied so much: pre-school aged kids. In a \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/07/31/peds.2013-0570d.abstract\" target=\"_blank\">major new study\u003c/a> released today in the journal Pediatrics, researchers found that, yes, sugar-sweetened beverages also put such very young children at greater risk for obesity.\u003c/p>\n\u003caside class=\"pullquote alignright\">About one in 10 children drank one or more servings of sugar-sweetened beverages daily.\u003c/aside>\n\u003cp>Specifically, researchers followed 9,600 children (in other words, a really big sample) from birth to age 5. It's this kind of \"longitudinal\" approach that gives this study a great deal of research power. \"We were more interested in looking at children over a period of time,\" said lead author Mark DeBoer, in the department of pediatrics at the University of Virginia. He says they wanted to see whether those children who drank sugary drinks were more likely to gain an unhealthy amount of weight over those who didn't.\u003c!--more-->\u003c/p>\n\u003cp>At ages 2, 4, and 5, parents of the children were interviewed in their home and asked about consumption of sugar-sweetened beverages -- defined as \"soda pop (for example, Coke, Pepsi or Mountain Dew), sports drinks (for example, Gatorade) or fruit drinks that are not 100% fruit juice (for example, Kool-Aid, Sunny Delight, Hi-C, Fruitopia, or Fruitworks.\"\u003c/p>\n\u003cp>About one in ten of these 9,600 children drank one or more servings of sugar-sweetened beverages daily. Those children \"were more likely to gain weight between 2 and 4 years of age than those who didn't,\" says DeBoer. \"They were more likely to become obese over that time frame.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Not surprisingly, as time went on, the worse it got. By the time the kids hit age 5, \"those who consistently drank sugar-sweetened beverages were the heaviest group,\" DeBoer said.\u003c/p>\n\u003cp>While the researchers adjusted for variables including socioeconomic status, race, television viewing habits and more, they still found a \"clear linear relationship\" between the amount of sugary drinks consumed and the \"\u003ca href=\"http://www.noo.org.uk/uploads/doc/vid_11601_A_simple_guide_to_classifying_BMI_in_children.pdf\" target=\"_blank\">BMI z score\u003c/a>,\" a special body mass index to assess weight in children.\u003c/p>\n\u003cp>In addition, children who regularly drink sugar-sweetened beverages consumer 17 to 20 percent more calories. \"We also found it notable,\" the authors write, \"that children drinking > SSB serving daily were more likely than infrequent/nondrinkers to watch >2 hours of television daily.\"\u003c/p>\n\u003cp>The authors advise parents to give children only calorie-free drinks and milk to drink to help avoid excess weight gain. In an \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/07/31/peds.2013-1799.extract\" target=\"_blank\">accompanying editorial\u003c/a>, researchers from UC San Francisco and UC Berkeley call for policy changes to cut down on sugar-sweetened beverages in young children.'\u003c/p>\n\u003cp>They note that more than 80 percent of U.S. school districts have policies prohibiting or limiting students' access to these drinks, there are few similar policies for pre-schools or childcare facilities. California, however, is a leader in this regard. In 2010, the California legislature passed \u003ca href=\"http://www.leginfo.ca.gov/pub/09-10/bill/asm/ab_2051-2100/ab_2084_bill_20100930_chaptered.html\" target=\"_blank\">AB 2084\u003c/a> which requires child care facilities to make water available during the day and prohibits serving drinks with added sugar.\u003c/p>\n\u003cp>These are some of the most \"stringent regulations\" for child care facilities right now, UCSF's Anisha Patel noted, putting the issue on the national agenda. \"Hopefully it will spread across the country,\" she added.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Patel and co-author Lorrene Ritchie also make a case for adding limits on sugar-sweetened beverages in the U.S. \u003ca href=\"http://www.choosemyplate.gov/dietary-guidelines.html\" target=\"_blank\">dietary guidelines\u003c/a>. \"Provide concrete messages (i.e., limit your child's sugar drinks to no more than once a week) to help families\" clearly understand the message, they say. They also believe the federal guidelines should \"promote water as the first beverage of choice for thirst.\"\u003c/p>\n\n",
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"excerpt": "Adults have been studied; teens have been studied; other school-age children have been studied. And the evidence shows pretty conclusively that sugar-sweetened beverages are linked to increased risk of obesity.\r\n\r\nBut one group has not been studied so much: pre-school aged kids. In a major new study released today in the journal Pediatrics, researchers found that, yes, sugar-sweetened beverages also put such very young children at greater risk for obesity.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14140\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://www.flickr.com/photos/30974104@N00/1430326746/in/photolist-3boNiY-8pAmUN-5LJ7Ea-6sgAAa-57h9rt-y6Axn-bmg4i8\">\u003cimg class=\"size-large wp-image-14140 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/koolaid-620x496.jpg\" alt=\"The pre-schoolers weren’t necessarily drinking soda. Kool-Aid also is a sugar-sweetened beverage. (Dimmerswitch/Flickr)\" width=\"620\" height=\"496\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The pre-schoolers weren’t necessarily drinking soda. Kool-Aid also is a sugar-sweetened beverage. (Dimmerswitch/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Adults have been studied; \u003ca href=\"http://www.pediatricsdigest.mobi/content/117/3/673.full\" target=\"_blank\">teens\u003c/a> have been studied; other \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1203034\" target=\"_blank\">school-age children \u003c/a>have been studied. And the evidence shows pretty conclusively that sugar-sweetened beverages are linked to increased risk of obesity.\u003c/p>\n\u003cp>But one group has not been studied so much: pre-school aged kids. In a \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/07/31/peds.2013-0570d.abstract\" target=\"_blank\">major new study\u003c/a> released today in the journal Pediatrics, researchers found that, yes, sugar-sweetened beverages also put such very young children at greater risk for obesity.\u003c/p>\n\u003caside class=\"pullquote alignright\">About one in 10 children drank one or more servings of sugar-sweetened beverages daily.\u003c/aside>\n\u003cp>Specifically, researchers followed 9,600 children (in other words, a really big sample) from birth to age 5. It's this kind of \"longitudinal\" approach that gives this study a great deal of research power. \"We were more interested in looking at children over a period of time,\" said lead author Mark DeBoer, in the department of pediatrics at the University of Virginia. He says they wanted to see whether those children who drank sugary drinks were more likely to gain an unhealthy amount of weight over those who didn't.\u003c!--more-->\u003c/p>\n\u003cp>At ages 2, 4, and 5, parents of the children were interviewed in their home and asked about consumption of sugar-sweetened beverages -- defined as \"soda pop (for example, Coke, Pepsi or Mountain Dew), sports drinks (for example, Gatorade) or fruit drinks that are not 100% fruit juice (for example, Kool-Aid, Sunny Delight, Hi-C, Fruitopia, or Fruitworks.\"\u003c/p>\n\u003cp>About one in ten of these 9,600 children drank one or more servings of sugar-sweetened beverages daily. Those children \"were more likely to gain weight between 2 and 4 years of age than those who didn't,\" says DeBoer. \"They were more likely to become obese over that time frame.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Not surprisingly, as time went on, the worse it got. By the time the kids hit age 5, \"those who consistently drank sugar-sweetened beverages were the heaviest group,\" DeBoer said.\u003c/p>\n\u003cp>While the researchers adjusted for variables including socioeconomic status, race, television viewing habits and more, they still found a \"clear linear relationship\" between the amount of sugary drinks consumed and the \"\u003ca href=\"http://www.noo.org.uk/uploads/doc/vid_11601_A_simple_guide_to_classifying_BMI_in_children.pdf\" target=\"_blank\">BMI z score\u003c/a>,\" a special body mass index to assess weight in children.\u003c/p>\n\u003cp>In addition, children who regularly drink sugar-sweetened beverages consumer 17 to 20 percent more calories. \"We also found it notable,\" the authors write, \"that children drinking > SSB serving daily were more likely than infrequent/nondrinkers to watch >2 hours of television daily.\"\u003c/p>\n\u003cp>The authors advise parents to give children only calorie-free drinks and milk to drink to help avoid excess weight gain. In an \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/07/31/peds.2013-1799.extract\" target=\"_blank\">accompanying editorial\u003c/a>, researchers from UC San Francisco and UC Berkeley call for policy changes to cut down on sugar-sweetened beverages in young children.'\u003c/p>\n\u003cp>They note that more than 80 percent of U.S. school districts have policies prohibiting or limiting students' access to these drinks, there are few similar policies for pre-schools or childcare facilities. California, however, is a leader in this regard. In 2010, the California legislature passed \u003ca href=\"http://www.leginfo.ca.gov/pub/09-10/bill/asm/ab_2051-2100/ab_2084_bill_20100930_chaptered.html\" target=\"_blank\">AB 2084\u003c/a> which requires child care facilities to make water available during the day and prohibits serving drinks with added sugar.\u003c/p>\n\u003cp>These are some of the most \"stringent regulations\" for child care facilities right now, UCSF's Anisha Patel noted, putting the issue on the national agenda. \"Hopefully it will spread across the country,\" she added.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Patel and co-author Lorrene Ritchie also make a case for adding limits on sugar-sweetened beverages in the U.S. \u003ca href=\"http://www.choosemyplate.gov/dietary-guidelines.html\" target=\"_blank\">dietary guidelines\u003c/a>. \"Provide concrete messages (i.e., limit your child's sugar drinks to no more than once a week) to help families\" clearly understand the message, they say. They also believe the federal guidelines should \"promote water as the first beverage of choice for thirst.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "When Treating ‘Stage Zero Breast Cancer,’ Can Less Be More? ",
"title": "When Treating ‘Stage Zero Breast Cancer,’ Can Less Be More? ",
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"content": "\u003cp>By Patti Neighmond and Richard Knox, \u003ca href=\"http://www.npr.org/blogs/health/2013/08/05/208239545/when-treating-abnormal-breast-cells-sometimes-less-is-more\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_14089\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-14089\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/tonigreaves_npr-peggymacdonald-0068-3000_custom-b670792b14b188500fd97e8ce18ac89bef6425bb-s40-620x412.jpg\" alt=\"Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.\" width=\"620\" height=\"412\">\u003cfigcaption class=\"wp-caption-text\">Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cp>When Sally O'Neill's doctor told her she had an early form of cancer in one of her breasts, she didn't agonize about what she wanted to.\u003c/p>\n\u003cp>The 42-year-old mother of two young girls wanted a double mastectomy.\u003c/p>\n\u003caside class=\"pullquote alignleft\">In many cases it doesn't ever progress to invasive cancer, the type that can be life-threatening.\u003c/aside>\n\u003cp>\"I decided at that moment that I wanted them both taken off,\" says O'Neill, who lives in a suburb of Boston. \"There wasn't a real lot of thought process to it. I always thought, 'If this happens to me, this is what I'm going to do.' Because I'm not taking any chances. I want the best possible outcome. I don't want to do a wait-and-see.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Today, 10 years later, O'Neill has no regrets about what most people would consider a radical decision. And as it turns out, she was at the leading edge of a \u003ca href=\"http://www.npr.org/blogs/health/2012/11/28/166064484/more-women-choose-double-mastectomy-but-study-says-many-dont-need-it\">trend\u003c/a>.\u003c/p>\n\u003cp>O'Neill had \u003ca href=\"http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page4\">ductal carcinoma in situ, or DCIS\u003c/a>. The number of women who get double mastectomies because of DCIS is small – around one in 16 women (see accompanying chart). But the rate has doubled in the past 10 years.\u003c!--more-->\u003c/p>\n\u003cp>DCIS is an abnormality that most specialists call \"stage zero\" breast cancer – on a scale of 1 to 4. In many cases it doesn't ever progress to invasive cancer, the type that can be life-threatening.\u003c/p>\n\u003cp>These women are in a very different position than actress Angelina Jolie,who recently chose to have a double mastectomy. She has a gene mutation that gives her a very high risk of breast cancer. \u003ca href=\"http://www.npr.org/blogs/health/2012/11/28/166064484/more-women-choose-double-mastectomy-but-study-says-many-dont-need-it\">Research shows\u003c/a>\u003cdel>\u003c/del> many of the women choosing double mastectomy have the same diagnosis as O'Neill, not Jolie.\u003cdel>\u003c/del>\u003c/p>\n\u003cp>The debate over appropriate treatment for DCIS is part of an even bigger debate about what many specialists call the \"over\u003cdel>\u003c/del>diagnosis\" of cancer, especially cancers of the breast, prostate and thyroid.\u003c/p>\n\u003cp>This means the discovery of growths that look like cancer, but are not destined to cause the patient a problem if they go untreated.\u003c/p>\n\u003cp>The National Cancer Institute recently convened a group to look at overdiagnosis and overtreatment of cancer. \u003cem>JAMA\u003c/em>, the journal of the American Medical Association, last week \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/07/29/cutting-down-on-cancer-overdiagnosis-national-panel-weighs-in/\" target=\"_blank\">published a summary\u003c/a> of its conclusions.\u003c/p>\n\u003cp>Overdiagnosis is a product of widespread screening programs that look for cancers before they cause symptoms, on the assumption that early treatment will invariably reduce the chance that a cancer will kill. There's growing evidence that's not necessarily true.\u003c/p>\n\u003cp>Routine mammography and PSA screening for prostate cancer are thought to reveal many malignancies that wouldn't show up otherwise. And many doctors worry that a federal task force's new recommendation to increase\u003ca href=\"http://www.npr.org/blogs/health/2013/07/31/206693913/panel-urges-lung-cancer-screening-for-millions-of-americans\"> screening with CT scans to look for early lung cancer\u003c/a> will also lead to overdiagnosis.\u003c/p>\n\u003cp>Stepping back further, the issues of cancer over\u003cdel>\u003c/del>diagnosis and overtreatment are part of an even bigger concern about unnecessary medical care. It's a problem NPR intends to explore in coming months as part of a series we're calling \"Less Is More.\" The series will focus on situations when less treatment may actually be better for patients.\u003c/p>\n\u003cp>DCIS is a touch point of the over\u003cdel>\u003c/del>diagnosis debate. Nearly 70,000 women are diagnosed with it each year. Before mammography screening, only about 3 percent of breast cancers were DCIS. Now the condition accounts for \u003ca href=\"http://www2.mdanderson.org/depts/oncolog/articles/10/1-jan/1-10-compass.html\">about a third\u003c/a> of all \"breast cancers.\"\u003c/p>\n\u003cp>The reason for those quote marks is that, while most cancer doctors view DCIS as a very early stage of breast cancer, a growing number say it really shouldn't be called \"cancer\" at all.\u003c/p>\n\u003cp>DCIS is an overgrowth of cells within the lining of a woman's milk ducts. Such growths are not dangerous unless and until they break through and invade other breast tissue and ultimately spread to lymph nodes and other organs.\u003c/p>\n\u003cp>\"Many of these precancerous lesions are not going to go on to become cancer,\" says Dr. Laura Esserman, a breast cancer surgeon at the UC San Francisco. \"I don't think we should label it as cancer. I think we should call it a 'ductal lesion.' I think people would be much more willing to be calm about it.\"\u003c/p>\n\u003cp>We'll come back to Esserman's ideas about how woman and their doctors should address DCIS. But first, let's go back to Sally O'Neill; her case capsulizes the dilemma.\u003c/p>\n\u003cfigure id=\"attachment_14087\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003cimg class=\"size-full wp-image-14087\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/breast-cancer-300.png\" alt=\"Treatment options by women diagnosed with DCIS. Source: Laura Esserman, UC San Francisco (Chart/NPR)\" width=\"300\" height=\"165\">\u003cfigcaption class=\"wp-caption-text\">Treatment options by women diagnosed with DCIS. Source: Laura Esserman, UC San Francisco (Chart/NPR)\u003c/figcaption>\u003c/figure>\n\u003cp>Her decision to have a double mastectomy, even though she had DCIS in only one breast, was so radical that the first surgeon she consulted refused to do it without a letter from a psychiatrist. \"His exact words were, 'You're cancer-phobic,'\" she says.\u003c/p>\n\u003cp>So she found a different surgeon, Dr. Kevin Hughes at Massachusetts General Hospital. When it comes to treating DCIS, Hughes errs on the side of caution.\u003c/p>\n\u003cp>\"We don't know what percent are not deadly, and we have no idea which patients do or do not have a deadly form of cancer,\" Hughes says. \"So as a surgeon I need to treat every cancer as if it might be deadly, because I don't know which ones are and which ones aren't.\"\u003c/p>\n\u003cp>Hughes does not advocate removing a healthy breast that doesn't have any DCIS. But he'll do it if he thinks a woman wants it for the right reasons.\u003c/p>\n\u003cp>\"If they want to take the opposite breast off to never experience breast cancer again, that ... is a good reason to do it,\" Hughes says. \"If they are taking their opposite breast off so they will live longer, that's not a good reason to take the opposite breast off.\"\u003c/p>\n\u003cp>This is a critical point. Many women – perhaps assuming all breast cancers are dangerous – may believe that removing the healthy breast after a diagnosis of DCIS improves their chances of survival.\u003c/p>\n\u003cp>But DCIS is nearly 100 percent curable. Typically, the treatment is a small operation called \u003ca href=\"http://www.breastcancer.org/treatment/surgery/lumpectomy\">lumpectomy\u003c/a>, often but not always followed by radiation to the area. (About a quarter of women with DCIS have a single mastectomy, usually because the abnormal growth occupies too great a percentage of the breast to make lumpectomy feasible.)\u003c/p>\n\u003cp>The chance of DCIS later appearing in the opposite breast is not precisely known, but is thought to be well under 1 percent per year. And Hughes points out that if DCIS does appear in the second breast – or even if invasive cancer turns up –it would likely be highly curable, too.\u003c/p>\n\u003cp>\"We normally find it at a very early, very curable stage,\" Hughes says. \"We very seldom have patients die from cancer in the opposite breast.\"\u003c/p>\n\u003cp>Some say concern about survival is not the only thing that's driving some women to seek a double mastectomy.\u003c/p>\n\u003cp>Patients may be distressed about the experience of breast cancer diagnosis and treatment and have a \"very strong aversion\" to going through it again, Seema Khan of Northwestern University writes in a \u003ca href=\"http://jco.ascopubs.org/content/29/16/2132.full.pdf\">commentary\u003c/a> in the \u003cem>Journal of Clinical Oncology\u003c/em>.\u003c/p>\n\u003cp>Whatever their reasons, some patients and some doctors are pushing back against what they consider too much treatment for DCIS.\u003c/p>\n\u003cp>Peggy MacDonald of Portland, Ore., is one of those patients. She was stunned after she recently got a diagnosis of DCIS and discovered that all the doctors she saw thought she should have surgery to remove it – right away.\u003c/p>\n\u003cp>\"Quite honestly,\" she says, \"I just didn't like the options being presented to me. It didn't ... make sense to me.\"\u003c/p>\n\u003cp>None of the surgeons recommended that MacDonald should remove her healthy breast, but all agreed she should have surgery. She was almost ready to give in when one of her sisters sent her an article quoting Esserman, the San Francisco breast surgeon.\u003c/p>\n\u003cp>MacDonald made an appointment to see Esserman, and discovered a different approach.\u003c/p>\n\u003cp>\"She said, 'OK, I've looked at your MRI, I've looked at your mammograms, I've looked at your blood tests. Here's what I will tell you – this is not an emergency and you have options,'\" MacDonald says.\u003c/p>\n\u003cp>Esserman stresses there's no need for women to rush into surgery after a DCIS diagnosis.\u003c/p>\n\u003cp>\"I think we all need to take a step back and not be so hysterical,\" Esserman says. \"When I see people who've been told they've got to make a decision within two weeks, that's just crazy! No one has shown a progression [from DCIS] to invasive cancer in a two-week period of time – ever.\"\u003c/p>\n\u003cp>After seeing Esserman, MacDonald decided not to have surgery, at least for now. Instead, the doctor put her on \u003ca href=\"http://www.breastcancer.org/treatment/hormonal\">hormone suppression therapy\u003c/a>. McDonald now takes a drug that blocks estrogen. Because her DCIS cells are fueled by estrogen, the hope is that once they are starved of the hormone the cells will shrink and perhaps even disappear.\u003c/p>\n\u003cp>MacDonald says she realizes she may end up needing surgery anyway, but if so she'll be clearer about the decision.\u003c/p>\n\u003cp>She's hoping her case will turn out like another of Esserman's patients, Barbara Mann. Mann took an estrogen-blocking medication as well, for six months. Today, an MRI scan and biopsy show no trace of DCIS in her breast.\u003c/p>\n\u003cp>\"It's amazing,\" Mann says. \"It's not even a case of less-is-more. This is a case of less-is-best. I am just hugely relieved, absolutely thrilled. And what I would really like is for every other woman in my position to know this is an option.\"\u003c/p>\n\u003cp>But it's an option that will require lifelong vigilance. Anyone who chooses not to have surgery will have to be watched carefully and have routine mammograms and maybe even MRI scans and biopsies.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And women who choose this alternate route must be willing to live with the risk, however tiny, that DCIS might return, and might turn into invasive cancer.\u003c/p>\n\n",
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"excerpt": "DCIS is a touch point of the overdiagnosis debate. Nearly 70,000 women are diagnosed with it each year. Before mammography screening, only about 3 percent of breast cancers were DCIS. Now the condition accounts for about a third of all \"breast cancers.\"\r\n\r\nThe reason for those quote marks is that, while most cancer doctors view DCIS as a very early stage of breast cancer, a growing number say it really shouldn't be called \"cancer\" at all.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Patti Neighmond and Richard Knox, \u003ca href=\"http://www.npr.org/blogs/health/2013/08/05/208239545/when-treating-abnormal-breast-cells-sometimes-less-is-more\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_14089\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-14089\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/tonigreaves_npr-peggymacdonald-0068-3000_custom-b670792b14b188500fd97e8ce18ac89bef6425bb-s40-620x412.jpg\" alt=\"Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.\" width=\"620\" height=\"412\">\u003cfigcaption class=\"wp-caption-text\">Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cp>When Sally O'Neill's doctor told her she had an early form of cancer in one of her breasts, she didn't agonize about what she wanted to.\u003c/p>\n\u003cp>The 42-year-old mother of two young girls wanted a double mastectomy.\u003c/p>\n\u003caside class=\"pullquote alignleft\">In many cases it doesn't ever progress to invasive cancer, the type that can be life-threatening.\u003c/aside>\n\u003cp>\"I decided at that moment that I wanted them both taken off,\" says O'Neill, who lives in a suburb of Boston. \"There wasn't a real lot of thought process to it. I always thought, 'If this happens to me, this is what I'm going to do.' Because I'm not taking any chances. I want the best possible outcome. I don't want to do a wait-and-see.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Today, 10 years later, O'Neill has no regrets about what most people would consider a radical decision. And as it turns out, she was at the leading edge of a \u003ca href=\"http://www.npr.org/blogs/health/2012/11/28/166064484/more-women-choose-double-mastectomy-but-study-says-many-dont-need-it\">trend\u003c/a>.\u003c/p>\n\u003cp>O'Neill had \u003ca href=\"http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page4\">ductal carcinoma in situ, or DCIS\u003c/a>. The number of women who get double mastectomies because of DCIS is small – around one in 16 women (see accompanying chart). But the rate has doubled in the past 10 years.\u003c!--more-->\u003c/p>\n\u003cp>DCIS is an abnormality that most specialists call \"stage zero\" breast cancer – on a scale of 1 to 4. In many cases it doesn't ever progress to invasive cancer, the type that can be life-threatening.\u003c/p>\n\u003cp>These women are in a very different position than actress Angelina Jolie,who recently chose to have a double mastectomy. She has a gene mutation that gives her a very high risk of breast cancer. \u003ca href=\"http://www.npr.org/blogs/health/2012/11/28/166064484/more-women-choose-double-mastectomy-but-study-says-many-dont-need-it\">Research shows\u003c/a>\u003cdel>\u003c/del> many of the women choosing double mastectomy have the same diagnosis as O'Neill, not Jolie.\u003cdel>\u003c/del>\u003c/p>\n\u003cp>The debate over appropriate treatment for DCIS is part of an even bigger debate about what many specialists call the \"over\u003cdel>\u003c/del>diagnosis\" of cancer, especially cancers of the breast, prostate and thyroid.\u003c/p>\n\u003cp>This means the discovery of growths that look like cancer, but are not destined to cause the patient a problem if they go untreated.\u003c/p>\n\u003cp>The National Cancer Institute recently convened a group to look at overdiagnosis and overtreatment of cancer. \u003cem>JAMA\u003c/em>, the journal of the American Medical Association, last week \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/07/29/cutting-down-on-cancer-overdiagnosis-national-panel-weighs-in/\" target=\"_blank\">published a summary\u003c/a> of its conclusions.\u003c/p>\n\u003cp>Overdiagnosis is a product of widespread screening programs that look for cancers before they cause symptoms, on the assumption that early treatment will invariably reduce the chance that a cancer will kill. There's growing evidence that's not necessarily true.\u003c/p>\n\u003cp>Routine mammography and PSA screening for prostate cancer are thought to reveal many malignancies that wouldn't show up otherwise. And many doctors worry that a federal task force's new recommendation to increase\u003ca href=\"http://www.npr.org/blogs/health/2013/07/31/206693913/panel-urges-lung-cancer-screening-for-millions-of-americans\"> screening with CT scans to look for early lung cancer\u003c/a> will also lead to overdiagnosis.\u003c/p>\n\u003cp>Stepping back further, the issues of cancer over\u003cdel>\u003c/del>diagnosis and overtreatment are part of an even bigger concern about unnecessary medical care. It's a problem NPR intends to explore in coming months as part of a series we're calling \"Less Is More.\" The series will focus on situations when less treatment may actually be better for patients.\u003c/p>\n\u003cp>DCIS is a touch point of the over\u003cdel>\u003c/del>diagnosis debate. Nearly 70,000 women are diagnosed with it each year. Before mammography screening, only about 3 percent of breast cancers were DCIS. Now the condition accounts for \u003ca href=\"http://www2.mdanderson.org/depts/oncolog/articles/10/1-jan/1-10-compass.html\">about a third\u003c/a> of all \"breast cancers.\"\u003c/p>\n\u003cp>The reason for those quote marks is that, while most cancer doctors view DCIS as a very early stage of breast cancer, a growing number say it really shouldn't be called \"cancer\" at all.\u003c/p>\n\u003cp>DCIS is an overgrowth of cells within the lining of a woman's milk ducts. Such growths are not dangerous unless and until they break through and invade other breast tissue and ultimately spread to lymph nodes and other organs.\u003c/p>\n\u003cp>\"Many of these precancerous lesions are not going to go on to become cancer,\" says Dr. Laura Esserman, a breast cancer surgeon at the UC San Francisco. \"I don't think we should label it as cancer. I think we should call it a 'ductal lesion.' I think people would be much more willing to be calm about it.\"\u003c/p>\n\u003cp>We'll come back to Esserman's ideas about how woman and their doctors should address DCIS. But first, let's go back to Sally O'Neill; her case capsulizes the dilemma.\u003c/p>\n\u003cfigure id=\"attachment_14087\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003cimg class=\"size-full wp-image-14087\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/breast-cancer-300.png\" alt=\"Treatment options by women diagnosed with DCIS. Source: Laura Esserman, UC San Francisco (Chart/NPR)\" width=\"300\" height=\"165\">\u003cfigcaption class=\"wp-caption-text\">Treatment options by women diagnosed with DCIS. Source: Laura Esserman, UC San Francisco (Chart/NPR)\u003c/figcaption>\u003c/figure>\n\u003cp>Her decision to have a double mastectomy, even though she had DCIS in only one breast, was so radical that the first surgeon she consulted refused to do it without a letter from a psychiatrist. \"His exact words were, 'You're cancer-phobic,'\" she says.\u003c/p>\n\u003cp>So she found a different surgeon, Dr. Kevin Hughes at Massachusetts General Hospital. When it comes to treating DCIS, Hughes errs on the side of caution.\u003c/p>\n\u003cp>\"We don't know what percent are not deadly, and we have no idea which patients do or do not have a deadly form of cancer,\" Hughes says. \"So as a surgeon I need to treat every cancer as if it might be deadly, because I don't know which ones are and which ones aren't.\"\u003c/p>\n\u003cp>Hughes does not advocate removing a healthy breast that doesn't have any DCIS. But he'll do it if he thinks a woman wants it for the right reasons.\u003c/p>\n\u003cp>\"If they want to take the opposite breast off to never experience breast cancer again, that ... is a good reason to do it,\" Hughes says. \"If they are taking their opposite breast off so they will live longer, that's not a good reason to take the opposite breast off.\"\u003c/p>\n\u003cp>This is a critical point. Many women – perhaps assuming all breast cancers are dangerous – may believe that removing the healthy breast after a diagnosis of DCIS improves their chances of survival.\u003c/p>\n\u003cp>But DCIS is nearly 100 percent curable. Typically, the treatment is a small operation called \u003ca href=\"http://www.breastcancer.org/treatment/surgery/lumpectomy\">lumpectomy\u003c/a>, often but not always followed by radiation to the area. (About a quarter of women with DCIS have a single mastectomy, usually because the abnormal growth occupies too great a percentage of the breast to make lumpectomy feasible.)\u003c/p>\n\u003cp>The chance of DCIS later appearing in the opposite breast is not precisely known, but is thought to be well under 1 percent per year. And Hughes points out that if DCIS does appear in the second breast – or even if invasive cancer turns up –it would likely be highly curable, too.\u003c/p>\n\u003cp>\"We normally find it at a very early, very curable stage,\" Hughes says. \"We very seldom have patients die from cancer in the opposite breast.\"\u003c/p>\n\u003cp>Some say concern about survival is not the only thing that's driving some women to seek a double mastectomy.\u003c/p>\n\u003cp>Patients may be distressed about the experience of breast cancer diagnosis and treatment and have a \"very strong aversion\" to going through it again, Seema Khan of Northwestern University writes in a \u003ca href=\"http://jco.ascopubs.org/content/29/16/2132.full.pdf\">commentary\u003c/a> in the \u003cem>Journal of Clinical Oncology\u003c/em>.\u003c/p>\n\u003cp>Whatever their reasons, some patients and some doctors are pushing back against what they consider too much treatment for DCIS.\u003c/p>\n\u003cp>Peggy MacDonald of Portland, Ore., is one of those patients. She was stunned after she recently got a diagnosis of DCIS and discovered that all the doctors she saw thought she should have surgery to remove it – right away.\u003c/p>\n\u003cp>\"Quite honestly,\" she says, \"I just didn't like the options being presented to me. It didn't ... make sense to me.\"\u003c/p>\n\u003cp>None of the surgeons recommended that MacDonald should remove her healthy breast, but all agreed she should have surgery. She was almost ready to give in when one of her sisters sent her an article quoting Esserman, the San Francisco breast surgeon.\u003c/p>\n\u003cp>MacDonald made an appointment to see Esserman, and discovered a different approach.\u003c/p>\n\u003cp>\"She said, 'OK, I've looked at your MRI, I've looked at your mammograms, I've looked at your blood tests. Here's what I will tell you – this is not an emergency and you have options,'\" MacDonald says.\u003c/p>\n\u003cp>Esserman stresses there's no need for women to rush into surgery after a DCIS diagnosis.\u003c/p>\n\u003cp>\"I think we all need to take a step back and not be so hysterical,\" Esserman says. \"When I see people who've been told they've got to make a decision within two weeks, that's just crazy! No one has shown a progression [from DCIS] to invasive cancer in a two-week period of time – ever.\"\u003c/p>\n\u003cp>After seeing Esserman, MacDonald decided not to have surgery, at least for now. Instead, the doctor put her on \u003ca href=\"http://www.breastcancer.org/treatment/hormonal\">hormone suppression therapy\u003c/a>. McDonald now takes a drug that blocks estrogen. Because her DCIS cells are fueled by estrogen, the hope is that once they are starved of the hormone the cells will shrink and perhaps even disappear.\u003c/p>\n\u003cp>MacDonald says she realizes she may end up needing surgery anyway, but if so she'll be clearer about the decision.\u003c/p>\n\u003cp>She's hoping her case will turn out like another of Esserman's patients, Barbara Mann. Mann took an estrogen-blocking medication as well, for six months. Today, an MRI scan and biopsy show no trace of DCIS in her breast.\u003c/p>\n\u003cp>\"It's amazing,\" Mann says. \"It's not even a case of less-is-more. This is a case of less-is-best. I am just hugely relieved, absolutely thrilled. And what I would really like is for every other woman in my position to know this is an option.\"\u003c/p>\n\u003cp>But it's an option that will require lifelong vigilance. Anyone who chooses not to have surgery will have to be watched carefully and have routine mammograms and maybe even MRI scans and biopsies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And women who choose this alternate route must be willing to live with the risk, however tiny, that DCIS might return, and might turn into invasive cancer.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
"airtime": "SAT 4pm-5pm",
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"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"order": 16
},
"link": "/podcasts/rightnowish",
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