According to dietician Elena Solomatina, overeating can have fatal consequences. Internal organs often suffer, as the swollen stomach presses on the diaphragm, which can even lead to death during sleep. Existing medical conditions can also worsen, causing belching, gastritis, and inflamed gallbladder. "If a person sleeps with a full stomach, it can lead to snoring and even to stopping breathing during sleep. If there are already cardiovascular diseases, it can lead to heart failure, angina, and even a heart attack or stroke... If there is nausea, vomiting with greenish content, weakness - an ambulance must be called," Solomatina was quoted as saying by URA.RU. To reduce the risk of aggravating old illnesses and let the food lump pass, it is necessary to take a walk in the fresh air. Afterwards, it is recommended to prepare a caffeine-containing beverage that can act as a mild laxative.

Neurologist-vertebrologist and manual therapy specialist, Professor of the UnitelmaSapienza Roman University and the UniCamillus International Medical University, Jalal Saidbegov, explains why sitting cross-legged can have a negative impact on the health of the spine. This position can cause a disruption of the anatomical structures of the intervertebral disc, which can lead to the development of protrusions and hernias in the lumbar region. Even for healthy individuals, this position is not very beneficial, so it should not be abused. However, there are a number of recommendations that can help reduce the risk of negative consequences: If you cannot avoid this position, try not to sit in it for a long time and not use it too often. Try to sit in this position for no more than five minutes, after which switch legs, making the upper leg the lower one, and vice versa. This will help redistribute the load on the spine and reduce its one-sided tension. Never bend forward or twist when sitting in this position, as this can further increase the load on the intervertebral discs. It is better to spend most of the time sitting in a classic and more useful position, leaning back and resting against the back of the chair, without leaving empty space between the lower back and the lower part of the chair back. Your legs should be able to reach the floor freely. If your chair or armchair is too high, you can use a footrest to achieve a comfortable position.

Makaronina.Ru has compiled a list of natural antidepressants, namely indoor plants that have the ability to positively affect a person's emotional state. One such plant is lavender, whose aroma can help alleviate headaches, anxiety, and stress. The plant's essential oils, which are actively released into the air, can also reduce high blood pressure and combat insomnia. Basil is another plant that can have a positive impact on both the cardiovascular system and emotional state, while lemon is effective in combating stress, anxiety, and tension.

Margarita Koroleva, a professor at the Federal Medical and Biological Agency of Russia, a doctor of medical sciences and a dietician, shared her recommendations regarding the way of cooking vegetables to get the best of them. Some vegetables should be boiled to extract as many nutrients as possible. For example, boiled carrots are better absorbed by the body than raw ones, which allows us to obtain more vitamin A from this vegetable. When tomatoes and red peppers are thermally processed, lycopene, a wonderful antioxidant that is highly beneficial for tissue and blood health, is activated and better absorbed by the body. The specialist also advised people with digestive problems should consume boiled turnip and radish, as their nutrients are better digested by the human body if those vegetables are boiled.

Smoking vapes and electronic cigarettes may lead to the development of a new lung disease that was dubbed as EVALI (E-cigarette and Vaping use-Associated Lung Injury). Research works to study EVALI slowed down with the onset of the coronavirus pandemic due to the similarity of symptoms, whereas the detection rate stopped growing, the Russian Health Ministry said. Symptoms of EVALI similar to those of COVID-19 Symptoms of the new disease are in many ways similar to symptoms of COVID-19. They include:

UCLA investigators have shown that that combining pembrolizumab, an immunotherapy drug, with standard chemotherapy can improve treatment outcomes for patients with small cell bladder cancer and small cell/neuroendocrine prostate cancer.

University of Wisconsin-Madison researchers targeting a group of hereditary neurodegenerative diseases have found success using a gene therapy treatment in an animal model. The approach, which uses CRISPR-Cas9 genome editing technology, offers a unique and promising strategy that could one day treat rare but debilitating motor neuron diseases in humans.

The American Association of Critical-Care Nurses awarded three AACN Impact Research Grants of up to $50,000 each, bringing its total support to more than $1.5 million in funding since 2011.

Catina Latham, PhD, will succeed Brenda Battle as UChicago Medicine's Senior Vice President for Community Health Transformation and Chief Equity Officer

With its large scientific community and engaged leadership, UdeM plays a unique role in advancing and applying the One Health approach to the well-being of humans, animals and ecosystems.

A new study finds that seniors who tend to mirror other people's feelings are more likely to show signs of being anxious or depressed themselves.

Scientists have identified a molecule that appears to restore normal breathing in mice following a large dose of fentanyl.

A radioterapia tem sido usada para tratar o cancer desde o inicio do seculo 20. Este tipo de tratamento continua sendo um dos tratamentos mais eficazes para tumores cerebrais cancerigenos (malignos) e nao cancerigenos (benignos). A forma como ele e ministrado -- e a tecnologia utilizada -- continuou evoluindo e melhorando.

استُخدم العلاج الإشعاعي لعلاج مرض السرطان منذ بدايات القرن العشرين. ولا يزال هذا النوع من العلاج واحد من العلاجات الأكثر فاعلية للقضاء على الأورام الدماغية السرطانية (الخبيثة) وغير السرطانية (الحميدة). تقول د. جينيفر بيترسون، طبيبة العلاج الإشعاعي في مايو كلينك بجاكسونفيل، فلوريدا، "إن طرق وأجهزة العلاج الإشعاعي لا تتوقف عن التطور والتحسن".

In an effort to foster economic growth throughout Southern California's diverse communities, Cedars-Sinai has taken a lead role in creating a first-of-its-kind centralized resource directory designed to help diverse-owned vendors secure business opportunities with Southern California hospitals.

These miniature immune system models -- known as human immune organoids -- mimic the real-life environment where immune cells learn to recognize and attack harmful invaders and respond to vaccines. Not only are these organoids powerful new tools for studying and observing immune function in cancer, their use is likely to accelerate vaccine development, better predict disease treatment response for patients, and even speed up clinical trials.

Physicians and investigators from the Smidt Heart Institute at Cedars-Sinai will give more than 30 presentations at the American Heart Association (AHA) Scientific Sessions Nov. 16-18 in Chicago.

Childhood trauma can increase a breast cancer survivor's chance of experiencing more severe and longer-lasting treatment-related anxiety, depression and fatigue, as well as reduced cognitive function, years after cancer treatment has ended, according to a preliminary study led by Jamie Myers, Ph.D., FAAN, research associate professor at the University of Kansas School of Nursing.

Only half of people with early-onset cancers reported discussing fertility preservation options prior to their oncology treatments, according to results of a cross-sectional study published Nov. 12 in JAMA Network Open.

Looking for medical experts to comment on the findings of the following embargoed study: Vitamin D Supplements May Lower Blood Pressure in Older People with Obesity

Supporting a loved one as they near the end of their life can be confronting. Palliative care is there to help but such services are not equally accessible to all Australians, particularly those in rural areas.

The use of biologic and targeted therapies for children with juvenile idiopathic arthritis (JIA) surpassed more typical therapies in recent years, according to Rutgers Health researchers.

The Korea Research Institute of Standards and Science (KRISS) announced that they have developed an advanced disease diagnosis and treatment system based on nanomaterials.

Over 60 percent of Illinois parents had never asked another parent about an unlocked firearm in their home before allowing their child to visit for a playdate, according to a survey from Ann & Robert H. Lurie Children's Hospital of Chicago published in Pediatrics. Many parents reported they had not asked about firearms because it never occurred to them to do so, which highlights a critical need to raise awareness of this important safety concern.

A research team has identified 2,586 orphan genes (OGs) in Rosa chinensis, offering new insights into the role of these unique genes in flower development, stress response, and environmental adaptation.

A research team has conducted a comprehensive study on the effects of various sterilization methods on the quality of Aronia melanocarpa juice (AMJ).

People with conditions or habits such as high blood pressure, an irregular heartbeat called atrial fibrillation, or smoking, not only have a higher risk of stroke, they may also have more severe strokes than people without these risk factors, according to a study published in the November 13, 2024, online issue of Neurology(r), the medical journal of the American Academy of Neurology.

Gay and bisexual men in England, Scotland, and Wales can now donate blood, plasma and platelets under certain circumstances without having to wait three months, the National Health Service announced this week.; Credit: Wilfredo Lee/AP

Gay and bisexual men in England, Scotland, and Wales can now donate blood, plasma and platelets under certain circumstances, the National Health Service announced this week in a momentous shift in policy for most of the U.K.

Beginning Monday, gay men in sexually active, monogamous relationships for at least three months can donate for the first time. The move reverses a policy that limited donor eligibility on perceived risks of contracting HIV/AIDs and other sexually transmitted infections.

The new rules come as the U.K. and other countries around the world report urgent, pandemic-induced blood supply issues.

Donor eligibility will now be based on each person's individual circumstances surrounding health, travel and sexual behaviors regardless of gender, according to the NHS. Potential donors will no longer be asked if they are a man who has had sex with another man, but they will be asked about recent sexual activity.

Anyone who has had the same sexual partner for the last three months can donate, the NHS said.

"Patient safety is at the heart of everything we do. This change is about switching around how we assess the risk of exposure to a sexual infection, so it is more tailored to the individual," said Ella Poppitt, Chief Nurse for blood donation at NHS Blood and Transplant, in a statement. "We screen all donations for evidence of significant infections, which goes hand-in-hand with donor selection to maintain the safety of blood sent to hospitals."

People who engage in anal sex with a new partner or multiple people or who have recently used PrEP or PEP (medication used to prevent HIV infection) will have to wait three months to donate - regardless of their gender.

Why did the U.K. make this change?

The NHS moved to alter its blood donation eligibility rules following a review by the FAIR (For the Assessment of Individualised Risk) steering group. The panel determined an individualized, gender-neutral approach to determining who can donate blood, platelets, and plasma is fairer and still maintains the safety of the U.K.'s blood supply.

The findings were accepted in full by the government last December.

Researchers will continue to monitor the impact of the donor selection changes for the next 12 months to determine if more changes are needed, NHS said.

What is the policy in the U.S.?

Despite efforts by advocates to change regulations in the U.S, the ability for gay and bisexual men to donate blood is still restricted.

A ban on gay and bisexual blood donors has been in effect since the early 1980s when fears about HIV/AIDS were widespread.

The Food and Drug Administration's current policy states a man who has sex with another man in the previous three months can't donate. Federal rules previously made such donors wait 12 months before giving blood, but due to low blood supplies during the pandemic the federal government changed the policy in April.

The Red Cross said they are participating in a pilot study funded by the FDA using behavior-based health history questionnaires, similar to those used in the U.K.

This content is from Southern California Public Radio. View the original story at SCPR.org.

; Credit: /Joy Ho for NPR

Perhaps the only respite pandemic closures brought to my family — which includes two kids under age 6 — was freedom from the constant misery of dripping noses, sneezes and coughs. And statistics suggest we weren't the only ones who had fewer colds last year: With daycares and in-person schools closed and widespread use of masks and hand sanitizer in most communities, cases of many seasonal respiratory infections went down, and flu cases dropped off a cliff.

That reprieve might be ending. Social mixing has been starting up again in much of the U.S. and so have cases of garden-variety sniffles. The Centers for Disease Control and Prevention just warned physicians that RSV, a unpleasant respiratory virus, is surging right now in southern states. And it's not just happening in the U.S. — researchers in the U.K. and Hong Kong found that rhinovirus outbreaks spiked there, too, when COVID-19 lockdowns ended.

My family is at the vanguard of this trend. Right after Washington D.C. lifted its mask mandate a few weeks ago, both my kids got runny noses and coughs, and as soon as they tested negative for COVID-19, my pandemic fears were replaced by a familiar dread. I had visions of sleepless, cough-filled nights, dirty tissues everywhere, and — in short order — my own miserable cold.

"If someone in your house is sick, you're not only breathing in their sick air, you're touching those contaminated surfaces. You're having closer contact, you're having longer exposures," says Seema Lakdawala, a researcher at the University of Pittsburgh School of Medicine, who studies how influenza viruses transmit between people. It can start to feel inevitable that the whole family will get sick.

Take heart, my fellow parents-of-adorable-little-germ-machines! Lakdawala says many strategies we all picked up to fight COVID-19 can also stop the spread of many routine respiratory viruses. In fact, they may be even more effective against run-of-the-mill germs, since, unlike the viruses behind most colds, SARS-CoV2 was new to the human immune system.

Those strategies start with everyone keeping their children home from school, camp and playdates when they're sick and keeping up with any and all vaccinations against childhood illnesses. Beyond that, specialists in infectious disease transmission I consulted offer five more tips for keeping my family and yours healthier this summer.

Tip #1: Hang on to those masks

In pre-pandemic times, it might have seemed like a weird move to put on a mask during storytime with your drippy-nosed kid, but Dr. Tina Tan says that's her top tip. She's a professor of pediatrics at the Feinberg School of Medicine at Northwestern University and a pediatric infectious disease physician at Lurie Children's Hospital in Chicago.

When it comes to influenza, a rhinovirus, or any of the other respiratory bugs constantly circulating, "once these viruses touch your mucous membranes, whether it's your eyes, your nose or your mouth, you do have a chance of contracting it," says Tan. Masks help stop infectious particles and virus-filled droplets from getting into your body.

"You don't need a N95," Tan says. A light-weight surgical mask or homemade cloth mask can work as long as it has two or more layers. The mask-wearing also doesn't have to be constant. "If you're going to be face to face with them — they're sitting in your lap, you're reading to them, you're feeding them, etc. — then I would say wear a mask," Tan advises.

Even better, if it's not too uncomfortable for your sick child, have them wear a mask, Lakdawala says. "If your kids are old enough to wear a mask, that would probably be the best strategy, because then you're reducing the amount of virus-laden aerosols in the environment."

How long should you stay masked-up?

For most respiratory viruses, "the infectious period is probably similar to that of COVID," says Dr. Jennifer Shu, a pediatrician in Atlanta and medical editor of the American Academy of Pediatrics' site HealthyChildren.org. It might technically start a few days before symptoms begin and last for up to two weeks, but your sniffly kids are likely most contagious during those first runny-nosed days Shu says. "You could have kids over [age] 2 wear a mask for the first three or four days of symptoms," she suggests.

And if you can't bring yourself to wear a mask or put one on your child inside your own home to fight a cold, don't worry. Lakdawala has a few more ideas.

Tip #2: Air it out, space it out

When Lakdawala's 5- and 8-year-old kids get sick, "I open the windows, I turn on the fans, I get a lot more air circulation going on in the house," she says — that is, weather and allergies permitting, of course.

"A lot of these viruses tend to circulate more during the colder weather, so where you live is going to determine how much you can open your windows," Tan points out. But certainly, she says, "the better the ventilation, the less likely the viruses are going to get transmitted from one person to another."

What about buying HEPA filter air purifiers, or changing the filter in your heating and air conditioning system? "I would not suggest going out to purchase extra HEPA filters just for this purpose," says Dr. Ibukun Kalu, a pediatric infectious disease physician at Duke University. For hospitals that are treating very contagious and serious pathogens like tuberculosis or SARS-CoV2, those upgrades may be important, she says. "But for all of the other routine viruses, it's routine ventilation."

Kalu says you might also want to think strategically about creating some social distance — when it's possible — like strategically having the parent who tends not to get as sick provide the one-on-one care for the sick kid.

Obviously, you can't isolate a sick child in a room by themselves until they recover, but Lakdawala says not getting too close or for too long can help. When her kids are sick, "I do try to just not snuggle them — keep them a little bit at a distance."

Tip #3: Don't try to be a HAZMAT team

There's good news on the house-cleaning front. "Most of these viruses don't live on surfaces for very long periods of time," says Tan.

The research on exactly how long cold-causing rhinoviruses can survive on surfaces — and how likely they are to remain infectious — isn't definitive. As Dr. Donald Goldmann of Boston Children's Hospital poetically put it in The Pediatric Infectious Disease Journal a couple decades ago, "Despite many years of study, from the plains of Salisbury, to the hills of Virginia, to the collegiate environment of Madison, WI, the precise routes rhinovirus takes to inflict the misery of the common cold on a susceptible population remain controversial." That's still true today, doctors say.

There's some evidence that contaminated surfaces are not very important in the spread of colds. In one little study from the 1980s, a dozen healthy men played poker with cards and chips that "were literally gummy" from the secretions of eight other men who had been infected with a rhinovirus as part of the study. Even after 12 hours of poker, none of the healthy volunteers caught colds.

Shu's take home advice? Be methodical in your cleaning of often-touched surfaces (kitchen table, countertops and the like) with soap and water when everybody's healthy, and maybe add bleach wipes or other disinfectant when someone in your household has a cold. But don't panic.

Tan agrees. "Wipe down frequently-touched surfaces multiple times a day," she says. "But you don't have to go crazy and, like, scour everything down with bleach."

You also don't need to do a lot of extra laundry in hopes of eliminating germs on clothes, towels, dishtowels and the like — that can be exhausting and futile. Instead, just try to encourage kids who are sick to use their own towel — and do what you can to give towels a chance to dry out between uses. "Having some common sense and doing laundry every few days — washing your towels every few days and washing your sheets every couple of weeks — is probably good enough," Shu says. "You don't need to go overboard for run-of-the-mill viruses."

Don't fret that there are germs everywhere and you can't touch anything, says Lakdawala. "If I touch something, that -- in itself — is not infecting me," she notes. Instead, it's getting a certain amount of virus on our hands and then touching our own nose, eyes or mouth that can infect us. "If I just go wash my hands, that risk is gone," Lakdawala says.

You can also skip wearing gloves around the house. "People think that they are safe when they're wearing the gloves — and then they touch their face with their gloves [on]" and infect themselves, she says.

Instead, just make it a habit to wash your hands frequently.

Tip #4: Seriously, just wash your hands

"The same handwashing guidelines for COVID also apply for common respiratory illnesses," Shu says. That is: regular soap with warm water, lathered for about 20 seconds.

"The reason why 20 seconds is recommended is because some studies show that washing your hands shorter than that doesn't really get rid of germs." She warns that there hasn't been a whole lot of research on this, and 20 seconds is not a magic number. "But it is thought that anywhere from 15 to 30 seconds is probably good enough to get rid of most of the germs," she says. (Note: No need to drive your family crazy singing the birthday song twice — y'all have options.)

"Wash your hands before you eat, after you eat, after you go to the bathroom ... if you're changing your child's diaper, et cetera.," says Tan. "And if you're going to use hand sanitizer, it has to be at least 60% alcohol."

"Your hands are probably the most important source of transmission outside of someone really coughing or sneezing in your face," Kalu adds.

Tip #5: Don't give up, but do keep perspective

So, what if your beloved child does cough or sneeze in your face? Should you then forget all this stuff and just give in to the inevitable?

Don't give up, says Lakdawala. "Just because you got one large exposure in your mouth and in close range, it doesn't mean that that was sufficient to initiate an infection," she says. Whether you get sick from that germy onslaught is going to depend on a lot of things — the particular virus, whether the sneeze landed in your mouth or nose, whether you've been exposed to some version of that virus before and more.

One tiny positive side effect of the coronavirus pandemic for Lakdawala has been a broader public understanding of "dose-response" in viral transmission. "Just because somebody breathed on you once doesn't necessarily mean that that's what's going to get you infected," she says.

Consider practicing the swiss cheese model of transmission control, Shu says. "Every layer of protection helps — if you find that wearing a face shield is too much, but you do everything else, you're still going to limit your exposure," she says. Just do what works for you and your family.

This content is from Southern California Public Radio. View the original story at SCPR.org.

A teen gets a dose of Pfizer's COVID-19 vaccine at Holtz Children's Hospital in Miami on May 18. Nearly 7 million U.S. teens and pre-teens (ages 12 through 17) have received at least one dose of a COVID-19 vaccine, so far, the CDC says.; Credit: Eva Marie Uzcategui/Bloomberg via Getty Images

It's been a little more than a month since adolescents as young as 12 became eligible in the United States to receive the Pfizer vaccine against COVID-19, and nearly all reports have been positive: The vaccine is very effective in this age group, and the vast majority of kids experience mild side effects, if any — the same sore arm or mild flu-like symptoms seen among adults who get the shot.

The Centers for Disease Control and Prevention has recommended that everyone 12-years-old and older get vaccinated against COVID-19, and the rollout is well underway: According to the CDC, nearly 7 million U.S. teens and pre-teens (ages 12 through 17) have received at least one dose of a COVID-19 vaccine, so far.

Still, soon after the FDA authorized the use of Pfizer's vaccine in young people, federal agencies began receiving reports of mild chest pain or other signs of possible heart inflammation (known as myocarditis) in a very small percentage of recently vaccinated teens.

CDC director Rochelle Walensky said at a White House briefing Friday that there have been more than 300 cases of heart inflammation reported among more than 20 million teens and young adults who have received one of the vaccines made by Moderna or Pfizer. She said that in the "vast majority" of cases, the inflammation went away.

An expert advisory committee to the health agency is expected to review the cases in more depth at a meeting Friday.

So, in the meantime, should parents of teens hesitate to have their kids vaccinated against COVID-19? Vaccine experts and the American Academy of Pediatrics say no, don't hesitate. It's good for doctors and patients to be aware that there might be a connection between the mRNA vaccines and heart inflammation, and to report to their pediatrician anything they see in that first week after vaccination. But it is also important, the CDC notes, to recognize that even if this does turn out to be an extremely rare side effect of the vaccine, "most patients who received care responded well to medicine and rest and quickly felt better." And the serious risks of COVID -19 — even for young healthy people — outweigh the risks of any possible side effects from the vaccine. Here are some questions you may have, and what's known:

What exactly is myocarditis?

Myocarditis is an inflammation of the heart muscle, and pericarditis, also being investigated, is an inflammation of the sac around the heart.

Long before the pandemic, thousands of cases of myocarditis were diagnosed in the U.S. and around the world each year, often triggered by the body's immune response to infections. SARS-CoV-2 can trigger it, and so can cold viruses, and staph and strep and HIV. Other causes include toxins and allergies.

Symptoms include chest pain and shortness of breath. It's often mild enough to go unnoticed, but a full-blown case in adults can cause arrhythmias and heart failure that require careful treatment with multiple medications, and several months of strict rest. In a case study of seven teenagers who got myocarditis following vaccination published last week in the journal Pediatrics, all seven got better after routine treatment with anti-inflammatory drugs.

Pediatric cardiologist Dr. Stuart Berger of the Northwestern University Feinberg School of Medicine, a spokesperson for the American Academy of Pediatrics, says vaccine-related myocarditis in teens is not all that worrisome. "Although they appear with some symptoms of chest pain, and maybe some findings on EKGs, all of the cases we've seen have been on the mild end of the spectrum," he says.

So, what's the concern?

Several hundred reports about the inflammation have been filed with the federal government's Vaccine Adverse Event Reporting System (VAERS); that's a repository of reports sent in by health professionals and patients about any health events they spot in the hours or days after vaccinations. Many of the events reported turn out to be coincidental — not caused by a vaccine. The database is just meant as a starting point for further investigation and not proof of cause and effect. But as NPR's Geoff Brumfiel noted this week, "when millions of people are vaccinated within a short period, the total number of these reported events can look big."

That said, anecdotes reported by doctors in medical journals and reports to VAERS suggest that both of the mRNA vaccines authorized for use in the U.S. — the Pfizer and Moderna vaccines — might slightly increase the incidence of myocarditis in young people. In 2003, a report in the New England Journal of Medicine estimated the background incidence of myocarditis to be 1.13 cases in 100,000 children per year.

Paul Offit, professor of pediatrics at the Children's Hospital of Philadelphia and a member of a Food and Drug Administration vaccine advisory committee says there likely is a causal link between the heart inflammation some doctors are seeing in these teens and the second dose of vaccine. "I think it's real," he says, but hastens to add that the effect is exceedingly small – based on the data collected so far, maybe one in 50,000 vaccinees between the ages of 16 and 39. "And the good news is at least so far it looks to be transient and self-resolving."

Still, maybe I should wait to get my teen vaccinated and see how this plays out?

Uhm, no, according to several vaccine experts contacted by NPR. And this is where a little math comes in handy.

"Take a stadium full of 100,000 people between the ages of 16 and 39, which is the subset that appears to be at greater risk," Offit says. "Vaccinate all of them, and two might get myocarditis." But if you don't vaccinate any of the 100,000, he estimates that about 1,300 would eventually get COVID-19. And those numbers are likely to increase this winter.

About one in 1,000 children who get COVID-19 have gone on to develop a condition called MIS-C (multisystem inflammatory syndrome in children), says Offit, and most of those kids have had some level of myocarditis. In addition, the new coronavirus has directly caused myocarditis in some children and adults. Which of the two stadiums in Offit's metaphor would have more cases of myocarditis — the vaccinated children or unvaccinated kids — is not known precisely. But Offit says he suspects it would be the unvaccinated group. And there's no doubt that 1,000 unvaccinated children would suffer more COVID-19-related illnesses. "A choice not to get a vaccine is not a choice to avoid myocarditis," he says. "It's a choice to take a different risk — and I would argue a more serious one" — of developing a bad case of COVID-19 or long-COVID or COVID-caused myocarditis.

Are the experts advising their own kids in this age group to get vaccinated?

Yes. "I understand people having concerns," says Dr. Judith Guzman-Cottrill. She's a parent and professor of pediatric infectious diseases at the Oregon Health and Science University, as well as the senior author on a small study that came out this month in the journal Pediatrics. In the report, Guzman-Cottrill and her colleagues analyzed the cases of seven boys around the country who developed myocarditis within four days of receiving the Pfizer-BioNTech vaccine.

She and her family recently faced the vaccination decision for her own 13-year-old daughter — and said a whole-hearted yes to the shot.

Guzman-Cottrill suspects there may turn out to be a slightly increased risk of heart inflammation from vaccination in young people, but she and her co-authors note in the Pediatrics report that a direct cause-and-effect connection — even in these seven cases — has yet to be established. And she's impressed that despite the millions of doses that have so far been delivered to teens, no clear and serious post-vaccination problems have shown up. "The emergency departments and urgent care clinics are not filled with teenagers complaining of chest pain," she says.

She's treated unvaccinated teens who developed severe myocarditis from an infection with the COVID-19 virus, and others who developed COVID-19 pneumonia and respiratory failure. Seeing those teens struggle — teens who lacked the powerful immune protection the vaccine provides — was enough for her to suggest vaccination to her daughter, who got her second vaccination earlier this week.

"She saw it as a pathway back to a normal post pandemic life," Guzman-Cottrill says.

And that's where public health comes in. "We really need a highly vaccinated student body when kids return to the classroom this fall," says Guzman-Cottrill, "so we don't see surges in COVID-19 cases."

Joanne Silberner, a former health policy correspondent for NPR, is a freelance journalist living in Seattle.

This content is from Southern California Public Radio. View the original story at SCPR.org.

The pandemic has taken a massive toll on people's mental health. But a new report by the U.S. Centers for Disease Control and Prevention confirms what many of us are seeing and feeling in our own lives: The impact has been particularly devastating for parents and unpaid caregivers of adults.

Two-thirds of survey respondents who identified as unpaid caregivers said they experienced mental health challenges during the pandemic, such as symptoms of anxiety or depression, or suicidal thoughts.

Only one-third of people with no caregiving responsibilities reported the same symptoms.

Of the more than 10,000 survey respondents, more than 40% identified as being unpaid caregivers.

"What is striking here is just how widespread unpaid caregiving responsibilities are in the population and how much of a burden and a toll these responsibilities" are having, says Shantha Rajaratnam, a co-author of the study and a psychologist at the Turner Institute of Brain and Mental Health at Monash University in Australia.

The study also found that people who care for both children under 18 and adults — many of them part of the sandwich generation — are faring the worst, with 85% of this group experiencing adverse mental health symptoms.

"It's an extremely important study," says psychologist Dolores Gallagher-Thompson, professor emeritus at Stanford University who has researched family caregivers and their challenges.

The study is the first to document the problems caregivers have experienced during COVID-19, she notes, and underscores "the importance of paying attention to caregiver issues, caregiver mental health" and the need for education and resources to better support them.

The contrast between caregivers and others is stark

The study, part of ongoing research by The COVID-19 Outbreak Public Evaluation (COPE) Initiative, is based on surveys conducted in December 2020 and February-March 2021.

More than half of those who identified as caregivers said they had experienced symptoms of anxiety or depression, or of disorders like PTSD related to the stress and trauma of COVID-19.

A significant number of caregivers said they had contemplated suicide. Nearly 40% reported having passive suicidal thoughts, meaning "wishing that they had gone to bed and didn't wake up," says study co-author Mark Czeisler, a graduate student at Monash University and a research trainee at Brigham and Women's Hospital in Boston.

And more than 30% had seriously considered taking their own life — about five times the number of noncaregivers, the study found.

Across the board, mental health impacts have been more severe for people who care for both children and adults. Half of this group said it had seriously considered suicide in the past month.

The pandemic worsened the challenges caregivers face

Even before the pandemic, being an unpaid caregiver was stressful and associated with a higher risk of mental health issues, says Gallagher-Thompson. The COVID-19 pandemic has made things even harder.

For instance, the pandemic has taken away many formal and informal sources of support for caregivers.

That was the case for Dr. Nicole Christian-Brathwaite. She's a Boston-based child psychiatrist and lives with her husband, her mother, her husband's father and two sons, who are 4 and 6.

Before the pandemic, her father-in-law, who has dementia, went to a day program for seniors with cognitive decline. Her mother, a survivor of breast and lung cancers, went to physical therapy twice a week, doctor appointments and met with friends.

When the pandemic hit, they lost those services and social support — at the same time Christian-Brathwaite and her husband began working from home while taking care of their sons and parents.

Life at home became much more complicated. Her sons developed behavioral problems with the transitions and stresses of the pandemic. Her mother struggled with chronic pain, and was hospitalized during the pandemic. And there were days when her father-in-law was confused, disoriented or aggressive.

"Many days I was walking around on edge waiting for something to happen because our entire setup was so very fragile and vulnerable," says Christian-Brathwaite. "It's been exhausting."

And her mental health has suffered. "I certainly was dealing with insomnia," she says. "I was short tempered. I was more irritable. I didn't have the same tolerance for things."

More support needed to help caregivers cope

The new study highlights the extent to which unpaid caregivers have struggled during the pandemic, says Gallagher-Thompson.

"There are some serious issues here that shouldn't be ignored," she says.

And yet caregivers are often ignored by the health system, which is set up to focus only on patients.

"Family members are rarely asked, 'How does this affect you? What is difficult? How can we help you? How can we support you in being able to carry out your role, your tasks, your responsibilities?'" Gallagher-Thompson says.

As the new study shows, support can make a big difference — respondents who could rely on others for help with caregiving had a lower incidence of mental health symptoms.

So it's important to educate and support caregivers. For example, physicians can start by screening their patients' caregivers for mental health symptoms and provide more resources to those who need it, says Gallagher-Thompson.

Christian-Brathwaite hopes the new study will help physicians recognize that family caregivers are just as important to consider while treating patients.

"We really need to take a step back and look at the village that's around them because our patients can't be successful without having the support from family," she says.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Reconstructions from the Daynès Studio in Paris depict a male Neanderthal (right) face to face with a human, Homo sapiens.; Credit: /Science Source

It's something that many of us reckon with: the sense that we're not quite as sharp as we once were.

I recently turned 42. Having lost my grandfather to Alzheimer's, and with my mom suffering from a similar neurodegenerative disease, I'm very aware of what pathologies might lurk beneath my cranium.

In the absence of a cure for Alzheimer's and other forms of dementia, the most important interventions for upholding brain function are preventive — those that help maintain our most marvelous, mysterious organ.

Based on the science, I take fish oil and broil salmon. I exercise. I try to challenge my cortex to the unfamiliar.

As I wrote my recent book, A History of the Human Brain, which recounts the evolutionary tale of how our brain got here, I began to realize that so many of the same influences that shaped our brain evolution in the first place reflect the very measures we use to preserve our cognitive function today.

Being social, and highly communicative. Exploring creative pursuits. Eating a varied, omnivorous diet low in processed foods. Being physically active.

These traits and behaviors help retrace our past, and, I believe, were instrumental in why we remain on the planet today.

And they all were, at least in part, enabled by our brain.

Social smart alecks finish first

The human saga is riddled with extinctions.

By "human," I don't just mean Homo sapiens, the species we belong to, but any member of the genus Homo. We've gotten used to being the only human species on Earth, but in our not so distant past — probably a few hundred thousand years ago – there were at least nine of us running around.

There was Homo habilis, or the "handy man." And Homo erectus, the first "pitcher." The Denisovans roamed Asia, while the more well-known Neanderthals spread throughout Europe.

But with the exception of Homo sapiens, they're all gone. And there's a good chance it was our fault.

Humans were never the fastest lot on the African plains, and far from the strongest. Cheetahs, leopards and lions held those distinctions. In our lineage, natural selection instead favored wits and wiliness.

Plenty of us became cat food, but those with a slight cognitive edge — especially Homo sapiens — lived on. In our ilk, smarts overcame strength and speed in enabling survival.

Ecology, climate, location and just sheer luck would've played important roles in who persisted or perished as well, as they do for most living beings. But the evolutionary pressure for more complex mental abilities would lead to a massive expansion in our brain's size and neurocircuitry that is surely the paramount reason we dominate the planet like no other species ever has.

Much of this "success," if you can call it that, was due to our social lives.

Primates are communal creatures. Our close monkey and ape cousins are incredibly interactive, grooming each other for hours a day to maintain bonds and relationships. Throw in a few hoots and hollers and you have a pretty complex community of communicating simians.

An active social life is now a known preserver of brain function.

Research shows that social isolation worsens cognitive decline (not to mention mental health, as many of us experienced this past year). Larger social networks and regular social activities are associated with mental preservation and slowed dementia progression.

Entwined in this new social life was an evolutionary pressure that favored innovation. Our eventual ability to generate completely novel thoughts and ideas, and to share those ideas, came to define our genus.

As we hunted and foraged together, and honed stones into hand axes, there was a collective creativity at work that gave us better weapons and tools that enabled more effective food sourcing, and, later, butchering and fire. Effectively sharing these innovations with our peers allowed information to spread faster than ever before - a seed for the larger communities and civilizations to come.

Challenging ourselves to new pursuits and mastering new skills can not only impress peers and ingratiate us to our group, but literally help preserve our brain. New hobbies. New conversations. Learning the banjo. Even playing certain video games and simply driving a new route home from work each day, as neuroscientist David Eagleman does, can keep our function high.

Whether it's honing ancient stone or taking up Sudoku, any pursuit novel and mentally challenging may help keep the neural circuits firing.

We really are what we eat

All the while, as we hunted and crafted in new and communal ways, we had to eat. And we did so with an uniquely adventurous palette.

Homo sapiens is among the most omnivorous species on the planet. Within reason we eat just about anything. Whether it's leaves, meat, fungus, or fruit, we don't discriminate. At some point, one of us even thought it might be a good idea to try the glistening, grey blobs that are oysters - and shellfish are, it turns out, among the healthiest foods for our brain.

The varied human diet is an integral part of our story. As was the near constant physicality required to source it.

On multiple occasions over the past 1 to 2 million years climate changes dried out the African landscape, forcing our ancestors out of the lush forest onto the dangerous, wide-open grasslands. As evolution pressured us to create and commune to help us survive, a diverse diet also supported our eventual global takeover.

Our arboreal past left us forever craving the dangling fruits of the forest, a supreme source of high-calorie sugars that ensured survival. Back then we didn't live long enough to suffer from Type 2 diabetes: if you encountered sweets, you ate them. And today we're stuck with a taste for cookies and candy that, given our longer lifespans, can take its toll on the body and brain.

But humans were just as amenable to dining on the bulbs, rhizomes and tubers of the savanna, especially once fire came along. We eventually became adept scavengers of meat and marrow, the spoils left behind by the big cats, who preferred more nutritive organ meat.

As our whittling improved we developed spears, and learned to trap and hunt the beasts of the plains ourselves. There is also evidence that we learned to access shellfish beds along the African coast and incorporate brain-healthy seafood into our diet.

Studying the health effects of the modern diet is tricky. Dietary studies are notoriously dubious, and often involve countless lifestyle variables that are hard to untangle.

Take blueberries. Multiple studies have linked their consumption with improved brain health. But, presumably, the berry-prone among us are also more likely to eat healthy all around, exercise, and make it to level 5 on their meditation app.

Which is why so many researchers, nutritionists, and nutritional psychiatrists now focus on dietary patterns, like those akin to Mediterranean culinary customs, rather than specific ingredients. Adhering to a Mediterranean diet is linked with preserved cognition; and multiple randomized-controlled trials suggest doing so can lower depression risk.

A similar diversity in our ancestral diet helped early humans endure an ever-shifting climate and times of scarcity. We evolved to subsist and thrive on a wide range of foods, in part because our clever brains allowed us access to them. In turn, a similarly-varied diet (minus submitting to our innate sugar craving of course) is among the best strategies to maintain brain health.

All of our hunting, and foraging, and running away from predators would have required intense physical exertion. This was certainly not unique to humans, but we can't ignore the fact that regular exercise is another effective means of preserving brain health.

Being active improves performance on mental tasks, and may help us better form memories. Long before the Peletons sold out, our brains relied on both mental and physical activity.

But overwhelmingly the evidence points to embracing a collection of lifestyle factors to keep our brain healthy, none of which existed in a Darwinian vacuum.

Finding food was as social an endeavor as it was mental and physical. Our creative brains harnessed information; gossiping, innovating, and cooking our spoils around the campfire.

Researchers are beginning to piece together the complex pathology behind the inevitable decline of the human brain, and despite a parade of failed clinical trials in dementia, there should be promising treatments ahead.

Until then, in thinking about preserving the conscious experience of our world and relationships — and living our longest, happiest lives — look to our past.

Bret Stetka is a writer based in New York and an editorial director at Medscape. His work has appeared in Wired, Scientific American, and on The Atlantic.com. His new book, A History of the Human Brain, is out from Timber/Workman Press. He's also on Twitter: @BretStetka.

This content is from Southern California Public Radio. View the original story at SCPR.org.

The dangerous Delta variant of the coronavirus is spreading so quickly in the United States that it's likely the mutant strain will become predominant in the U.S. within weeks, according to a new analysis.

The variant, first identified in India, is the most contagious yet and, among those not yet vaccinated, may trigger serious illness in more people than other variants do, say scientists tracking the spread of infection.

The Delta variant apparently already accounts for at least 14% of all new infections, according to the research analysis posted online Monday of more than 242,000 infections nationwide over the last six months.

Another reason to get vaccinated

"It definitely is of concern," says William Lee, the vice president of science at Helix, which is under contract with the Centers for Disease Control and Prevention to help track the variants.

"Just the fact that it's so transmissible means that it's it's dangerous," Lee says, "and so I think you'll see outbreaks of Delta around the country and more people will get sick from it."

Helix launched the study when researchers spotted a drop in the prevalence of the Alpha variant, a contagious strain first spotted in the U.K. that had quickly become the dominant variant in that country and the U.S.

The researchers discovered the drop in relative frequency of the Alpha variant in their spot checks of strains circulating in the U.S. was due to a rapid increase in two other variants: the Gamma variant, first spotted in Brazil, and the Delta variant. The Gamma variant may be slightly better than the original strain at outmaneuvering the vaccines, researchers say.

"It looks like both of them are going to slowly push out Alpha," says Lee, whose study has not yet been peer-reviewed but has been posted on a pre-print server.

How Delta could prompt another U.S. COVID-19 surge

All the vaccines authorized for use in the U.S. appear, in general, to provide powerful protection against all the variants, including Delta. But the rapid spread of the variants is still raising concern because of the large number of people who remain unvaccinated.

"There still are big portions of the country where the rates of vaccination are quite low," notes Dr. Jeremy Luban, a virologist at the University of Massachusetts Medical School. "And, in fact, the Helix paper shows that this Delta variant is increasing in frequency — the speed at which it's increasing in frequency is greatest in those areas where vaccination rates are lowest."

The Delta variant could trigger yet another moderate surge of infections through many parts of the U.S. because of these pockets of unvaccinated people, according to a recent set of projections from the COVID-19 Scenario Modeling Hub, which is helping the CDC plot the future course of the pandemic.

The projections indicate that infections could start to rise again as soon as some time in July, especially if the vaccination campaign continues to stall.

"For the most part, it's a moderate resurgence," says Justin Lessler, an epidemiologist at Johns Hopkins University who is helping coordinate the hub.

"We're not having massive epidemics at a national level, but we have this kind of continuation of the virus just sticking around and keeping us on our toes," Lessler says. "And in specific places there could be substantial epidemics still."

This content is from Southern California Public Radio. View the original story at SCPR.org.

Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services, leads some of the Biden administration's efforts to expand Medicaid access.; Credit: Caroline Brehman/CQ-Roll Call, Inc via Getty Imag

The Biden administration is quietly engineering a series of expansions to Medicaid that may bolster protections for millions of low-income Americans and bring more people into the program.

Biden's efforts — which have been largely overshadowed by other economic and health initiatives — represent an abrupt reversal of the Trump administration's moves to scale back the safety-net program.

The changes could further boost Medicaid enrollment — which the pandemic has already pushed to a record 80.5 million. Some of the expansion is funded by the COVID-19 relief bill that passed in March, including coverage for new mothers.

Others who could also gain coverage under Biden are inmates and undocumented immigrants. At the same time, the administration is opening the door to new Medicaid-funded services such as food and housing that the government insurance plan hasn't traditionally offered.

"There is a paradigm change underway," said Jennifer Langer Jacobs, Medicaid director in New Jersey, one of a growing number of states trying to expand home-based Medicaid services to keep enrollees out of nursing homes and other institutions.

"We've had discussions at the federal level in the last 90 days that are completely different from where we've ever been before," Langer Jacobs said.

Taken together, the Medicaid moves represent some of the most substantive shifts in federal health policy undertaken by the new administration.

"They are taking very bold action," said Rutgers University political scientist Frank Thompson, an expert on Medicaid history, noting in particular the administration's swift reversal of Trump policies. "There really isn't a precedent."

The Biden administration seems unlikely to achieve what remains the holy grail for Medicaid advocates: getting 12 holdout states, including Texas and Florida, to expand Medicaid coverage to low-income working-age adults through the Affordable Care Act.

And while some of the recent expansions – including for new mothers -- were funded by close to $20 billion in new Medicaid funding in the COVID relief bill Biden signed in March, much of that new money will stop in a few years unless Congress appropriates additional money.

The White House strategy has risks. Medicaid, which swelled after enactment of the 2010 health law, has expanded further during the economic downturn caused by the pandemic, pushing enrollment to a record 80.5 million, including those served by the related Children's Health Insurance Program. That's up from 70 million before the COVID crisis began.

The programs now cost taxpayers more than $600 billion a year. And although the federal government will cover most of the cost of the Biden-backed expansions, surging Medicaid spending is a growing burden on state budgets.

The costs of expansion are a frequent target of conservative critics, including Trump officials like Seema Verma, the former administrator of the Centers for Medicare & Medicaid Services, who frequently argued for enrollment restrictions and derided Medicaid as low-quality coverage.

But even less partisan experts warn that Medicaid, which was created to provide medical care to low-income Americans, can't make up for all the inadequacies in government housing, food and education programs.

"Focusing on the social drivers of health ... is critically important in improving the health and well-being of Medicaid beneficiaries. But that doesn't mean that Medicaid can or should be responsible for paying for all of those services," said Matt Salo, head of the National Association of Medicaid Directors, noting that the program's financing "is simply not capable of sustaining those investments."

Restoring federal support

However, after four years of Trump administration efforts to scale back coverage, Biden and his appointees appear intent on not only restoring federal support for Medicaid, but also boosting the program's reach.

"I think what we learned during the repeal-and-replace debate is just how much people in this country care about the Medicaid program and how it's a lifeline to millions," Biden's new Medicare and Medicaid administrator, Chiquita Brooks-LaSure, told KHN, calling the program a "backbone to our country."

The Biden administration has already withdrawn permission the Trump administration had granted Arkansas and New Hampshire to place work requirements on some Medicaid enrollees.

In April, Biden blocked a multibillion-dollar Trump administration initiative to prop up Texas hospitals that care for uninsured patients, a policy that many critics said effectively discouraged Texas from expanding Medicaid coverage through the Affordable Care Act, often called Obamacare. Texas has the highest uninsured rate in the nation.

The moves have drawn criticism from Republicans, some of whom accuse the new administration of trampling states' rights to run their Medicaid programs as they choose.

"Biden is reasserting a larger federal role and not deferring to states," said Josh Archambault, a senior fellow at the conservative Foundation for Government Accountability.

But Biden's early initiatives have been widely hailed by patient advocates, public health experts and state officials in many blue states.

"It's a breath of fresh air," said Kim Bimestefer, head of Colorado's Department of Health Care Policy and Financing.

Chuck Ingoglia, head of the National Council for Mental Wellbeing, said: "To be in an environment where people are talking about expanding health care access has made an enormous difference."

Mounting evidence shows that expanded Medicaid coverage improves enrollees' health, as surveys and mortality data in recent years have identified greater health improvements in states that expanded Medicaid through the 2010 health law versus states that did not.

Broadening eligibility

In addition to removing Medicaid restrictions imposed by Trump administration officials, the Biden administration has backed a series of expansions to broaden eligibility and add services enrollees can receive.

Biden supported a provision in the COVID relief bill that gives states the option to extend Medicaid to new mothers for up to a year after they give birth. Many experts say such coverage could help reduce the U.S. maternal mortality rate, which is far higher than rates in other wealthy nations.

Several states, including Illinois and New Jersey, had sought permission from the Trump administration for such expanded coverage, but their requests languished.

The COVID relief bill — which passed without Republican support — also provides additional Medicaid money to states to set up mobile crisis services for people facing mental health or substance use emergencies, further broadening Medicaid's reach.

And states will get billions more to expand so-called home and community-based services such as help with cooking, bathing and other basic activities that can prevent Medicaid enrollees from having to be admitted to expensive nursing homes or other institutions.

Perhaps the most far-reaching Medicaid expansions being considered by the Biden administration would push the government health plan into covering services not traditionally considered health care, such as housing.

This reflects an emerging consensus among health policy experts that investments in some non-medical services can ultimately save Medicaid money by keeping patients out of the hospital.

In recent years, Medicaid officials in red and blue states — including Arizona, California, Illinois, Maryland and Washington — have begun exploring ways to provide rental assistance to select Medicaid enrollees to prevent medical complications linked to homelessness.

The Trump administration took steps to support similar efforts, clearing Medicare Advantage health plans to offer some enrollees non-medical benefits such as food, housing aid and assistance with utilities.

But state officials across the country said the new administration has signaled more support for both expanding current home-based services and adding new ones.

That has made a big difference, said Kate McEvoy, who directs Connecticut's Medicaid program. "There was a lot of discussion in the Trump administration," she said, "but not the capital to do it."

Other states are looking to the new administration to back efforts to expand Medicaid to inmates with mental health conditions and drug addiction so they can connect more easily to treatment once released.

Kentucky health secretary Eric Friedlander said he is hopeful federal officials will sign off on his state's initiative.

Still other states, such as California, say they are getting a more receptive audience in Washington for proposals to expand coverage to immigrants who are in the country without authorization, a step public health experts say can help improve community health and slow the spread of communicable diseases.

"Covering all Californians is critical to our mission," said Jacey Cooper, director of California's Medicaid program, known as Medi-Cal. "We really feel like the new administration is helping us ensure that everyone has access."

The Trump administration moved to restrict even authorized immigrants' access to the health care safety net, including the "public charge" rule that allowed immigration authorities to deny green cards to applicants if they used public programs such as Medicaid. In March, Biden abandoned that rule.

KHN correspondent Julie Rovner contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

This content is from Southern California Public Radio. View the original story at SCPR.org.

A COVID-19 vaccination clinic last month in Auburn, Maine. A drop in life expectancy in the U.S. stems largely from the coronavirus pandemic, a new study says.; Credit: Robert F. Bukaty/AP

A new study estimates that life expectancy in the U.S. decreased by nearly two years between 2018 and 2020, largely due to the COVID-19 pandemic. And the declines were most pronounced among minority groups, including Black and Hispanic people.

In 2018, average life expectancy in the U.S. was about 79 years (78.7). It declined to about 77 years (76.9) by the end of 2020, according to a new study published in the British Medical Journal.

"We have not seen a decrease like this since World War II. It's a horrific decrease in life expectancy," said Steven Woolf of the Virginia Commonwealth University School of Medicine and an author of the study released on Wednesday. (The study is based on data from the National Center for Health Statistics and includes simulated estimates for 2020.)

Beyond the more than 600,000 deaths in the U.S. directly from the coronavirus, other factors play into the decreased longevity, including "disruptions in health care, disruptions in chronic disease management, and behavioral health crisis, where people struggling with addiction disorders or depression might not have gotten the help that they needed," Woolf said.

The lack of access to care and other pandemic-related disruptions hit some Americans much harder than others. And it's been well documented that the death rate for Black Americans was twice as high compared with white Americans.

The disparity is reflected in the new longevity estimates. "African Americans saw their life expectancy decrease by 3.3 years and Hispanic Americans saw their life expectancy decrease by 3.9 years," Woolf noted.

"These are massive numbers," Woolf said, that reflect the systemic inequalities that long predate the pandemic.

"It is impossible to look at these findings and not see a reflection of the systemic racism in the U.S.," Lesley Curtis, chair of the Department of Population Health Sciences at Duke University School of Medicine, told NPR.

"This study further destroys the myth that the United States is the healthiest place in the world to live," Dr. Richard Besser, president of the Robert Wood Johnson Foundation (an NPR funder), said in an email.

He said wide differences in life expectancy rates were evident before COVID-19. "For example, life expectancy in Princeton, NJ—a predominantly White community—is 14 years higher than Trenton, NJ, a predominantly Black and Latino city only 14 miles away," Besser said.

Life expectancy in the U.S. had already been declining — albeit slowly — in the years leading up to the pandemic. And the U.S. has been losing ground compared with other wealthy countries, said Magali Barbieri of the University of California, Berkeley, in an editorial published alongside the new study.

The study estimates that the decline in life expectancy was .22 years (or about one-fifth of a year) in a group of 16 peer countries (including Austria, Finland, France, Israel, the Netherlands and the United Kingdom) compared with the nearly two-year decline in the United States.

"The U.S. disadvantage in mortality compared with other high income democracies in 2020 is neither new nor sudden," Barbieri wrote. It appears the pandemic has magnified existing vulnerabilities in U.S. society, she added.

"The range of factors that play into this include income inequality, the social safety net, as well as racial inequality and access to health care," Duke's Curtis said.

So, what's the prognosis going forward in the United States? "I think life expectancy will rebound," Woolf of Virginia Commonwealth said.

But it's unlikely that the U.S. is on course to reverse the trend entirely.

"The U.S. has some of the best hospitals and some of the greatest scientists. But other countries do far better in getting quality medical care to their population," Woolf said. "We have big gaps in getting care to people who need it most, when they need it most."

This content is from Southern California Public Radio. View the original story at SCPR.org.

Housing activists erect a sign in front of Massachusetts Gov. Charlie Baker's house in Swampscott, Mass., on Oct. 14, 2020. The Centers for Disease Control and Prevention has extended a moratorium on evictions until the end of July.; Credit: Michael Dwyer/AP

The Centers for Disease Control and Prevention has extended a moratorium on evictions until the end of July. The ban had been set to expire next week, raising concerns that there could be a flood of evictions with some seven million tenants currently behind on their rent.

The Biden administration says the extension is for "one final month" and will allow time for it to take other steps to stabilize housing for those facing eviction and foreclosure. The White House says it is encouraging state and local courts to adopt anti-eviction diversion programs to help delinquent tenants stay housed and avoid legal action.

The federal government will also try to speed up distribution of tens of billions of dollars in emergency rental assistance that's available but has yet to be spent. In addition, a moratorium on foreclosures involving federally backed mortgages has been extended for "a final month," until July 31.

In announcing the extension of the eviction moratorium, the CDC said that the COVID-19 "pandemic has presented a historic threat to the nation's public health. Keeping people in their homes and out of crowded or congregate settings — like homeless shelters — by preventing evictions is a key step in helping to stop the spread of COVID-19."

The CDC first issued the moratorium last September. It was extended once already in March, until June 30.

But landlords have been pushing back, arguing that they've taken a huge financial hit over the past year, losing billions of dollars a month in rent. Several business groups have sued the CDC and won, though court decisions to lift the moratorium have been stayed pending appeal.

The Alabama Association of Realtors, which brought one of the cases, argued that the CDC exceeded its authority in issuing the ban. The group is seeking relief from the U.S. Supreme Court, but the justices have yet to respond.

In its petition, the Realtors association called the CDC's "continued insistence that public-health concerns necessitate that landlords continue to provide free housing for tenants who have received vaccines (or passed up the chance to get them)...sheer doublespeak."

Housing advocates have argued that the moratorium is still very much needed. They note that $46 billion in emergency rental assistance approved by Congress has been slow getting into the hands of those it was intended to help. The money is supposed to cover rent that tenants currently owe.

The National Low Income Housing Coalition reports that in some states, less than five percent of the funds have been distributed so far. The group pushed the administration to extend the ban to give states and localities more time to get the money out.

Despite the moratorium, thousands of renters have still faced the threat of eviction because of loopholes in the law. Many are the lowest income tenants and disproportionately people of color. A new study by the Eviction Lab at Princeton University has found that communities with the lowest vaccination rates tend to have the highest eviction filings, raising additional health concerns.

"Allowing the moratorium to expire before vaccination rates increase in marginalized communities could lead to increased spread of, and deaths from, COVID-19," a group of more than 40 House lawmakers wrote in a letter this week to President Biden and CDC Director Rochelle Walensky, urging them to extend the moratorium.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Patrick Doherty volunteered for a new medical intervention of gene-editor infusions for the treatment of genetically-based diseases.; Credit: /Patrick Doherty

Patrick Doherty had always been very active. He trekked the Himalayas and hiked trails in Spain.

But about a year and a half ago, he noticed pins and needles in his fingers and toes. His feet got cold. And then he started getting out of breath any time he walked his dog up the hills of County Donegal in Ireland where he lives.

"I noticed on some of the larger hill climbs I was getting a bit breathless," says Doherty, 65. "So I realized something was wrong."

Doherty found out he had a rare, but devastating inherited disease — known as transthyretin amyloidosis — that had killed his father. A misshapen protein was building up in his body, destroying important tissues, such as nerves in his hands and feet and his heart.

Doherty had watched others get crippled and die difficult deaths from amyloidosis.

"It's terrible prognosis," Doherty says. "This is a condition that deteriorates very rapidly. It's just dreadful."

So Doherty was thrilled when he found out that doctors were testing a new way to try to treat amyloidosis. The approach used a revolutionary gene-editing technique called CRISPR, which allows scientists to make very precise changes in DNA.

"I thought: Fantastic. I jumped at the opportunity," Doherty says.

On Saturday, researchers reported the first data indicating that the experimental treatment worked, causing levels of the destructive protein to plummet in Doherty's body and the bodies of five other patients treated with the approach.

"I feel fantastic," Doherty says. "It's just phenomenal."

The advance is being hailed not just for amyloidosis patients but also as a proof-of-concept that CRISPR could be used to treat many other, much more common diseases. It's a new way of using the innovative technology.

"This is a major milestone for patients," says Jennifer Doudna of the University of California, Berkeley, who shared a Nobel Prize for her work helping develop CRISPR.

"While these are early data, they show us that we can overcome one of the biggest challenges with applying CRISPR clinically so far, which is being able to deliver it systemically and get it to the right place," Doudna says.

CRISPR has already been shown to help patients suffering from the devastating blood disorders sickle cell disease and beta thalassemia. And doctors are trying to use it to treat cancer and to restore vision to people blinded by a rare genetic disorder.

But those experiments involve taking cells out of the body, editing them in the lab, and infusing them back in or injecting CRISPR directly into cells that need fixing.

The study Doherty volunteered for is the first in which doctors are simply infusing the gene-editor directly into patients and letting it find its own way to the right gene in the right cells. In this case, it's cells in the liver making the destructive protein.

"This is the first example in which CRISPR-Cas9 is injected directly into the bloodstream — in other words systemic administration — where we use it as a way to reach a tissue that's far away from the site of injection and very specifically use it to edit disease-causing genes," says John Leonard, the CEO of Intellia Therapeutics, which is sponsoring the study.

Doctors infused billions of microscopic structures known as nanoparticles carrying genetic instructions for the CRISPR gene-editor into four patients in London and two in New Zealand. The nanoparticles were absorbed by their livers, where they unleashed armies of CRISPR gene-editors. The CRISPR editor honed in on the target gene in the liver and sliced it, disabling production of the destructive protein.

Within weeks, the levels of protein causing the disease plummeted. Researchers reported at the Peripheral Nerve Society Annual Meeting and in a paper published in The New England Journal of Medicine.

"It really is exciting," says Dr. Julian Gillmore, who is leading the study at the University College London, Royal Free Hospital.

"This has the potential to completely revolutionize the outcome for these patients who have lived with this disease in their family for many generations. It's decimated some families that I've been looking after. So this is amazing," Gillmore says.

The patients will have to be followed longer, and more patients will have to be treated, to make sure the treatment's safe, and determine how much it's helping, Gillmore stresses. But the approach could help those struck by amyloidosis that isn't inherited, which is a far more common version of the disease, he says.

Moreover, the promising results potentially open the door for using the same approach to treatment of many other, more common diseases for which taking cells out of the body or directly injecting CRISPR isn't realistic, including heart disease, muscular dystrophy and brain diseases such as Alzheimer's.

"This is really opening a new era as we think about gene-editing where we can begin to think about accessing all kinds of different tissue in the body via systemic administration," Leonard says.

Other scientists who are not involved in the research agree.

"This is a wonderful day for the future of gene-editing as a medicine,"
agree Fyodor Urnov, a professor of genetics at the University of California, Berkeley. "We as a species are watching this remarkable new show called: our gene-edited future."

Doherty says he started feeling better within weeks of the treatment and has continued to improve in the weeks since then.

"I definitely feel better," he told NPR. "I'm speaking to you from upstairs in our house. I climbed stairs to get up here. I would have been feeling breathless. I'm thrilled."

This content is from Southern California Public Radio. View the original story at SCPR.org.

; Credit: /Rose Wong for NPR/KHN

Claire Lang-Ree was in a lab coat taking a college chemistry class remotely in the kitchen of her Colorado Springs, Colo., home, when a profound pain twisted into her lower abdomen. She called her mom, Jen Lang-Ree, a nurse practitioner who worried it was appendicitis and found a nearby hospital in the family's health insurance network.

After a long wait in the emergency room of Penrose Hospital, Claire received morphine and an anti-nausea medication delivered through an IV. She also underwent a CT scan of her abdomen and a series of tests.

Hospital staffers ruled out appendicitis and surmised Claire was suffering from a ruptured ovarian cyst, which can be a harmless part of the menstrual cycle but can also be problematic and painful. After a few days — and a chemistry exam taken through gritted teeth — the pain went away.

Then the bill came.

Patient: Claire Lang-Ree, a 21-year-old Stanford University student who was living in Colorado for a few months while taking classes remotely. She's insured by Anthem Blue Cross through her mom's work as a pediatric nurse practitioner in Northern California.

Total Bill: $18,735.93, including two $722.50 fees for a nurse to "push" drugs into her IV, a process that takes seconds. Anthem's negotiated charges were $6,999 for the total treatment. Anthem paid $5,578.30, and the Lang-Rees owed $1,270.45 to the hospital, plus additional bills for radiologists and other care. (Claire also anted up a $150 copay at the ER.)

Service Provider: Penrose Hospital in Colorado Springs, part of the regional health care network Centura Health.

What Gives: As hospitals disaggregate charges for services once included in an ER visit, a hospitalization or a surgical procedure, there has been a proliferation of newfangled fees to increase billing. In the health field, this is called "unbundling." It's analogous to the airlines now charging extra for each checked bag or for an exit row seat. Over time, in the medical industry, this has led to separate fees for ever-smaller components of care. A charge to put medicine into a patient's IV line — a "push fee" — is one of them.

Though the biggest charge on Claire's bill, $9,885.73, was for a CT scan, in many ways Claire and her mom found the push fees most galling. (Note to readers: Scans are frequently many times more expensive when ordered in an ER than in other settings.)

"That was so ridiculous," says Claire, who adds she had previously taken the anti-nausea drug they gave her; it's available in tablet form for the price of a cup of coffee, no IV necessary. "It works really well. Why wasn't that an option?"

In Colorado, the average charge for the code corresponding to Claire's first IV push has nearly tripled since 2014, and the dollars hospitals actually get for the procedure has doubled. In Colorado Springs specifically, the cost for IV pushes rose even more sharply than it did statewide.

A typical nurse in Colorado Springs makes about $35 an hour. At that rate, it would take nearly 21 hours to earn the amount of money Penrose charged for a push of plunger that likely took seconds or at most minutes.

The hospital's charge for just one "IV push" was more than Claire's portion of the monthly rent in the home she shared with roommates. In the end, Anthem did not pay the push fees in its negotiated payment. But claims data shows that in 2020 Penrose typically received upward of $1,000 for the first IV push. And patients who didn't have an insurer to dismiss such charges would be stuck with them. Colorado hospitals on average received $723 for the same code, according to the claims database.

"It's insane the variation that we see in prices, and there's no rhyme or reason," says Cari Frank with the Center for Improving Value in Health Care, a Colorado nonprofit that runs a statewide health care claims database. "It's just that they've been able to negotiate those prices with the insurance company and the insurance company has decided to pay it."

To put the total cost in context, Penrose initially charged more money for Claire's visit than the typical Colorado hospital would have charged for helping someone give birth, according to data published by the Colorado Division of Insurance.

Even with the negotiated rate, "it was only $1,000 less than an average payment for having a baby," Frank says.

In an email statement, Centura said it "conducted a thorough review and determined all charges were accurate" and went on to explain that "an Emergency Room (ER) must be prepared for anything and everything that comes through the doors," requiring highly trained staff, plus equipment and supplies. "All of this adds up to large operating costs and can translate into patient responsibility."

As researchers have found, little stands in the way of hospitals charging through the roof, especially in a place like an emergency room, where a patient has few choices. A report from National Nurses United found that hospital markups have more than doubled since 1999, according to data from the United States Bureau of Labor Statistics. In an email, Anthem called the trend of increasing hospital prices "alarming" and "unsustainable."

But Ge Bai, an associate professor of accounting and health policy at Johns Hopkins University, says when patients see big bills it isn't only the hospital's doing — a lot depends on the insurer, too. For one, the negotiated price depends on the negotiating power of the payer, in this case, Anthem.

"Most insurance companies don't have comparable negotiating or bargaining power with the hospital," said Bai. Prices in a state like Michigan, where Bai said the UAW union covers a big proportion of Michigan patients, will look very different from those in Colorado.

Also, insurers are not the wallet defenders patients might assume them to be.

"In many cases, insurance companies don't negotiate as aggressively as they can, because they earn profit from the percentage of the claims," she says. The more expensive the actual payment is, the more money they get to extract.

Though Anthem negotiated away the push fees, it paid the hospital 30% more than the average Level IV emergency department visit in Colorado that year, and it paid quadruple what Medicare would allow for her CT scan.

Resolution: Claire and her mom decided to fight the bill, writing letters to the hospital and searching for information on what the procedures should have cost. The cost of the IV pushes and CT scan infuriated them — the hospital wanted more than double for a CT than what top-rated hospitals typically charged in 2019.

But the threat of collections wore them out and ultimately they paid their assigned share of the bill — $1,420.45, which was mostly coinsurance.

"Eventually it got to the point where I was like, 'I don't really want to go to collections, because this might ruin my credit score,'" says Claire, who didn't want to graduate from college with dinged credit.

Bai and Frank say the state of Maryland can provide a useful benchmark for medical bills, since it sets the prices that hospitals can charge for each procedure. Data provided by the Maryland Health Care Commission shows that Anthem and Claire paid seven times what she likely would have paid for the CT scan there, and nearly 10 times what they likely would have paid for the emergency department Level IV visit. In Maryland, intravenous pushes typically cost about $200 apiece in 2019. A typical Maryland hospital would have received only about $1,350 from a visit like Claire's, and the Lang-Rees would have been on the hook for about $270.

Claire's pain has come back a few times, but never as bad as that night in Colorado. She has avoided reentering an emergency room since then. After visiting multiple specialists back home in California, she learned she might have had a condition called ovarian torsion.

The Takeaway: Even at an in-network facility and with good insurance, patients can get hurt financially by visiting the ER. A few helpful documents can help guide the way to fighting such charges. The first is an itemized bill.

"I just think it's wrong in the U.S. to charge so much," says Jen Lang-Ree. "It's just a little side passion of mine to look at those and make sure I'm not being scammed."

Bai, of Johns Hopkins, suggests asking for an itemized explanation of benefits from the insurance company, too. That will show what the hospital actually received for each procedure.

Find out if the hospital massively overcharged. The Medicare price lookup tool can be useful for getting a benchmark. And publicly available data on health claims in Colorado and at least 17 other states can help, too.

Vincent Plymell with the Colorado Division of Insurance encourages patients to reach out if something on a bill looks sketchy. "Even if it's not a plan we regulate," he wrote in an email, departments such as his "can always arm the consumer with info."

Finally, make scrutinizing such charges fun. Claire and Jen made bill-fighting their mother-daughter hobby for the winter. They recommend pretzel chips and cocktails to boost the mood.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

This content is from Southern California Public Radio. View the original story at SCPR.org.

Moderna says recently completed studies have found its vaccine to have a neutralizing effect against all COVID-19 variants tested, including the delta variant.; Credit: Fred Tanneau/AFP via Getty Images

Studies have found that Moderna's COVID-19 vaccine is effective against several variants of concern, including the delta variant, the biotech company announced.

Moderna said Tuesday that recently completed studies have found the vaccine to have a neutralizing effect against all COVID-19 variants tested, including the beta, delta, eta and kappa variants.

While still highly effective against the delta variant, the study showed the vaccine was less effective against it and certain other variants than against the original strain of the virus.

The antibody response against the delta variant was about two times weaker than against the ancestral strain of the virus.

The news echoes other findings that the Moderna and Pfizer vaccines are highly effective against the delta variant. A study published this month in Nature found that Pfizer's vaccine was able to neutralize variants including delta, though at somewhat reduced strength.

"These new data are encouraging and reinforce our belief that the Moderna COVID-19 Vaccine should remain protective against newly detected variants," Stéphane Bancel, Moderna's chief executive officer, said in a statement. "These findings highlight the importance of continuing to vaccinate populations with an effective primary series vaccine."

The company also said it is developing a booster candidate: a 50-50 mix of its currently authorized COVID-19 vaccine and another messenger RNA vaccine it has developed.

The delta variant is spreading fast

The delta variant is the fast-moving form of the coronavirus that is now found in 96 countries, including the United States.

Last week, Dr. Anthony Fauci of the National Institutes of Health said the delta variant is "currently the greatest threat in the U.S. to our attempt to eliminate COVID-19," noting that the proportion of infections being caused by the variant is doubling every two weeks.

The delta variant is now infecting at least 1 out of every 5 people who get the virus in the United States. In some sections of the country, the variant is already far more common, particularly in parts of the Midwest and West. At its current pace, the delta variant is expected to be the dominant virus in the U.S. within weeks.

Dr. Maria Van Kerkhove, an infectious disease expert at the World Health Organization, called the delta variant "incredibly transmissible."

"These viruses are becoming more fit. The virus is evolving, and this is natural," she told NPR's Morning Edition. "It's more transmissible than the alpha variant, so we need to just do all we can to prevent as many infections as we can and do what we can do to reduce the spread."

This content is from Southern California Public Radio. View the original story at SCPR.org.

Advocates for expanding Medicaid in Kansas staged a protest outside the entrance to the statehouse parking garage in Topeka in May 2019. Today, twelve states have still not expanded Medicaid. The biggest are Texas, Florida, and Georgia, but there are a few outside the South, including Wyoming and Kansas.; Credit: John Hanna/AP

There are more than 2 million people across the United States who have no option when it comes to health insurance. They're in what's known as the "coverage gap" — they don't qualify for Medicaid in their state, and make too little money to be eligible for subsidized health plans on the Affordable Care Act insurance exchanges.

Briana Wright is one of those people. She's 27, lives near Jackson, Miss., works at McDonalds, and doesn't have health insurance. So to figure out her options when she recently learned she needed to have surgery to remove her gallbladder, she called Health Help Mississippi, a nonprofit that helps people enroll in health insurances.

Because she lives in Mississippi, "I wasn't going to be eligible for Medicaid — because I don't have children [and] I'm not pregnant," she tells NPR. When she had her income checked for Healthcare.gov, it was just shy of the federal poverty line — the minimum to qualify for subsidies. "It was $74 [short]. I was like, oh wow," she says.

Wright's inability to get a subsidized policy on Healthcare.gov is related to how the Affordable Care Act was originally designed. People needing insurance who were above the poverty line were supposed to be funneled via the federal and state insurance exchanges to private policies — with federal subsidies to help make those policies affordable. People who were under the poverty line were to be funneled to a newly-expanded version of Medicaid — the public health insurance program that is jointly funded by states and the federal government. But the Supreme Court made Medicaid expansion essentially optional in 2012, and many Republican-led states declined to expand. Today, there are 12 holdout states that have not expanded Medicaid, and Mississippi is one of them.

So, Wright is still uninsured. Her gallbladder is causing her pain, but she can't afford the surgery without shuffling household bills, and risking leaving something else unpaid. "I'm stressed out about it. I don't know what I'm going to do," she says. "I'm going to just have to pay it out of pocket or get on some payment plan until it all gets paid for."

Hoping to finally find a fix for Wright and the millions like her who are in Medicaid limbo, several teams of Democratic lawmakers have recently been hashing out several options — hoping to build on the momentum of the latest Supreme Court confirmation that the ACA is here to stay.

OPTION 1: Sweet-talk the 12 holdout states

The COVID-19 relief bill passed in March included financial enticements for these 12 states to expand Medicaid. Essentially, the federal government will cover 90% of the costs of the newly eligible population, and an additional 5% of the costs of those already enrolled.

It's a good financial deal. An analysis by the nonprofit Kaiser Family Foundation estimates that the net benefit for these states would be $9.6 billion. But, so far — publicly, at least — no states have indicated they intend to take the federal government up on its offer.

"If that is not getting states to move, then that suggests that the deep root of their hesitation is not about financial constraint," says Jamila Michener, a professor of government at Cornell University and author of the book Fragmented Democracy: Medicaid Federalism And Unequal Politics.

Instead, Michener says, the reluctance among some Republican-led legislatures and governors to expand Medicaid may be a combination of partisan resistance to President Obama's signature health law, and not believing "this kind of government intervention for these groups of people is appropriate."

What's Next: When asked about progress on this front in an April press briefing, Biden's press secretary Jen Psaki said "the President is certainly supportive of — and an advocate for — states expanding Medicaid," but did not answer a follow up about whether the White House was directly reaching out to governors regarding this option.

OPTION 2: Create a federal public option to fill the gap

Some have advocated for circumventing these holdout states and creating a new, standalone federal Medicaid program that people who fall into this coverage gap could join. It would be kind of like a tailored public option just for this group.

This idea was included in Biden's 2022 budget, which says, in part: "In States that have not expanded Medicaid, the President has proposed extending coverage to millions of people by providing premium-free, Medicaid-like coverage through a Federal public option, paired with financial incentives to ensure States maintain their existing expansions."

But it wouldn't be simple. "That can be quite complex — to implement a federal program that's targeted to just these 2.2 million people across a handful of states," says Robin Rudowitz, co-director of the Medicaid program at the Kaiser Family Foundation, who wrote a recent analysis of the policy options.

It also may be a heavy lift, politically, says Michener. "Anything that expanded the footprint of the federal government and its role in subsidizing health care would be especially challenging," she says.

What's next: This idea was raised as a possible solution in a letter last month from Georgia's Democratic senators to Senate leaders, and Sen. Raphael Warnock said this week he plans to introduce legislation soon.

OPTION 3: Get around stubborn states by letting cities expand Medicaid

Instead of centralizing the approach, this next idea goes even more local. The COVER Now Act, introduced by Rep. Lloyd Doggett, D-Texas, would empower local jurisdictions to expand Medicaid. So, if you live in Austin, Texas, maybe you could get Medicaid, even if someone in Lubbock still couldn't.

The political and logistical challenges would be tough, policy analysts say. Logistically, such a plan would require counties and cities to create new infrastructure to run a Medicaid program, Rudowitz notes, and the federal government would have to oversee how well these new local programs complied with all of Medicaid's rules.

"It does not seem feasible politically," Michener says. "The legislators who would have to vote to make this possible would be ceding quite a bit of power to localities." It also might amplify geographic equity concerns, she says. People's access to health insurance would not just "be arbitrarily based on what state you live in — which is the current state of affairs — It's also going to be arbitrary based on what county you live in, based on what city you live in."

What's next: Doggett introduced the bill earlier this month. There's no guarantee it would get a vote on the House floor and — even if it did — it wouldn't survive a likely filibuster in the evenly divided Senate.

OPTION 4: Change the ACA to open up the exchanges

A fourth idea, Rudowitz says, is to change the law to remove the minimum cutoff for the private health insurance exchanges, since "right now, individuals who are below poverty are not eligible for subsidies in the marketplace." With this option, states wouldn't be paying any of the costs, since the federal government pays premium subsidies, Rudowitz says, but "there are issues around beneficiary protections, benefits, out-of-pocket costs."

What's next: This idea hasn't yet been included in any current congressional bills.

Will any of these ideas come to fruition?

Even with a variety of ideas on the table, "there's no slam dunk option, it's a tough policy issue," Rudowitz says. All of these would be complicated to pull off.

It's possible Democrats will include one of these ideas in a reconciliation bill that could pass without the threat of a Republican filibuster. But that bill has yet to be written, and what will be included is anyone's guess.

Even so, Michener says she's glad the discussion of the Medicaid coverage gap is happening, because it's sensitizing the public, as well as people in power, to the problem and potentially changing the political dynamic down the line. "Even in policy areas where you don't have any kind of guaranteed victory, it is often worth fighting the fight," she says. "Politics is a long game."

This content is from Southern California Public Radio. View the original story at SCPR.org.

Many hospitals around the country, including Medstar Washington Hospital in Washington DC., have started sharing their prices online in compliance with a recent federal rule.; Credit: DANIEL SLIM/AFP via Getty Images

A colonoscopy might cost you or your insurer a few hundred dollars — or several thousand, depending on which hospital or insurer you use.

Long hidden, such price variations are supposed to be available in stark black and white under a Trump administration price transparency rule that took effect at the start of this year. It requires hospitals to post a range of actual prices — everything from the rates they offer cash-paying customers to costs negotiated with insurers.

Many have complied.

But some hospitals bury the data deep on their websites or have not included all the categories of prices required, according to industry analysts. A sizable minority of hospitals have not disclosed the information at all.

While imperfect and potentially of limited use right now to the average consumer, the disclosures that are available illustrate the huge differences in prices — nationally, regionally and within the same hospital. But they're challenging for consumers and employers to use, giving a boost to a cottage industry that analyzes the data.

While it's still an unanswered question whether price transparency will lead to overall lower prices, KHN took a dive into the initial trove of data to see what it reveals. Here are five takeaways from the newly public data and tips for how you might be able to use it to your benefit

1) As expected, prices are all over the map

The idea behind the requirement to release prices is that the transparency may prompt consumers to shop around, weighing cost and quality. Perhaps they could save a few hundred dollars by getting their surgery or imaging test across town instead of at the nearby clinic or hospital.

Under the Trump-era rule, hospitals must post what they accept from all insurers for thousands of line items, including each drug, procedure or treatment they provide. In addition, hospitals must present this in a format easily readable by computers and include a consumer-friendly separate listing of 300 "shoppable" services, bundling the full price a hospital accepts for a given treatment, such as having a baby or getting a hip replacement.

The negotiated rates now being posted publicly often show an individual hospital accepting a wide range of prices for the same service, depending on the insurer, often based on how much negotiating power each has in a market.

In some cases, the cash-only price is less than what insurers pay. And prices may vary widely within the same city or region.

In Virginia, for example, the average price of a diagnostic colonoscopy is $2,763, but the range across the state is from $208 to $10,563, according to a database aggregated by San Diego-based Turquoise Health, one of the new firms looking to market the data to businesses, while offering some information free of charge to patients.

2) Patients can look up the information, but it's incomplete

Patients can try to find the price information themselves by searching hospital websites, but even locating the correct tab on a hospital's website is tricky.

Typically, consumers don't comparison-shop, preferring to choose convenience or the provider their doctor recommends. A recent Peterson-KFF Health System Tracker brief, for instance, found that 85% of adults said they had not researched online the price of a hospital treatment.

And hospitals say the transparency push alone won't help consumers much, because each patient's situation is different and may vary from the average— and individual deductibles and insurance plans complicate matters.

But if you do want to try, here's one tip: "You can Google the hospital name and the words 'price transparency' and see where that takes you," says Caitlin Sheetz, director and head of analytics at the consulting firm ADVI Health in the Washington, D.C., metro area.

Typing in "MedStar Health hospital transparency," for example, likely points to the MedStar Washington Hospital Center's "price transparency disclosure" page, with a link to its full list of prices, as well as its separate list of 300 shoppable services.

By clicking on the list of shoppable services, consumers can download an Excel file. Searching it for "colonoscopy" pulls up several variations of the procedure, along with prices for different insurers, such as Aetna and Cigna, but a "not available" designation for the cash-only price. The file explains that MedStar does not have a standard cash price but makes determinations case by case.

Performing the same Google search for the nearby Inova health system results in less useful information.

Inova's website links to a long list of thousands of charges, which are not the discounts negotiated by insurers, and the list is not easily searchable. The website advises those who are not Inova patients or who would like to create their own estimate to log into the hospitals' "My Chart" system, but a search on that for "colonoscopy" failed to produce any data.

3) Third-party firms are trying to make searching prices simpler – and cash in

Because of the difficulty of navigating these websites — or locating the negotiated prices once there — some consumers may turn to sites like Turquoise. Another such firm is Health Cost Labs, which will have pricing information for 2,300 hospitals in its database when it goes live July 1.

Doing a similar search for "colonoscopy" on Turquoise shows the prices at MedStar by insurer, but the process is still complicated. First, a consumer must select the "health system" button from the website's menu of options, click on "surgical procedures," then click again on "digestive" to get to it.

There is no similar information for Inova because the hospital has not yet made its data accessible in a computer-friendly format, said Chris Severn, CEO of Turquoise.

Inova spokesperson Tracy Connell said in a written statement that the health system will create personalized estimates for patients and is "currently working to post information on negotiated prices and discounts on services."

Firms like Turquoise and Health Cost Labs aim to sell the data gathered from hospitals nationally to insurers, employers and others. In turn, those groups may use it in negotiations with hospitals over future prices. While that may drive down prices in areas with a lot of competition, it might do the opposite where there are few hospitals to choose from, or in situations where a hospital raises its prices to match competitors.

4) Consumers could use this data to negotiate, especially if they're paying cash

For consumers who go the distance and can find price data from their hospitals, it may prove helpful in certain situations:

• Patients who are paying cash or who have unmet deductibles may want to compare prices among hospitals to see if driving farther could save them money.
• Uninsured patients could ask the hospital for the cash price or attempt to negotiate for the lowest amount the facility accepts from insurers.
• Insured patients who get a bill for out-of-network care may find the information helpful because it could empower them to negotiate a discount off the hospitals' gross charges for that care.

While there's no guarantee of success, "if you are uninsured or out of network, you could point to some of those prices and say, 'That's what I want,'" says Barak Richman, a contract law expert and professor of law at Duke University School of Law.

But the data may not help insured patients who notice their prices are higher than those negotiated by other insurers.

In those cases, legal experts say the insured patients are unlikely to get a bill changed because they have a contract with that insurer, which has negotiated the price with their contracted hospitals.

"Legally, a contract is a contract," says Mark Hall, a health law professor at Wake Forest University.

Richman agrees.

"You can't say, 'Well, you charged that person less,'" he notes, but neither can they say they'll charge you more.

Getting the data, however, relies on the hospital having posted it.

5) Hospitals still aren't really on board

When it comes to compliance, "we're seeing the range of the spectrum," says Jeffrey Leibach, a partner at the consulting firm Guidehouse, which found earlier this year that about 60% of 1,000 hospitals surveyed had posted at least some data, but 30% had reported nothing at all.

Many in the hospital industry have long fought transparency efforts, even filing a lawsuit seeking to block the new rule. The suit was dismissed by a federal judge last year.

They argue the rule is unclear and overly burdensome. Additionally, hospitals haven't wanted their prices exposed, knowing that competitors might then adjust theirs, or health plans could demand lower rates. Conversely, lower-cost hospitals might decide to raise prices to match competitors.

The rule stems from requirements in the Affordable Care Act. The Obama administration required hospitals to post their chargemaster rates, which are less useful because they are generally inflated, hospital-set amounts that are almost never what is actually paid.

Insurers and hospitals are also bracing for next year when even more data is set to come online. Insurers will be required to post negotiated prices for medical care across a broader range of facilities, including clinics and doctors' offices.

In May, the Centers for Medicare & Medicaid Services sent letters to some of the hospitals that have not complied, giving them 90 days to do so or potentially face penalties, including a $300-a-day fine.

"A lot of members say until hospitals are fully compliant, our ability to use the data is limited," says Shawn Gremminger, director of health policy at the Purchaser Business Group on Health, a coalition of large employers.

His group and others have called for increasing the penalty for noncomplying hospitals from $300 a day to $300 a bed per day, so "the fine would be bigger as the hospital gets bigger," Gremminger says. "That's the kind of thing they take seriously."

Already, though, employers or insurers are eyeing the hospital data as leverage in negotiations, says Severn, Turquoise's CEO. Conversely, some employers may use it to fire their insurers if the rates they're paying are substantially more than those agreed to by other carriers.

"It will piss off anyone who is overpaying for health care, which happens for various reasons," he says.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation).

This content is from Southern California Public Radio. View the original story at SCPR.org.

For weight maintenance, the common belief is that calories in should equal calories out. For weight loss, calories in should be less than calories out. Sounds simple, right?

Our bodies constantly experience wear and tear. As a result, they produce substances called free radicals that attack healthy cells.

Fiber is an essential part of a healthy diet, yet it is a nutrient that is under-consumed by the majority of Americans.

Prior to joining the Grain Foods Foundation (GFF), I knew a few basic things about grains: They provide fiber. They are an essential part of a healthy, balanced diet.

Gluten-free is a hot product category. It seems everyone in the food industry wants to be involved in this trend, and the gluten-free label claim does attract a segment of the population that is highly sensitive to the ingestion of traces of gluten. Consumers with celiac disease must completely avoid gluten.

With daily schedules more hectic than ever and meals often becoming grab-and-go occasions, it can be challenging for people to get the vitamins and minerals they need.