Coronavirus Has Upended Our World. It’s OK To Grieve.

On weekday evenings, sisters Lesley Laine and Lisa Ingle stage online happy hours from the Southern California home they share. It’s something they’ve been enjoying with local and faraway friends during this period of social distancing and self-isolation. And on a recent evening, I shared a toast with them.

We laughed and had fun during our half-hour FaceTime meetup. But unlike our pre-pandemic visits, we now worried out loud about a lot of things — like our millennial-aged kids: their health and jobs. And what about the fragile elders, the economy? Will life ever return to ‘normal’?

“It feels like a free fall,” said Francis Weller, a Santa Rosa, California, psychotherapist. “What we once held as solid is no longer something we can rely upon.”

The coronavirus pandemic sweeping the globe has not only left many anxious about life-and-death issues, but it also has left people struggling with a host of less obvious, existential losses as they heed stay-home warnings and wonder how bad all this will get.

To weather these uncertain times, it’s important to acknowledge and grieve lost routines, social connections, family structures and our sense of security — and then create new ways to move forward — said interfaith chaplain and trauma counselor Terri Daniel.

“We need to recognize that mixed in with all the feelings we’re having of anger, disappointment, perhaps rage, blame and powerlessness is grief,” said Daniel, who works with the dying and bereaved.

Left unrecognized and unattended, grief can negatively affect “every aspect of our being — physically, cognitively, emotionally, spiritually,” said Sonya Lott, a Philadelphia psychologist specializing in grief counseling.

Yet with our national focus on the daily turn of events as the new coronavirus spreads and with the chaos it has brought, these underlying or secondary losses may escape us. People who are physically well may not feel entitled to their emotional upset over the disruption of normal life. Yet, Lott argued, it’s important to honor our own losses even if those losses seem small compared with others.

“We can’t heal what we don’t have an awareness of,” said Lott.

Recognize Our Losses

Whether we’ve named them or not, these are some of the communitywide losses many of us are grieving. Consider how you feel when you think of these.

Social connections. Perhaps the most impactful of the immediate losses as we hunker down at home is the separation from close friends and family. “Children aren’t able to play together. There’s no in-person social engagement, no hugging, no touching — which is disruptive to our emotional well-being,” said Daniel.

Separation from our colleagues and office mates also creates a significant loss. Said Lott: “Our work environment is like a second family. Even if we don’t love all the people we work with, we still depend on each other.”

Habits and habitat. With the world outside our homes no longer safe to inhabit the way we once did, Daniel said, we’ve lost our “habits and habitats.” We can no longer engage in our usual routines and rituals. And no matter how mundane they may have seemed — whether grabbing a morning coffee at the local cafe, driving to work or picking up the kids from school — routines help define your sense of self in the world. Losing them, Daniel said, “shocks your system.”

Assumptions and security. We go to sleep assuming that we’ll wake up the next morning, “that the sun will be there and your friends will all be alive and you’ll be healthy,” Weller said. But the spread of the coronavirus has shaken nearly every assumption we once counted on. “And so we’re losing our sense of safety in the world and our assumptions about ourselves,” he said.

Trust in our systems. When government leaders, government agencies, medical systems, religious bodies, the stock market and corporations fail to meet public expectations, citizens can feel betrayed and emotionally unmoored. “We are all grieving this loss,” Daniel said.

Sympathy for others’ losses. Even if you’re not directly affected by a particular loss, you may feel the grief of others, including that of displaced workers, of health care workers on the front lines, of people barred from visiting older relatives in nursing homes, of those who have already lost friends and family to the virus, and of those who will.

4 Ways To Honor Your Grief

Once you identify the losses you’re feeling, look for ways to honor the grief surrounding you, grief experts urge.

Bear witness and communicate. Sharing our stories is an essential step, Daniel said. “If you can’t talk about what’s happened to you and you can’t share it, you can’t really start working on it,” Daniel said. “So communicate with your friends and family about your experience.”

It can be as simple as picking up the phone and calling a friend or family member, said Weller. He suggests simply asking for and offering a space in which to share your feelings without either of you offering advice or trying to fix anything for the other.

“Grief is not a problem to be solved,” he said. “It’s a presence in the psyche awaiting, witnessing.”

For those with robust social networks, Daniel suggests gathering a group of friends virtually to share these losses together. Using apps like Zoom, Skype, FaceTime or Facebook Live, virtual meetups are easy to set up daily or weekly.

Write, create, express. Whether you’re an extrovert or introvert, keeping a written or recorded journal of these days offers another way to express, to identify and to acknowledge loss and grief.

And then there’s art therapy, which can be especially helpful for children unable to express themselves well with words, and also for teens and even many adults. “Make a sculpture, draw a picture or create a ceremonial object,” said Daniel, who often incorporates shamanic ceremonies into grief workshops she conducts.

Another exercise she often uses in grief workshops is a simple one in which participants use their breath to blow their sadness, fear and anger into a rock they then throw away.

“What this does is takes all that intense, painful energy out of your body and into an inanimate object that they symbolically throw far away from themselves,” Daniel said.

Meditate. Regular meditation or just taking time to slow down and take several deep, calming breaths throughout the day also works to lower stress — and is available to everyone, Lott said. For beginners who want guidance, she suggests downloading a meditation app onto your smartphone or computer.

Be open to joy. And finally, Lott urges, make sure to let joy and gratitude into your life during these challenging times. Whether it’s a virtual happy hour, teatime or dance party, reach out to others, she said.

“If we can find gratitude in the creative ways that we connect with each other and help somebody,” she said, “then we can hold our grief better and move through it with less difficulty and more grace.”

This story was produced in partnership with NPR and Kaiser Health News.

Stephanie O’Neill is the recipient of a journalism fellowship at the Natural Hazards Center at the University of Colorado-Boulder, supported by Direct Relief.

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U.S. coronavirus cases surpass 100,000 as doctors cope with medical shortages

NEW YORK, March 28 (Reuters) – The sum of known coronavirus U.S. cases soared well past 100,000, with more than 1,600 dead, as weary doctors and nurses coping with shortages resorted to extremes ranging from hiding scarce medical supplies to buying them on the black market.

American healthcare workers in the trenches of the pandemic appealed on Friday for more protective gear and equipment to treat a surge in patients that is already pushing hospitals to their limits in virus hot spots such as New York City, New Orleans and Detroit.

“We are scared,” said Dr. Arabia Mollette of Brookdale University Hospital and Medical Center in New York City’s Brooklyn borough. “We’re trying to fight for everyone else’s life, but we also fight for our lives as well, because we’re also at the highest risk of exposure.”

Doctors are especially concerned about a shortage of ventilators, machines that help patients breathe and are widely needed for those suffering from COVID-19, the pneumonia-like respiratory ailment caused by the highly contagious novel coronavirus.

Hospitals have also sounded the alarm about scarcities of drugs, oxygen tanks and trained staff.

The number of confirmed U.S. infections rose by about 18,000 on Friday, the highest jump in a single day, to more than 103,000. The United States has led the world in coronavirus cases since its count of known infections eclipsed those of China and Italy on Thursday.

With at least 1,634 lives lost as of Friday night – also a record daily increase – the United States ranked sixth in national death tolls from the pandemic, according to a Reuters tabulation of official data.

As shortages of key medical supplies abounded, desperate physicians and nurses were forced to take matters into their own hands.

New York-area doctors say they have had to recycle some protective gear, or even resort to bootleg suppliers.

Dr. Alexander Salerno of Salerno Medical Associates in northern New Jersey described going through a “broker” to pay $17,000 for masks and other protective equipment that should have cost about $2,500, and picking them up at an abandoned warehouse.

“You don’t get any names. You get just phone numbers to text,” Salerno said. “And so you agree to a term. You wire the money to a bank account. They give you a time and an address to come to.”

Nurses at Mount Sinai Hospital in New York said they were locking away or hiding N-95 respirator masks, surgical masks and other supplies that are prone to pilfering if left unattended.

An empty street is seen near the Oculus during the outbreak of the coronavirus disease (COVID-19) in Brooklyn, New York City, U.S., March 27, 2020. Picture taken March 27, 2020. REUTERS/Jeenah Moon

“Masks disappear,” nurse Diana Torres said. “We hide it all in drawers in front of the nurses’ station.”

One nurse at Westchester Medical Center, in the suburbs of the city, said colleagues have begun absconding with scarce supplies without asking, prompting better-stocked teams to lock masks, gloves and gowns in drawers and closets. (Full Story)

An emergency room doctor in Michigan, an emerging epicenter of the pandemic, said he was wearing one paper face mask for an entire shift due to a shortage and that hospitals in the Detroit area would soon run out of ventilators.

“We have hospital systems here in the Detroit area in Michigan who are getting to the end of their supply of ventilators and have to start telling families that they can’t save their loved ones because they don’t have enough equipment,” the physician, Dr. Rob Davidson, said in a video posted on Twitter.

U.S. President Donald Trump on Friday invoked emergency powers to require General Motors Co GM.N to start building ventilators after he accused the largest U.S. automaker of “wasting time” during negotiations.

He had previously resisted mounting calls for him to invoke the Defense Production Act, a Korean War-era statute that gives the president broad procurement powers in national emergencies.

Sophia Thomas, a nurse practitioner at DePaul Community Health Center in New Orleans, where Mardi Gras celebrations late last month fueled an outbreak in Louisiana’s largest city, said the numbers of coronavirus patients “have been staggering.”

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“We are truly a hotbed of COVID-19 here in New Orleans,” she said, adding that her hospital was shifting some patients to “telehealth” services that allow them to be evaluated from home.

In the nation’s second-largest city, Los Angeles Mayor Eric Garcetti said spiking cases were putting Southern California on track to match New York City’s infection figures in the next week.

Hospitals around the country are expected to receive some additional aid from a $2.2 trillion emergency relief bill given final passage by Congress on Friday, after days of wrangling, and signed into law by Trump. (Full Story)

The package will send cash to businesses and unemployed workers suffering from the effects of stay-at-home orders that have had the side effect of strangling the economy.

Reporting by Gabriella Borter, Roselle Chen, Nick Brown, Maria Caspani, Joseph Ax, Nathan Layne, Peter Szekely, Doina Chiacu, Tim Ahmann, Lisa Shumaker, Deena Beasley, Sharon Bernstein and Stephanie Kelly; Writing by Steve Gorman; Editing by Frank McGurty, Howard Goller and Daniel Wallis

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Coronavirus outbreak is stretching New York’s ambulance service to breaking point

The coronavirus outbreak sweeping through New York City has pushed its ambulance service close to the breaking point, with hundreds of personnel out ill and emergency calls skyrocketing, supervisors and rank-and-file emergency medical technicians said on Friday.

Some 20% of the 4,500 ambulance workers – EMTs, paramedics and supervisors – are out sick, said Dr. Lewis Marshall, board chairman of the New York City Regional Emergency Medical Services Council in an interview with Reuters.

Most of them are out of action because they either have the virus or have been exposed to it, he added.

The union representing EMS personnel said that two members of ambulance crews were on mechanical ventilators, which are used to help seriously ill patients breathe.

At the same time, ambulance calls are skyrocketing.

On Thursday, EMS received more than 6,000 calls. EMS lieutenant Vincent Variale, who also heads a supervisors’ union, said, “We’ve broken every call volume record we’ve ever seen before.”

Fire Commissioner Daniel Nigro on Friday asked the public to avoid making 911 calls except in real emergencies.

Marshall said even those ambulance workers who had tested positive for the coronavirus were being asked to work unless they show symptoms.

At times in recent days, up to 400 calls at a time deemed less serious had simply been left on hold, Variale said.

The number of EMS personnel out sick is increasing and may soon reach 30%, multiple EMS officials said, which would lead to a serious decline in ambulance services.

Marshall noted that the EMS has to deal with the crush of COVID-19 cases at the same time it must handle its normal workload of patients suffering from heart attacks, strokes and broken bones. The crisis is taking an emotional toll on EMS personnel.

Anthony Almojera, a Fire Department lieutenant and supervisor who goes out on EMS calls, said that even though he is a veteran, things he has seen since the pandemic hit New York have had a deep emotional impact.

For example, he said he and an ambulance team responded to a call concerning a woman in cardiac arrest. When they arrived, they were unable to resuscitate her.

He said the woman’s husband was standing at the front door crying. Almojera added that normally he would go over to a surviving husband or wife, “say I’m sorry for your loss,” hug the relative and let them cry.

But because of the virus he was not permitted to go within six feet of the husband.

“This time the man had totally broken down,” he said. Stricken by his inability to help the bereaved man, Almojera himself began to cry.

The city’s ambulance service is part of the New York City Fire Department. Two workers told Reuters that ambulance personnel who remain on the job are working 16 or 17-hour days.

“We don’t even have time to go to the bathroom,” said one emergency medical technician in Harlem while running to meet a call.

In a phone call, the Fire Department said it was not requiring ambulance personnel to work double shifts.

Variale predicted dire consequences if calls for help continue to soar and the number of emergency personnel continues to drop from illness. “If this continues we fully expect to have bodies on the street,” he said.

Reporting By Scot Paltrow; Editing by Ross Colvin and Aurora Ellis

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UC Davis launches two clinical trials to evaluate treatments for COVID-19

Reviewed by Emily Henderson, B.Sc.Mar 27 2020

UC Davis Health has two clinical trials underway for hospitalized patients with severe COVID-19, the disease caused by the novel coronavirus, SARS-CoV-2.

The studies are evaluating the safety and effectiveness of two drugs — the investigational antiviral remdesivir, and sarilumab, a drug that blocks the body’s acute inflammatory response.

We have a critical need to confirm safe and effective treatments for COVID-19. Although some patients with severe infection have received remdesivir, we do not have solid data to indicate it can improve clinical outcomes for everyone. The nation’s schools of medicine have the expertise and resources to advance knowledge about the infection to help guide the clinical care of patients worldwide.”

Allison Brashear, dean of the UC Davis School of Medicine

There are no specific therapeutic agents approved by the Food and Drug Administration (FDA) to treat people with COVID-19. The infection can cause mild to severe respiratory illness. Symptoms can include fever, cough and shortness of breath. Current clinical care of hospitalized patients include supplemental oxygen therapy, antibiotics, influenza antiviral drugs and intensive care as needed.

As of March 26, there were 526,006 confirmed cases of COVID-19 worldwide, including 68,440 in the U.S. and 3,006 in California. There were more than 23,721 deaths, including 994 deaths in the U.S. and 65 in California.

Remdesivir study

UC Davis is one of approximately 75 sites worldwide evaluating the benefits of remdesivir for severe COVID-19 infection. Remdesivir is an investigational broad-spectrum antiviral treatment developed by Gilead Sciences Inc. It was previously tested in humans with Ebola virus disease and has shown promise in animal models for treating Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS), which are caused by other coronaviruses.

UC Davis physicians used remdesivir in February, with emergency approval from the Food and Drug Administration, to treat a critically ill patient who was the first known case of community-acquired infection in the U.S. The patient has since returned home to recover.

The study will enroll up to 440 patients over the next several months, including about 10 or more at UC Davis. Among other criteria, participants must be 18 years of age or older, have a confirmed SARS-CoV-2 test and poor lung function.

The clinical trial is funded by the National Institute of Allergy and Infectious Diseases. It is part of the study recently launched at the University of Nebraska. Stuart Cohen is leading the investigation at UC Davis. He is chief of the Division of Infectious Diseases in the Department of Internal Medicine at UC Davis Health and director of Hospital Epidemiology and Infection Control.

Sarilumab study

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UC Davis is one of up to 50 sites in the U.S. assessing sarilumab, a drug jointly developed by Regeneron and Sanofi pharmaceutical companies for the treatment of rheumatoid arthritis. The drug is a human monoclonal antibody that blocks the receptor for interleukin-6 (IL-6), a cytokine that plays an important role in the body’s immune response and in generating fever and acute inflammation. The study will evaluate whether the drug can control the progression of the inflammatory response in the lungs of patients with severe COVID-19 infection.

Approximately 400 hospitalized patients age 18 and older with acute COVID-19 infection can be enrolled in the study nationwide. Individuals will be grouped according to the severity of their illness and progression of symptoms, from severe to critical to having multi-system organ failure as well as whether cortisone drugs were used to reduce inflammation. The researchers will be determining whether the health of individuals with high IL-6 levels and severe/critical levels of infection improve with the drug.

The study is sponsored by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response. Timothy Albertson, professor and chair of the Department of Internal Medicine, is leading the study at UC Davis.

Clinical studies essential

Both studies are double-blind, meaning trial investigators and participants will not know who is receiving the treatments. They are designed to identify the early signs of clinical benefit while avoiding the use of ineffective therapies in critically ill patients with COVID-19.

“Conducting well-controlled, randomized clinical trials enable us to confirm the safety and effectiveness of promising drugs to treat emerging infections like COVID-19,” Albertson said.

An independent data and safety monitoring board (DSMB) also will closely monitor ongoing results to ensure patient well-being and safety as well as study integrity. The board also will recommend that a study be halted if there is clear and substantial evidence of a treatment difference between drug and placebo.

The remdesivir clinical trial is being sponsored by the National Institute of Allergy and Infectious Diseases (NCT04280705). The sarilumab trial sponsored by the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (NCT04315298).

Source:

University of California – Davis Health

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U.S. men less likely to heed health warnings as coronavirus death toll mounts: Reuters Poll

NEW YORK (Reuters) – As America converts itself into a nation of shut-ins, one group appears to be less interested than others in following the ever-lengthening list of health tips aimed at slowing the spread of the coronavirus pandemic: men.

According to a March 18-24 Reuters/Ipsos poll, U.S. men are clearly taking the coronavirus less seriously than women, who are more likely to support aggressive steps to combat the virus, as well as take personal, proactive measures such as avoiding physical contact and washing their hands more often.

And while U.S. men are nearly as likely as women to say they are familiar with the virus that has killed more than 1,100 Americans, the national poll of nearly 4,500 American adults found that they were more likely to dismiss its potential to hurt them.

This gender gap is woven throughout American society: it is clear among men and women of the same race, political persuasion and community type.

For example, 54% of women said they were “very concerned” about the virus compared with 45% of men.

Women were also much more likely to make big changes to their daily routines, according to the poll, which showed 73% of women reported washing their hands more often and using disinfectants more frequently, compared with 60% of men.

Seventy-two percent of women say they have been avoiding large public gatherings, 14 percentage points higher than men, and 65% of women said they are now avoiding close physical contact with others, which is 9 points higher than men.

Mieke Beth Thomeer, a sociology professor at the University of Alabama at Birmingham, said women tend to be disproportionately responsible for “kinkeeping” such as checking on parents and grandparents whose health is now at risk.

“They are more likely to call their grandmother at the nursing home or have to figure out what store to go to to find toilet paper, or figure out future meals based only on what’s currently in the pantry,” Thomeer said.

“Then added to this, is that women do more childcare to begin with, and so the closing of schools is more impactful – and more likely alarming – for women.” 

When respondents were asked what the U.S. government should do to slow the spread of the virus, women were more likely than men to support some of the most aggressive restrictions, such as nighttime curfews, bans on public gatherings, and halting all public transportation and overseas flights.

For example, 58% of women supported closing all public schools, compared with 52% of men.

MEN MORE CAVALIER

A sizable minority of men appeared to be more cavalier than women about the potential of the coronavirus to harm them.

Twenty-five percent of men said they “strongly agree” that people are “unnecessarily panicking”, compared with 18% of women.

Similarly, men are more likely than women to strongly agree that the media is creating panic about something that “isn’t really a big deal for most people.”

As U.S. authorities tell residents to stay at home and limit all but essential healthcare, the directives aimed at saving lives have hit women particularly hard, according to patients and healthcare providers.

While about the same number of men and women said they were familiar with the novel coronavirus that causes COVID-19, men were less likely to show they understood how it spreads.

The virus has infected people in all 50 states, with at least 82,000 positive cases so far recorded, the highest number in New York state, followed by New Jersey then California.

Yet 32% of men said that the virus is “mostly a problem for people who travel a lot”, compared with 23% of women. And 28% of men said the virus is “mostly a problem for people who live in urban areas”, versus 17% of women.

Sara Mohr, 22, of Mountain View, California, told Reuters in an interview that her boyfriend’s idea of stockpiling medicine was handing her two packs of DayQuil cold and flu capsules and telling her, “We’re fine.”

“Does social distancing include changing the locks so I don’t have to come into contact with my boyfriend who is not taking the Coronavirus as seriously as me?” Mohr mused on Twitter two weeks ago.

FILE PHOTO: People practice social distancing while spending time outdoors at Gas Works Park, during the coronavirus disease (COVID-19) outbreak, in Seattle, Washington, U.S. March 25, 2020. REUTERS/David Ryder/File Photo

Celia Gisleson, 24, of Fort Lauderdale, Florida, said she has had to get back to basics with her boyfriend, including showing him that washing hands also means washing his thumbs.

“I clean and wipe down everything and for him, he’s just kind of like, ‘It’s fine, it is what it is,’” she said.

Click here to see the full poll results: reut.rs/2JbXeVB and reut.rs/3aibesK

Reporting by Chris Kahn; Additional reporting by Amanda Becker in Washington and Elizabeth Culliford in London; Editing by Soyoung Kim and Daniel Wallis

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Condom shortage looms after coronavirus lockdown shuts world’s top producer

KUALA LUMPUR (Reuters) – A global shortage of condoms is looming, the world’s biggest producer said, after a coronavirus lockdown forced it to shut down production.

FILE PHOTO: A worker performs a test on condoms at Malaysia’s Karex condom factory in Pontian, 320 km (200 miles) southeast of Kuala Lumpur November 7, 2012. Malaysia’s Karex Industries is the world’s largest condom maker by volume. Picture taken November 7, 2012. REUTERS/Bazuki Muhammad/File Photo

Malaysia’s Karex Bhd (KARE.KL) makes one in every five condoms globally. It has not produced a single condom from its three Malaysian factories for more than a week due to a lockdown imposed by the government to halt the spread of the virus.

That’s already a shortfall of 100 million condoms, normally marketed internationally by brands such as Durex, supplied to state healthcare systems such as Britain’s NHS or distributed by aid programs such as the UN Population Fund.

The company was given permission to restart production on Friday, but with only 50% of its workforce, under a special exemption for critical industries.

“It will take time to jumpstart factories and we will struggle to keep up with demand at half capacity,” Chief Executive Goh Miah Kiat told Reuters.

“We are going to see a global shortage of condoms everywhere, which is going to be scary,” he said. “My concern is that for a lot of humanitarian programs deep down in Africa, the shortage will not just be two weeks or a month. That shortage can run into months.”

Malaysia is Southeast Asia’s worst affected country, with 2,161 coronavirus infections and 26 deaths. The lockdown is due to remain in place at least until April 14.

The other major condom-producing countries are China, where the coronavirus originated and led to widespread factory shutdowns, and India and Thailand, which are seeing infections spiking only now.

Makers of other critical items like medical gloves have also faced hiccups in their operations in Malaysia.

“The good thing is that the demand for condoms is still very strong because like it or not, it’s still an essential to have,” Goh said. “Given that at this point in time people are probably not planning to have children. It’s not the time, with so much uncertainty.”

Reporting by Liz Lee; Editing by Peter Graff

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Could Sleep Apnea Put You at Risk for Alzheimer’s?

Latest Alzheimer’s News

News Picture: Could Sleep Apnea Put You at Risk for Alzheimer's?By Alan Mozes
HealthDay Reporter

WEDNESDAY, March 25, 2020 (HealthDay News) — New research out of France suggests that untreated sleep apnea could raise your odds for developing Alzheimer’s disease.

Evidence linking the two is based on a series of neurological assessments, brain scans and sleep analyses conducted between 2016 and 2018.

“This is further support of Alzheimer’s as a lifestyle chronic condition that results from a lifetime of experiences,” said George Perry, chairman of neurobiology at University of Texas at San Antonio, who reviewed the findings.

The new research — led by Gaël Chételat of the Cyceron Center in Caen, France — focused on 127 older people, whose average age was 69. None displayed any outward sign of dementia or thinking problems at the time of the study.

Chételat’s team first reviewed brain imagery to look for signs of beta-amyloid plaque in brain areas associated with Alzheimer’s. An abnormal build-up of this naturally occurring protein is known to be tied to dementia risk. The same brain areas were also analyzed for signs of neurological activity linked to Alzheimer’s.

Using portable home sleep trackers, the researchers found that roughly three-quarters of participants had breathing interruptions as they slept.

A well-known example of what the study called sleep-disordered breathing is sleep apnea, in which breathing repeatedly pauses for 10 seconds or more. Many patients use a device called a CPAP machine to prevent airway blockages that cause the start-and-stop breathing.

None of the study participants had been treated for a sleep disorder.

The research team found that untreated sleep-disordered breathing was associated with more of the early changes in brain structure and activity that boost Alzheimer’s risk.

Two North American researchers who reviewed the findings said the conclusions make sense.

“Sleep is thought of as a period of brain recharge,” said Perry. “And less-effective sleep will lead to reduced amyloid removal and oxygenation. Both of these changes are detrimental to brain metabolism.”

Dr. Tetyana Kendzerska, an assistant professor of medicine at the University of Ottawa in Canada, said the pool of people for whom the findings might be concerning could be enormous. She said sleep-disordered breathing affects about one-quarter of adults.

Chételat and her team suggested that their findings “highlight the need to treat sleep disorders in the older population,” even in the absence of any obvious signs of dementia or Alzheimer’s.

But is it actually clear that a sleeping disorder can directly cause Alzheimer’s risk to go up? Or that by tackling and treating something like sleep apnea one might effectively lower long-term dementia risk?

Kendzerska said the jury is still out.

“We still don’t know yet given current evidence,” she said. “This is a possibility to be tested in future studies.”

The findings were reported online March 23 in JAMA Neurology.

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QUESTION

Why do we sleep?
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References

SOURCES: George Perry, Ph.D., medical, scientific and memory screening advisory board member, Alzheimer’s Foundation of America, and professor and chairman of neurobiology, University of Texas at San Antonio; Tetyana Kendzerska, M.D., Ph.D., assistant professor of medicine, University of Ottawa, Ontario, Canada; March 23, 2020, JAMA Neurology, online

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Daily Aspirin Won’t Stop Dementia, Study Finds

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News Picture: Daily Aspirin Won't Stop Dementia, Study FindsBy Steven Reinberg
HealthDay Reporter

WEDNESDAY, March 25, 2020 (HealthDay News) — Millions of Americans pop a low-dose aspirin each day to help ward off heart issues, but a new study finds that protection may not extend to dementia.

Although the anti-inflammatory effects of aspirin have been touted as protection against thinking and memory (or “cognitive”) problems from Alzheimer’s and other dementias, a large, randomized trial suggests aspirin won’t slow mental decline.

“The findings are very relevant to the care of older people and indicate that aspirin should not be prescribed solely on the basis of potential cognitive benefits,” said lead researcher Joanne Ryan, of Monash University in Melbourne, Australia.

“Our study provides strong evidence that low-dose aspirin will not reduce the risk of Alzheimer’s disease,” she added.

Because aspirin benefits people with heart disease, it’s been thought — and other studies have suggested — that it might also lower dementia risk by lowering the risk of inflammation and small clots or by preventing narrowing of blood vessels in the brain.

“Unfortunately, our large study provides strong evidence that this is not the case,” Ryan said.

Because dementia is a major public health issue, intense international effort is focused on identifying treatments that could prevent or at least help delay problems with thinking and memory, she said.

As part of that effort, her team collected data on more than 19,000 seniors who didn’t have dementia or heart disease. Most were 70 or older. All took thinking and memory tests at the outset and during nearly five years of follow-up.

Half were given low-dose aspirin and the rest received an inactive placebo. Over the study period, 575 participants developed dementia.

No difference in the risk for mild cognitive impairment, dementia or Alzheimer’s disease was found between people who took aspirin and those who did not, Ryan said. Nor was there any difference between the two groups in rate of mental decline.

“These findings were consistent across men and women, different ethnic groups, and regardless of the health status of the individual when they first entered the study,” Ryan said.

The findings were published online March 25 in the journal Neurology.

Dr. David Knopman, a neurologist at the Mayo Clinic in Rochester, Minn., co-authored an editorial that accompanied the study.

Although the findings were not what researchers hoped, they can help guide future tests of other drugs to prevent dementia, Knopman said.

“Sometimes there is an absence of evidence on these sorts of questions, meaning that there has not been a definitive study, but in this instance, there is evidence of absence,” he said. “The trial definitively showed no value in aspirin for preventing dementia, unfortunately.”

So, the bottom line is: “No, don’t take aspirin in hopes of preventing dementia,” Knopman said.

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Copyright © 2020 HealthDay. All rights reserved.


QUESTION

One of the first symptoms of Alzheimer’s disease is __________________.
See Answer

References

SOURCES: Joanne Ryan, Ph.D., senior research fellow, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; David Knopman, M.D., neurologist, Mayo Clinic, Rochester, Minn.; March 25, 2020, Neurology, online

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Intense and targeted radiotherapy could slow progression of certain prostate cancers

A new study has identified that highly targeted and strong doses of a type of radiotherapy called stereotactic ablative radiation (SABR) could slow disease progression among a subgroup of men who have hormone-sensitive prostate cancer that has only spread to a few other parts of the body.

radiotherapyImage Credits: Thomas Hecker / Shutterstock.com

The findings are based on the primary outcomes of a phase II randomized clinical trial called ORIOLE. The study, which began in 2016 and was led by researchers at Johns Hopkins Kimmel Cancer Center, compared the effectiveness of the “wait and watch” approach with SABR treatment among men with recurring oligometastatic prostate cancer.

“It has been a longstanding question, especially important now in the era of immunotherapy, whether any type of radiation, and SABR specifically, can stimulate the immune system,” says study leader Phuoc Tran.

Tran, who is a professor of molecular radiation sciences at the Johns Hopkins University School of Medicine is co-director of the center’s “Cancer Invasion and Metastasis” program, along with post-docs Andrew Ewald and Ashani Weeraratna. The goal of the program is to study and understand the process of cancer metastasis in order to improve on or develop therapies for the treatment of advanced cancers.

Now, Tran says: “Our trial offers the best data to date to suggest that SABR can cause a systemic immune response.”

About oligometastatic cancers

An oligometastatic cancer is one that has spread from the primary site of disease to one to three other parts of the body

Prostate cancer is the third most prevalent cancer worldwide and the most common cancer among men in the US, where it kills approximately 30,000 every year.

An estimated 1.3 million men globally are diagnosed with prostate cancer every year. Of those newly diagnosed cases, about twenty percent have a disease that has spread (metastasis), although it is not known exactly how many of them have oligometastatic cancer.

Metastatic prostate cancer cannot be cured and men who suffer from recurrent hormone-sensitive cancers may opt to delay receiving the standard treatment (androgen deprivation therapy) because it commonly causes a number of adverse side effects, including erectile dysfunction, reduced bone density, fractures, muscle loss, tiredness, loss of strength and gynecomastia (breast tissue growth).

What did the researchers find?

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As reported in the journal JAMA Oncology, the ORIOLE trial found that among 54 patients (aged an average of 68 years) with recurrent oligometastatic prostate cancer, disease progression was observed within six months for seven of 36 (19%) participants who received SABR, compared with 11 of 18 (61%) participants who underwent the “wait and watch” observation approach.

Tran and team also found that at six months since enrollment, the risk for new cancers having developed was significantly lower among the SABR group than among the observation group, at 16% versus 63%.

Participants did not report any significant between-group differences in side effects or pain felt in relation to the two treatment regimens.

What are the implications of the study?

On analyzing immune cells in blood samples taken from the patients, the researchers found that the SABR approach was associated with the expansion of T cell populations. Tran says this suggests that the radiotherapy had induced a systemic immune response to the cancers.

The study also suggests that it could be clinically beneficial to couple SABR with other immunotherapies as a treatment approach to the recurrent cancers, but Tran also warns that such potential benefits would first need testing in clinical trials.

The researchers also identified a set of tumor gene mutations that are known to be involved in the suppression of cancer and the presence of this mutational signature was associated with an increased risk for disease progression, including among the men who received SABR.

“This may be a molecular signature which is indicative of the underlying biology of the patient’s cancer.”

Professor Tran Phuoc, Johns Hopkins University School of Medicine

He adds that this potential biomarker could help indicate to clinicians “which patients are going to benefit the most from a metastasis directed therapy like SABR” compared to a systemic treatment such as chemotherapy.”

Furthermore, Tran says the findings also suggest that treatment with SABR may reduce or even eliminate the cell signaling that promotes micrometastases in cases of recurrent oligometastatic prostate cancer, as opposed to simply halting disease until metastatic tumors become large again.  

Next, the researchers intend to conduct further phase II studies to see whether they can slow disease progression in more patients.

The team is also conducting another trial called RAVENS that targets newly formed metastatic bone lesions with a combination of SABR and the drug radium-23.

Source:

Intense form of radiation slows disease progression in some men with prostate cancer. EurekAlert! 2020. Available at: https://www.eurekalert.org/emb_releases/2020-03/jhm-ifo032320.php

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California Isn’t Testing Enough Children For Lead, Prompting Legislation

In some parts of California, a higher percentage of children who were tested had elevated levels of toxic lead in their blood than in Flint, Michigan, during the height of that city’s water crisis.

More than 5% of children under age 6 in nine mostly rural California counties had blood lead levels in 2015 that put them above state and federal reporting guidelines for lead exposure — at least 4.5 micrograms of lead per deciliter of blood — according to the most detailed data from the California Department of Public Health. Across the state, 1.4% of children who were tested, or about 7,650 kids, had elevated blood lead levels that year.

By comparison, when images of discolored water flowing from Flint’s taps made national news in 2015, 3.7% of Flint children under 6 who were tested had elevated lead levels, according to a study published in the Journal of Pediatrics.

California’s worrisome numbers were highlighted in a January report by the state auditor, which also found that more than 2 million children were not tested as required over a period of nine years.

The auditor faulted the state departments of Public Health and Health Care Services for failing to ensure children receive the tests, and for not taking prescribed actions to reduce childhood lead exposure in high-risk areas.

In response to the audit, the state Department of Public Health released 2018 data in early March showing that slightly fewer children were tested statewide than in 2015 and that the percentage of children with unacceptable lead levels did not decrease. The department did not release specific data for many of the rural counties that previously had high percentages of children with elevated blood lead levels.

State lawmakers also responded to the audit by introducing five bills to get more children tested as required, expand mandated testing to more children and improve follow-up care for children with elevated blood lead levels.

They “treat us like we’re a wasteland,” said Assembly member Cristina Garcia (D-Bell Gardens), author of one of the bills.

Garcia represents a Los Angeles County district where the soil in and around thousands of homes was contaminated with lead and arsenic by the Exide Technologies battery recycling plant in Vernon. A massive cleanup effort was launched after the plant closed in 2015. Despite tens of millions of dollars allocated for remediation, local officials and residents say more funding is needed because only a few hundred homes have been cleaned up, and thousands are still contaminated.

California’s top health care officials said they’re taking the auditor’s findings seriously. Dr. Sonia Angell, director of the Department of Public Health, said the department is working on a plan to improve its oversight of childhood lead testing and coordinate with local officials to reduce children’s exposure to the toxic metal.

“While it is impossible to eradicate all lead in the environment, there is more we can do to protect our children,” Angell acknowledged in a prepared statement.

Industrial emissions can cause concentrated exposure in some areas, but the most common source of lead exposure in children is lead paint in old homes, where young children ingest the neurotoxin through small flakes and paint dust. Lead paint was phased out in the 1970s but still exists in older houses and apartments, especially poorly maintained ones.

Lead can also leach into the water from old pipes. That was the case in Flint, where the local water authority didn’t properly treat water from the Flint River, which caused lead from old pipes to seep into the drinking water.

Exposure to lead has been linked to health and developmental problems, including learning and hearing disabilities, lower IQs, behavioral problems, hyperactivity and delayed puberty, according to the U.S. Environmental Protection Agency.

“There’s a really long and extensive body of evidence that shows that any amount of exposure to lead can be harmful,” said Jill Johnston, assistant professor of preventive medicine at the University of Southern California.

Researchers have found that low socioeconomic status is a risk factor for lead contamination. In California, efforts to address lead exposure have focused on children enrolled in Medi-Cal, the state Medicaid program for low-income people.

Federal and state laws require children enrolled in Medi-Cal to have blood lead tests at 1 and 2 years of age. Children under 6 are supposed to receive a makeup test if they were not tested when they were 2 years old.

About half of California children are enrolled in Medi-Cal.

The auditor’s report found that about half of the eligible children enrolled in Medi-Cal from fiscal years 2009-10 through 2017-18 — about 1.4 million kids — did not receive any of the state-mandated lead tests. And about 740,000 children missed one of the mandated tests.

In addition to kids on Medi-Cal, state regulations mandate that any child with an official risk factor, such as living in a home built before 1978, get tested. Garcia said that the list of official risk factors is not up to date with current research and that her proposed legislation would update it.

The auditor’s report does not pinpoint why so many children are not getting the tests, but the auditor recommended the state Department of Public Health update the risk factors, and inform health care providers about those risk factors and the testing requirements by this month.

Angell said the department would “issue regulations for public comment on enhanced screening requirements and data reporting for lead exposure” by August.

The data the department released in early March in response to the audit did not include results at the ZIP code level. A department spokesperson said that data is expected to be released this spring.

“If the department was taking this more seriously, what we received today would have provided more details,” Garcia said via email in early March.

“We need to have a regularly updated map showing what the blood lead levels are geographically and in a more granular manner.”

Richard Figueroa, then-acting director of the Department of Health Care Services, said the department “will do more to ensure that required blood lead tests are occurring.” The department will implement a public outreach campaign to inform families covered by Medi-Cal how to get their children tested, he said, and by June will require managed care plans to identify children who have not been tested and remind participating health care providers about the testing requirement.

Garcia said she does not trust the state agencies to fix these problems on their own. “They’re OK with blowing through deadlines and not prioritizing these communities,” she said, “even though we have a real serious public health risk.”

It is a matter that hits close to home for her.

“My sister and I used to joke that if we didn’t grow up in the place that we did, we might be geniuses,” Garcia said.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Related Topics

California Public Health States

Children’s Health Environmental Health

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